Head injury and its impact on sleep hygiene: An entity slowly coming out of the shell
SunilMunakomi, MCh Resident
Published May 13, 2016
The article by Imbach et al. brought to light rather neglected aspects of the consequences of traumatic brain injury (TBI) in the sleep-wake cycle. [1]
Sound and effective sleep hours are prudent in clearing harmful metabolites through the G-lymphatic pathways, thereby restoring the brain internal milieu. [2] Alteration in the sleep-wake cycle following trauma hinders this process. This can have a paramount effect on protracting recovery and increases odds of negative consequences.
There are various factors that ameliorate sleep hygiene in the ICU such as noise, lights, and the frequent physical interactions during patient care. [3] Furthermore, trauma with its impact on the hypothalamic pituitary axis can affect the circadian sleep rhythm. [4] Lastly, trauma increases the risk of amyloid accumulation within the brain, further increasing the waste load. [5] This amounts to a vicious cycle, further damaging the already traumatized brain.
Did Imbach et al. implement any approach to nullify the confounding biases due to alteration in sleep hygiene in ICU settings as well as the probable impact on the hypothalamic-pituitary axis following head injury (both can fragment sleep architecture in a patient with TBI)? Further research would provide insight to the relationship between the increased waste load (B-amyloid deposits) following TBI and its burden upon the clearance mechanism (G-lymphatic pathways) especially during sleep.
1. Imbach LL, Buchele F, Valko PO, et al. Sleep-awake disorders persist 18 months after traumatic brain injury but remain underrecognized. Neurology Epub 2016 Apr 27.
2. Xie L, Kang H, Xu Q, et al. Sleep Drives Metabolite Clearance from the Adult Brain. Science 2013;342:373-377.
3. Matthews EE. Sleep Disturbances and Fatigue in Critically Ill Patients. AACN Adv Crit Care 2011;22:204-224.
4. Rosario ER, Aqeel R, Brown MA, et al. Hypothalamic-pituitary dysfunction following traumatic brain injury affects functional improvement during acute inpatient rehabilitation. J Head Trauma Rehabil 2013;28:390-396.
5. Scott G, Ramlackhansingh AF, Edison P, et al. Amyloid pathology and axonal injury after brain trauma. Neurology 2016;86:821-828.
For disclosures, please contact the editorial office at journal@neurology.org.
Sound and effective sleep hours are prudent in clearing harmful metabolites through the G-lymphatic pathways, thereby restoring the brain internal milieu. [2] Alteration in the sleep-wake cycle following trauma hinders this process. This can have a paramount effect on protracting recovery and increases odds of negative consequences.
There are various factors that ameliorate sleep hygiene in the ICU such as noise, lights, and the frequent physical interactions during patient care. [3] Furthermore, trauma with its impact on the hypothalamic pituitary axis can affect the circadian sleep rhythm. [4] Lastly, trauma increases the risk of amyloid accumulation within the brain, further increasing the waste load. [5] This amounts to a vicious cycle, further damaging the already traumatized brain.
Did Imbach et al. implement any approach to nullify the confounding biases due to alteration in sleep hygiene in ICU settings as well as the probable impact on the hypothalamic-pituitary axis following head injury (both can fragment sleep architecture in a patient with TBI)? Further research would provide insight to the relationship between the increased waste load (B-amyloid deposits) following TBI and its burden upon the clearance mechanism (G-lymphatic pathways) especially during sleep.
1. Imbach LL, Buchele F, Valko PO, et al. Sleep-awake disorders persist 18 months after traumatic brain injury but remain underrecognized. Neurology Epub 2016 Apr 27.
2. Xie L, Kang H, Xu Q, et al. Sleep Drives Metabolite Clearance from the Adult Brain. Science 2013;342:373-377.
3. Matthews EE. Sleep Disturbances and Fatigue in Critically Ill Patients. AACN Adv Crit Care 2011;22:204-224.
4. Rosario ER, Aqeel R, Brown MA, et al. Hypothalamic-pituitary dysfunction following traumatic brain injury affects functional improvement during acute inpatient rehabilitation. J Head Trauma Rehabil 2013;28:390-396.
5. Scott G, Ramlackhansingh AF, Edison P, et al. Amyloid pathology and axonal injury after brain trauma. Neurology 2016;86:821-828.
For disclosures, please contact the editorial office at journal@neurology.org.