Sleep-wake disorders in TBI and the role of mental fatigue
Joukjevan der Naalt, Neurologist
Published June 08, 2016
We read with great interest the article by Imbach et al. on the chronic course of posttraumatic sleep-wake disturbances in traumatic brain injury (TBI). [1] The authors stated that the results provide evidence for reconsidering clinical management of TBI given the medicolegal consequences of the established link between excessive daytime sleepiness (EDS) and impaired daytime performance.
However, an important aspect of impaired daytime performance, mental fatigue, was not addressed. Mental fatigue is the most prevailing complaint after TBI that is also related to cognitive performance. Since only sleep parameters were measured and the applied fatigue scale did not fully assesses mental fatigue, [2] this study did not clarify how mental fatigue and EDS are related. [3]
Fatigue is a cause of EDS and is also related to anxiety and depression which, in turn, may exacerbate fatigue by affecting cognitive functioning. [4] This underlines the current knowledge that all psychosocial factors should be taken into account when determining outcome and, consequently, management of TBI. [5] We challenge the authors to comment whether sleepiness and mental fatigue are related and suggest to attenuate the sole focus on sleep-wake disturbances, replacing it with a plea for a multifactorial treatment approach.
1. Imbach LL, Buchele F, Valko PO, et al. Sleep-wake disorders persist 18 months after traumatic brain injury but remain underrecognized. Neurology Epub 2016 Apr 27.
2. Visser-Keizer AC, Hogenkamp A, Westerhof-Evers HJ, Egberink IJ, Spikman JM. Dutch multifactor fatigue scale: A new scale to measure the different aspects of fatigue after acquired brain injury. Arch Phys Med Rehabil 2015;96:1056-1063.
3. Schonberger M, Herrberg M, Ponsford J. Fatigue as a cause, not a consequence of depression and daytime sleepiness: a cross-lagged analysis. J Head Trauma Rehabil 2014;29:427-431.
4. Ponsford J, Schonberger M, Rajaratnam SM. A model of fatigue following traumatic brain injury. J Head Trauma Rehabil 2015;30:277-282.
5. Silverberg ND, Gardner AJ, Brubacher JR, et al. Systematic review of multivariable prognostic models for mild traumatic brain injury. J Neurotrauma 2015;32:517-526.
For disclosures, please contact the editorial office at journal@neurology.org.
We read with great interest the article by Imbach et al. on the chronic course of posttraumatic sleep-wake disturbances in traumatic brain injury (TBI). [1] The authors stated that the results provide evidence for reconsidering clinical management of TBI given the medicolegal consequences of the established link between excessive daytime sleepiness (EDS) and impaired daytime performance. However, an important aspect of impaired daytime performance, mental fatigue, was not addressed. Mental fatigue is the most prevailing complaint after TBI that is also related to cognitive performance. Since only sleep parameters were measured and the applied fatigue scale did not fully assesses mental fatigue, [2] this study did not clarify how mental fatigue and EDS are related. [3]
Fatigue is a cause of EDS and is also related to anxiety and depression which, in turn, may exacerbate fatigue by affecting cognitive functioning. [4] This underlines the current knowledge that all psychosocial factors should be taken into account when determining outcome and, consequently, management of TBI. [5] We challenge the authors to comment whether sleepiness and mental fatigue are related and suggest to attenuate the sole focus on sleep-wake disturbances, replacing it with a plea for a multifactorial treatment approach.
1. Imbach LL, Buchele F, Valko PO, et al. Sleep-wake disorders persist 18 months after traumatic brain injury but remain underrecognized. Neurology Epub 2016 Apr 27.
2. Visser-Keizer AC, Hogenkamp A, Westerhof-Evers HJ, Egberink IJ, Spikman JM. Dutch multifactor fatigue scale: A new scale to measure the different aspects of fatigue after acquired brain injury. Arch Phys Med Rehabil 2015;96:1056-1063.
3. Schonberger M, Herrberg M, Ponsford J. Fatigue as a cause, not a consequence of depression and daytime sleepiness: a cross-lagged analysis. J Head Trauma Rehabil 2014;29:427-431.
4. Ponsford J, Schonberger M, Rajaratnam SM. A model of fatigue following traumatic brain injury. J Head Trauma Rehabil 2015;30:277-282.
5. Silverberg ND, Gardner AJ, Brubacher JR, et al. Systematic review of multivariable prognostic models for mild traumatic brain injury. J Neurotrauma 2015;32:517-526.
For disclosures, please contact the editorial office at journal@neurology.org.