Prevalence and consequences of sleep disorders in traumatic brain injury.
OBJECTIVE
Determine prevalence and consequences of sleepiness and sleep disorders after traumatic brain injury (TBI).


METHODS
Prospective evaluation with polysomnography (PSG), multiple sleep latency test (MSLT), Epworth Sleepiness Scale (ESS) and neuropsychological testing including Psychomotor Vigilance Test (PVT), Profile of Mood States (POMS), and Functional Outcome of Sleep Questionnaire (FOSQ).


METHODS
Three academic medical centers with level I trauma centers, accredited sleep disorders centers, and rehabilitative medicine programs. Participants; Eighty-seven (87) adults at least 3 months post TBI.


RESULTS
Abnormal sleep studies were found in 40 subjects (46%), including 20 (23%) with obstructive sleep apnea (OSA), 10 (11%) with posttraumatic hypersomnia (PTH), 5 (6%) with narcolepsy, and 6 (7%) with periodic limb movements in sleep (PLMS). Among all subjects, 22 (25%) were found to have objective excessive daytime sleepiness with MSLT score <10 minutes. There was no correlation between ESS score and MSLT (r = 0.10). There were no differences in age, race, sex, or education between the sleepy and non-sleepy subjects. Likewise, there were no differences in severity of injury or time after injury between sleepy and non-sleepy subjects. Sleepy subjects had a greater body mass index (BMI) than those who were not sleepy (p = 0.01). OSA was more common in obese subjects (BMI > or =30, p < 0.001). Sleepy subjects demonstrated poorer PVT scores (p < 0.05), better self-reported sleep related quality of life (FOSQ scores [p < 0.05]), and no differences in POMS.


CONCLUSIONS
There is a high prevalence of sleep disorders (46%) and of excessive daytime sleepiness (25%) in subjects with TBI. Sleepy subjects may be more impaired than comparable non-sleepy TBI subjects, yet be unaware of problems. Given the high prevalence of OSA (23%), PTH (11%), and narcolepsy (7%) in this population, there is a clinical indication for NPSG and MSLT.
Castriotta
Richard J
RJ
Division of Pulmonary, Critical Care and Sleep Medicine, University of Texas Health Science Center at Houston, TX 77030, USA. Richard.J.Castriotta@uth.tmc.edu
Wilde
Mark C
MC
Lai
Jenny M
JM
Atanasov
Strahil
S
Masel
Brent E
BE
Kuna
Samuel T
ST
D000328:Adult; D000339:Affect; D015992:Body Mass Index; D001930:Brain Injuries / Q000453:epidemiology* / Q000523:psychology*; D003071:Cognition; D015897:Comorbidity; D006970:Disorders of Excessive Somnolence / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology; D005260:Female; D006801:Humans; D008297:Male; D009290:Narcolepsy / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology; D009483:Neuropsychological Tests / Q000706:statistics & numerical data; D009765:Obesity / Q000453:epidemiology / Q000523:psychology; D017286:Polysomnography / Q000379:methods / Q000706:statistics & numerical data; D015995:Prevalence; D011446:Prospective Studies; D011597:Psychomotor Performance; D011788:Quality of Life / Q000523:psychology; D012891:Sleep Apnea Syndromes / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology; D012893:Sleep Wake Disorders / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology*; D011795:Surveys and Questionnaires; D015599:Trauma Severity Indices
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