title: Abnormal sleep-wake cycles in patients with tuberculous meningitis: a case-control study.
abstract: BACKGROUND
  Patients with tuberculous meningitis (TBM) have been frequently observed to have excessive sleep during the day and frequent awakenings during night. We undertook this study to evaluate sleep related abnormalities in patients with TBM since there is no published literature pertaining to the same.
  
  
  OBJECTIVE
  To study sleep wake cycles in patients with tuberculous meningitis by actigraphy and sleep logs and compare these with age and sex matched controls.
  
  
  METHODS
  Consecutive patients admitted with tuberculous meningitis were studied clinically and with three days of continuous wrist actigraphy and sleep/wake parameters were compared to those of age and gender matched normal healthy controls.
  
  
  RESULTS
  Forty three patients with tuberculous meningitis were enrolled in the study. Of these, twenty-eight patients (15 females, 13 males; mean age 31.64 years) who were able to complete adequate actigraphy were compared with an equal number of controls (15 females, 13 males; mean age 30.93 years). Patients were found to have greater sleep time (p<0.0005) and more sleep episodes (p<0.0005) during the day while during the night they had less sleep (p<0.0005) with more frequent (p=0.019) and longer (p<0.0005) awakenings as compared to normal controls. Majority of the patients had reversal of sleep/wake cycles. There was poor co-relation between sleep parameters measured by actigraphy and sleep logs.
  
  
  CONCLUSIONS
  Tuberculous meningitis is associated with significant alteration of sleep-wake circadian cycles. This needs to be further characterized through studies involving polysomnography. There is a need to address these specific sleep difficulties to improve the quality of life of the patient as well as the care-giver.
authors.affiliation: Department of Neurology, All India Institute of Medical Sciences, New Delhi-110029, India.
authors.forename: Vibhor
authors.initials: V
authors.lastname: Pardasani
authors.forename: Garima
authors.initials: G
authors.lastname: Shukla
authors.forename: Sumit
authors.initials: S
authors.lastname: Singh
authors.forename: Vinay
authors.initials: V
authors.lastname: Goyal
authors.forename: Madhuri
authors.initials: M
authors.lastname: Behari
mesh_terms: D000293:Adolescent; D000328:Adult; D016022:Case-Control Studies; D021081:Chronobiology Disorders / Q000209:etiology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D017286:Polysomnography; D012890:Sleep / Q000502:physiology; D014390:Tuberculosis, Meningeal / Q000150:complications*; D014851:Wakefulness / Q000502:physiology