title: Prevalence of sleep disturbance in closed head injury patients in a rehabilitation unit.
abstract: Traumatic brain injury (TBI) is a leading cause of disability in young people in the United States. Disorders of arousal and attention are common in closed head injury (CHI). Daytime drowsiness impairs participation in rehabilitation, whereas nighttime wakefulness leads to falls and behavioral disturbances. Sleep disturbances in TBI reported in the literature have included excessive daytime somnolence, sleep phase cycle disturbance, narcolepsy, and sleep apnea. Although well known to the clinician treating these patients, the extent and prevalence of disrupted sleep in patients in an acute inpatient rehabilitation unit has not been described.
  
  
  OBJECTIVE
  To determine the prevalence of sleep wake cycle disturbance (SWCD) in patients with CHI in a TBI rehabilitation unit.
  
  
  METHODS
  Prospective observational.
  
  
  METHODS
  Inpatient specialized brain injury rehabilitation unit. Patients. Thirty-one consecutive admissions to a brain injury rehabilitation unit with the diagnosis of CHI.
  
  
  RESULTS
  Twenty-one patients (68%) had aberrations of nighttime sleep. There was no significant difference in Glasgow Coma Score on admission to trauma nor was there any significant difference in age between the affected and unaffected groups. Patients with SWCD had longer stays in both the trauma center (P < .003) and the rehabilitation center (P < .03).
  
  
  CONCLUSIONS
  There is a high prevalence of SWCD in CHI patients admitted to a brain injury rehabilitation unit. Patients with SWCD have longer stays in both acute and rehabilitation settings and may be a marker for more severe injury.
authors.affiliation: University of Maryland, c/o Kernan Hospital Brain Injury Unit, 2200 Kernan Dr, Baltimore, MD 21207, USA. mmakley@kernan.umm.edu
authors.forename: M J
authors.initials: MJ
authors.lastname: Makley
authors.forename: J B
authors.initials: JB
authors.lastname: English
authors.forename: D A
authors.initials: DA
authors.lastname: Drubach
authors.forename: A J
authors.initials: AJ
authors.lastname: Kreuz
authors.forename: P A
authors.initials: PA
authors.lastname: Celnik
authors.forename: P M
authors.initials: PM
authors.lastname: Tarwater
mesh_terms: D000208:Acute Disease / Q000453:epidemiology / Q000534:rehabilitation; D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D015897:Comorbidity; D006970:Disorders of Excessive Somnolence / Q000453:epidemiology; D005260:Female; D015600:Glasgow Coma Scale; D016489:Head Injuries, Closed / Q000453:epidemiology* / Q000534:rehabilitation; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009290:Narcolepsy / Q000453:epidemiology; D015995:Prevalence; D012890:Sleep / Q000502:physiology; D012891:Sleep Apnea Syndromes / Q000453:epidemiology; D012893:Sleep Wake Disorders / Q000453:epidemiology*; D014193:Trauma Centers / Q000706:statistics & numerical data; D014851:Wakefulness / Q000502:physiology