Treatment of sleep disorders after traumatic brain injury.
OBJECTIVE
Determine whether treatment of sleep disorders identified in brain injured adults would result in resolution of those sleep disorders and improvement of symptoms and daytime function.


METHODS
Prospective evaluation of unselected traumatic brain injury patients with nocturnal polysomnography (NPSG), 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) before and after treatment with continuous positive airway pressure (CPAP) for obstructive sleep apnea (OSA), modafinil (200 mg) for narcolepsy and posttraumatic hypersomnia (PTH), or pramipexole (0.375 mg) for periodic limb movements in sleep (PLMS).


METHODS
Three academic medical centers.


METHODS
Fifty-seven (57) adults > or = 3 months post traumatic brain injury (TBI).


RESULTS
Abnormal sleep studies were found in 22 subjects (39%), of whom 13 (23%) had OSA, 2 (3%) had PTH, 3 (5%) had narcolepsy, 4 (7%) had PLMS, and 12 had objective excessive daytime sleepiness with MSLT score < 10 minutes. Apneas, hypopneas, and snoring were eliminated by CPAP in OSA subjects, but there was no significant change in MSLT scores. Periodic limb movements were eliminated with pramipexole. One of 3 narcolepsy subjects and 1 of 2 PTH subjects had resolution of hypersomnia with modafinil. There was no significant change in FOSQ, POMS, or PVT results after treatment.


CONCLUSIONS
Treatment of sleep disorders after TBI may result in polysomnographic resolution without change in sleepiness or neuropsychological function.
Castriotta
Richard J
RJ
Division of Pulmonary, Critical Care and Sleep Medicine, University of Texas Health Science Center at Houston, 6431 Fannin St., MSB 1.274, Houston, TX 77030, USA. Richard.J.Castriotta@uth.tmc.edu
Atanasov
Strahil
S
Wilde
Mark C
MC
Masel
Brent E
BE
Lai
Jenny M
JM
Kuna
Samuel T
ST
D000328:Adult; D001559:Benzhydryl Compounds / Q000627:therapeutic use; D052160:Benzothiazoles / Q000627:therapeutic use; D001930:Brain Injuries / Q000150:complications* / Q000534:rehabilitation; D000697:Central Nervous System Stimulants / Q000627:therapeutic use; D006970:Disorders of Excessive Somnolence / Q000188:drug therapy / Q000209:etiology; D018491:Dopamine Agonists / Q000627:therapeutic use; D005260:Female; D006801:Humans; D008297:Male; D000077408:Modafinil; D009290:Narcolepsy / Q000188:drug therapy / Q000209:etiology; D020189:Nocturnal Myoclonus Syndrome / Q000188:drug therapy / Q000209:etiology; D000077487:Pramipexole; D011446:Prospective Studies; D011788:Quality of Life; D020181:Sleep Apnea, Obstructive / Q000209:etiology / Q000628:therapy; D012893:Sleep Wake Disorders / Q000209:etiology / Q000628:therapy*
D001559:Benzhydryl Compounds; D052160:Benzothiazoles; D000697:Central Nervous System Stimulants; D018491:Dopamine Agonists; D000077487:Pramipexole; D000077408:Modafinil