title: Sleep-wake disturbances 3 years after traumatic brain injury.
abstract: BACKGROUND
  6 months after traumatic brain injury (TBI), almost three out of four patients suffer from sleep-wake disturbances (SWD) such as post-traumatic hypersomnia (increased sleep need of ≥2 h compared with before injury), excessive daytime sleepiness (EDS), fatigue and insomnia. The long-term course of post-traumatic SWD, however, is unknown.
  
  
  OBJECTIVE
  To assess the prevalence and characteristics of post-traumatic SWD 3 years after trauma.
  
  
  METHODS
  Prospective longitudinal clinical study in 51 consecutive TBI patients (43 males, eight females, mean age 40±16 years).
  
  
  METHODS
  EDS (as assessed by the Epworth sleepiness scale), fatigue (fatigue severity scale), post-traumatic hypersomnia (sleep length per 24 h), insomnia, depression and anxiety.
  
  
  RESULTS
  Post-traumatic SWD were found in 34 patients (67%): post-traumatic hypersomnia in 14 (27%), EDS in six (12%), fatigue in 18 patients (35%) and insomnia in five patients (10%). SWD were not associated with severity or localisation of, or time interval since, TBI. Insomnia was linked to depressive symptoms.
  
  
  CONCLUSIONS
  This prospective study shows that 3 years after TBI, two out of three patients suffer from residual SWD, particularly fatigue and post-traumatic hypersomnia. In 45% of TBI patients, SWD appear directly related to the trauma itself.
authors.affiliation: Department of Neurology, University Hospital Zurich, Frauenklinikstrasse 26, 8091 Zurich, Switzerland; christian.baumann@usz.ch.
authors.forename: Julia
authors.initials: J
authors.lastname: Kempf
authors.forename: Esther
authors.initials: E
authors.lastname: Werth
authors.forename: Philippe R
authors.initials: PR
authors.lastname: Kaiser
authors.forename: Claudio L
authors.initials: CL
authors.lastname: Bassetti
authors.forename: Christian R
authors.initials: CR
authors.lastname: Baumann
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D020208:Brain Injury, Chronic / Q000175:diagnosis* / Q000453:epidemiology*; D003430:Cross-Sectional Studies; D003866:Depressive Disorder / Q000175:diagnosis / Q000453:epidemiology; D004185:Disability Evaluation; D006970:Disorders of Excessive Somnolence / Q000175:diagnosis / Q000453:epidemiology; D005221:Fatigue / Q000175:diagnosis / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D020919:Sleep Disorders, Intrinsic / Q000175:diagnosis* / Q000453:epidemiology*; D007319:Sleep Initiation and Maintenance Disorders / Q000175:diagnosis / Q000453:epidemiology; D055815:Young Adult