title: Factors contributing to chronic fatigue after traumatic brain injury.
abstract: BACKGROUND
  The annual incidence of traumatic brain injury in Europe amounts to 235 per 100 000 persons. About two-thirds will develop posttraumatic brain injury chronic fatigue (pTBI-CF).
  
  
  OBJECTIVE
  To identify the reversible hormonal and nonhormonal causes of pTBI-CF.
  
  
  METHODS
  Ninety patients with varying degrees of pTBI-CF underwent endocrine testing and an evaluation of sleep, attention, coping style, daily activity and dependency, physical performance, emotional well-being, and quality of life.
  
  
  RESULTS
  Vitamin D deficiency was found in 65%, poor sleep quality in 54%, anxiety disorders in 36%, growth hormone deficiency in 16%, and gonadal hormone deficiencies in 9%. Fatigue severity was correlated with poor sleep (R = +0.65, P < .0001), serum 25-hydroxy vitamin D levels (R = -0.50, P < .0001), and anxiety (R = +0.50, P < .0001) but not with growth hormone deficiency or gonadal hormone deficiencies. The first 3 factors together explained 59% of the fatigue score variance.
  
  
  CONCLUSIONS
  Poor sleep, vitamin D deficiency, and anxiety were the most important factors associated with pTBI-CF. Appropriate treatment of these disorders may help to reduce fatigue in these patients.
authors.affiliation: Department of Rehabilitation, Waterland Hospital, Purmerend, The Netherlands. j_schnieders@hotmail.com
authors.forename: Jessica
authors.initials: J
authors.lastname: Schnieders
authors.forename: Dennis
authors.initials: D
authors.lastname: Willemsen
authors.forename: Hans
authors.initials: H
authors.lastname: de Boer
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D001008:Anxiety Disorders / Q000453:epidemiology; D001288:Attention; D001930:Brain Injuries / Q000150:complications*; D002908:Chronic Disease; D005221:Fatigue / Q000209:etiology*; D013006:Growth Hormone / Q000378:metabolism; D006801:Humans; D008297:Male; D010809:Physical Fitness; D011788:Quality of Life; D012307:Risk Factors; D012893:Sleep Wake Disorders / Q000453:epidemiology; D014808:Vitamin D Deficiency / Q000453:epidemiology
chemical_list: D013006:Growth Hormone