title: Changes in sleep patterns following traumatic brain injury: a controlled study.
abstract: BACKGROUND
  Sleep changes are frequently reported following traumatic brain injury (TBI) and have an impact on rehabilitation and quality of life following injury. Potential causes include injury to brain regions associated with sleep regulation, as well as secondary factors, including depression, anxiety, and pain. Understanding the nature and causes of sleep changes following TBI represents a vital step in developing effective treatments.
  
  
  OBJECTIVE
  The study aimed to investigate subjective sleep changes in a community-based sample of individuals with TBI in comparison with noninjured age- and sex-matched controls and to explore the impact of secondary factors (pain, anxiety, depression, employment) on these self-reported sleep changes.
  
  
  METHODS
  A total of 153 participants with mild to severe TBI and 128 noninjured controls completed self-report measures relating to their sleep quality, daytime sleepiness, mood, fatigue, and pain and completed a sleep diary each day for 7 days.
  
  
  RESULTS
  Compared with the noninjured controls, participants with TBI reported significantly poorer sleep quality and higher levels of daytime sleepiness; sleep diaries revealed longer sleep onset latency, poorer sleep efficiency, longer sleep duration, and more frequent daytime napping in the TBI group, as well as earlier bedtimes and greater total sleep duration. Anxiety, depression, and pain were associated with poorer sleep quality. Greater injury severity was also associated with a need for longer sleep time.
  
  
  CONCLUSIONS
  These findings highlight the importance of assessing and addressing pain, anxiety, and depression as part of the process of treating TBI-related sleep disturbances.
authors.affiliation: School of Psychology and Psychiatry, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia. jennie.ponsford@monash.edu
authors.forename: Jennie L
authors.initials: JL
authors.lastname: Ponsford
authors.forename: Diane L
authors.initials: DL
authors.lastname: Parcell
authors.forename: Kelly L
authors.initials: KL
authors.lastname: Sinclair
authors.forename: Monique
authors.initials: M
authors.lastname: Roper
authors.forename: Shantha M W
authors.initials: SM
authors.lastname: Rajaratnam
mesh_terms: D000328:Adult; D001930:Brain Injuries / Q000150:complications*; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D011569:Psychiatric Status Rating Scales; D057566:Self Report; D012890:Sleep / Q000502:physiology; D012893:Sleep Wake Disorders / Q000175:diagnosis / Q000209:etiology*; D013223:Statistics as Topic; D011795:Surveys and Questionnaires; D055815:Young Adult
keywords: anxiety; depression; excessive daytime sleepiness; sleep disturbance; sleep quality; traumatic brain injury