title: Rest-Activity Cycle Disturbances in the Acute Phase of Moderate to Severe Traumatic Brain Injury.
abstract: BACKGROUND
  Sleep-wake disturbances are among the most persistent sequelae after traumatic brain injury (TBI) and probably arise during the hospital stay following TBI. These disturbances are characterized by difficulties sleeping at night and staying awake during the day.
  
  
  OBJECTIVE
  The aim of the present study was to document rest-activity cycle consolidation in acute moderate/severe TBI using actigraphy and to assess its association with injury severity and outcome.
  
  
  METHODS
  In all, 16 hospitalized patients (27.1 ± 11.3 years) with moderate/severe TBI wore actigraphs for 10 days, starting in the intensive care unit (ICU) when continuous sedation was discontinued and patients had reached medical stability. Activity counts were summed for daytime (7:00-21:59 hours) and nighttime periods (22:00-6:59 hours). The ratio of daytime period activity to total 24-hour activity was used to quantify rest-activity cycle consolidation. An analysis of variance was carried out to characterize the evolution of the daytime activity ratio over the recording period.
  
  
  RESULTS
  Rest-activity cycle was consolidated only 46.6% of all days; however, a significant linear trend of improvement was observed over time. Greater TBI severity and longer ICU and hospital lengths of stay were associated with poorer rest-activity cycle consolidation and evolution. Patients with more rapid return to consolidated rest-activity cycle were more likely to have cleared posttraumatic amnesia and have lower disability at hospital discharge.
  
  
  CONCLUSIONS
  Patients with acute moderate/severe TBI had an altered rest-activity cycle, probably reflecting severe fragmentation of sleep and wake episodes, which globally improved over time. A faster return to rest-activity cycle consolidation may predict enhanced brain recovery.
authors.affiliation: Hôpital du Sacré-Coeur de Montréal, Montréal, Canada Université de Montréal, Montréal, Canada.
authors.forename: Catherine
authors.initials: C
authors.lastname: Duclos
authors.affiliation: Hôpital du Sacré-Coeur de Montréal, Montréal, Canada Université de Montréal, Montréal, Canada.
authors.forename: Marie
authors.initials: M
authors.lastname: Dumont
authors.affiliation: Hôpital du Sacré-Coeur de Montréal, Montréal, Canada.
authors.forename: Hélène
authors.initials: H
authors.lastname: Blais
authors.affiliation: Hôpital du Sacré-Coeur de Montréal, Montréal, Canada.
authors.forename: Jean
authors.initials: J
authors.lastname: Paquet
authors.affiliation: Hôpital du Sacré-Coeur de Montréal, Montréal, Canada.
authors.forename: Elyse
authors.initials: E
authors.lastname: Laflamme
authors.affiliation: Hôpital du Sacré-Coeur de Montréal, Montréal, Canada Université du Québec à Trois-Rivières, Trois-Rivières, Canada.
authors.forename: Louis
authors.initials: L
authors.lastname: de Beaumont
authors.affiliation: Hôpital du Sacré-Coeur de Montréal, Montréal, Canada Université de Montréal, Montréal, Canada.
authors.forename: Catherine
authors.initials: C
authors.lastname: Wiseman-Hakes
authors.affiliation: University of Cambridge, Cambridge, UK.
authors.forename: David K
authors.initials: DK
authors.lastname: Menon
authors.affiliation: Hôpital du Sacré-Coeur de Montréal, Montréal, Canada Université de Montréal, Montréal, Canada.
authors.forename: Francis
authors.initials: F
authors.lastname: Bernard
authors.affiliation: Hôpital du Sacré-Coeur de Montréal, Montréal, Canada Université de Montréal, Montréal, Canada nadia.gosselin@umontreal.ca.
authors.forename: Nadia
authors.initials: N
authors.lastname: Gosselin
mesh_terms: D056044:Actigraphy; D000204:Activity Cycles / Q000502:physiology*; D000293:Adolescent; D000328:Adult; D000070642:Brain Injuries, Traumatic / Q000150:complications / Q000503:physiopathology*; D003071:Cognition / Q000502:physiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D012893:Sleep Wake Disorders / Q000209:etiology / Q000503:physiopathology*; D055815:Young Adult
keywords: actigraphy; circadian rhythms; intensive care; sleep; traumatic brain injury