title: The impact of poor sleep on cognition and activities of daily living after traumatic brain injury: a review.
abstract: OBJECTIVE
  Patients frequently report sleep disruptions or insomnia during their hospital stay, particularly after a traumatic brain injury (TBI). The consequences of these sleep disturbances on everyday activities are not well documented and are therefore not considered in the evaluation of independence in activities of daily living (ADLs). The goal of this narrative review is to explore the consequences of poor sleep quality on cognition and ADLs in the acute and subacute stages of a moderate and severe TBI, when patients are in acute care or inpatient rehabilitation.
  
  
  METHODS
  We will present an overview of normal sleep and its role in cognitive functioning, and then present the findings of studies that have investigated sleep characteristics in hospital settings and the consequences of sleep disturbances on ADLs.
  
  
  RESULTS
  During hospitalisation, TBI patients present severe sleep disturbances such as insomnia and sleep fragmentation, which are probably influenced by both the medical condition and the hospital or rehabilitation environment. Sleep disruption is associated with several cognitive deficits, including attention, memory and executive function impairments. Poor quality and/or insufficient quantity of sleep in acute TBI probably affect general functioning and ADLs calling for these cognitive functions.
  
  
  CONCLUSIONS
  The cognitive impairments present following TBI are probably exacerbated by poor sleep quality and sleep deprivation during hospitalisation, which in turn impact ADLs among this population. Health-care personnel should further consider sleep disturbances among people with TBI and a sleep protocol should be established.
authors.affiliation: Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Coeur de Montréal, Montreal, Québec, Canada; Department of Psychiatry, Université de Montréal, Montreal, Québec, Canada.
authors.forename: Catherine
authors.initials: C
authors.lastname: Duclos
authors.forename: Marie-Pascale
authors.initials: MP
authors.lastname: Beauregard
authors.forename: Carolina
authors.initials: C
authors.lastname: Bottari
authors.forename: Marie-Christine
authors.initials: MC
authors.lastname: Ouellet
authors.forename: Nadia
authors.initials: N
authors.lastname: Gosselin
mesh_terms: D000203:Activities of Daily Living; D001930:Brain Injuries / Q000150:complications* / Q000175:diagnosis / Q000534:rehabilitation; D003072:Cognition Disorders / Q000209:etiology* / Q000503:physiopathology / Q000534:rehabilitation; D056344:Executive Function; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D015601:Injury Severity Score; D007902:Length of Stay; D008297:Male; D017286:Polysomnography / Q000379:methods; D011379:Prognosis; D018570:Risk Assessment; D012893:Sleep Wake Disorders / Q000150:complications* / Q000175:diagnosis; D016896:Treatment Outcome
keywords: activities of daily living; cognition; critical care; sleep; traumatic brain injury