title: Increased sleep need and daytime sleepiness 6 months after traumatic brain injury: a prospective controlled clinical trial.
abstract: Post-traumatic sleep-wake disturbances are common after acute traumatic brain injury. Increased sleep need per 24 h and excessive daytime sleepiness are among the most prevalent post-traumatic sleep disorders and impair quality of life of trauma patients. Nevertheless, the relation between traumatic brain injury and sleep outcome, but also the link between post-traumatic sleep problems and clinical measures in the acute phase after traumatic brain injury has so far not been addressed in a controlled and prospective approach. We therefore performed a prospective controlled clinical study to examine (i) sleep-wake outcome after traumatic brain injury; and (ii) to screen for clinical and laboratory predictors of poor sleep-wake outcome after acute traumatic brain injury. Forty-two of 60 included patients with first-ever traumatic brain injury were available for follow-up examinations. Six months after trauma, the average sleep need per 24 h as assessed by actigraphy was markedly increased in patients as compared to controls (8.3 ± 1.1 h versus 7.1 ± 0.8 h, P < 0.0001). Objective daytime sleepiness was found in 57% of trauma patients and 19% of healthy subjects, and the average sleep latency in patients was reduced to 8.7 ± 4.6 min (12.1 ± 4.7 min in controls, P = 0.0009). Patients, but not controls, markedly underestimated both excessive sleep need and excessive daytime sleepiness when assessed only by subjective means, emphasizing the unreliability of self-assessment of increased sleep propensity in traumatic brain injury patients. At polysomnography, slow wave sleep after traumatic brain injury was more consolidated. The most important risk factor for developing increased sleep need after traumatic brain injury was the presence of an intracranial haemorrhage. In conclusion, we provide controlled and objective evidence for a direct relation between sleep-wake disturbances and traumatic brain injury, and for clinically significant underestimation of post-traumatic sleep-wake disturbances by trauma patients.
authors.affiliation: 1 Department of Neurology, University Hospital Zurich, 8091 Zurich, Switzerland christian.baumann@usz.ch.
authors.forename: Lukas L
authors.initials: LL
authors.lastname: Imbach
authors.affiliation: 1 Department of Neurology, University Hospital Zurich, 8091 Zurich, Switzerland.
authors.forename: Philipp O
authors.initials: PO
authors.lastname: Valko
authors.affiliation: 1 Department of Neurology, University Hospital Zurich, 8091 Zurich, Switzerland.
authors.forename: Tongzhou
authors.initials: T
authors.lastname: Li
authors.affiliation: 1 Department of Neurology, University Hospital Zurich, 8091 Zurich, Switzerland.
authors.forename: Angelina
authors.initials: A
authors.lastname: Maric
authors.affiliation: 1 Department of Neurology, University Hospital Zurich, 8091 Zurich, Switzerland.
authors.forename: Evangelia-Regkina
authors.initials: ER
authors.lastname: Symeonidou
authors.affiliation: 2 Department of Traumatology, University Hospital Zurich, 8091 Zurich, Switzerland.
authors.forename: John F
authors.initials: JF
authors.lastname: Stover
authors.affiliation: 3 Department of Neurology, Inselspital Bern, 3010 Bern, Switzerland.
authors.forename: Claudio L
authors.initials: CL
authors.lastname: Bassetti
authors.affiliation: 2 Department of Traumatology, University Hospital Zurich, 8091 Zurich, Switzerland.
authors.forename: Ladislav
authors.initials: L
authors.lastname: Mica
authors.affiliation: 1 Department of Neurology, University Hospital Zurich, 8091 Zurich, Switzerland.
authors.forename: Esther
authors.initials: E
authors.lastname: Werth
authors.affiliation: 1 Department of Neurology, University Hospital Zurich, 8091 Zurich, Switzerland.
authors.forename: Christian R
authors.initials: CR
authors.lastname: Baumann
mesh_terms: D056044:Actigraphy; D000328:Adult; D000704:Analysis of Variance; D001930:Brain Injuries / Q000150:complications* / Q000523:psychology; D002940:Circadian Rhythm / Q000502:physiology; D004185:Disability Evaluation; D006970:Disorders of Excessive Somnolence / Q000175:diagnosis / Q000209:etiology*; D004837:Epinephrine / Q000378:metabolism; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017286:Polysomnography; D011446:Prospective Studies; D012189:Retrospective Studies; D009418:S100 Proteins / Q000378:metabolism; D007319:Sleep Initiation and Maintenance Disorders / Q000175:diagnosis / Q000209:etiology*
chemical_list: D009418:S100 Proteins; D004837:Epinephrine
keywords: post-traumatic daytime sleepiness; post-traumatic pleiosomnia; sleep; traumatic brain injury