title: Sleep-wake disorders persist 18 months after traumatic brain injury but remain underrecognized.
abstract: OBJECTIVE
  This study is a prospective, controlled clinical and electrophysiologic trial examining the chronic course of posttraumatic sleep-wake disturbances (SWD).
  
  
  METHODS
  We screened 140 patients with acute, first-ever traumatic brain injury of any severity and included 60 patients for prospective follow-up examinations. Patients with prior brain trauma, other neurologic or systemic disease, drug abuse, or psychiatric comorbidities were excluded. Eighteen months after trauma, we performed detailed sleep assessment in 31 participants. As a control group, we enrolled healthy individuals without prior brain trauma matched for age, sex, and sleep satiation.
  
  
  RESULTS
  In the chronic state after traumatic brain injury, sleep need per 24 hours was persistently increased in trauma patients (8.1 ± 0.5 hours) as compared to healthy controls (7.1 ± 0.7 hours). The prevalence of chronic objective excessive daytime sleepiness was 67% in patients with brain trauma compared to 19% in controls. Patients significantly underestimated excessive daytime sleepiness and sleep need, emphasizing the unreliability of self-assessments on SWD in trauma patients.
  
  
  CONCLUSIONS
  This study provides prospective, controlled, and objective evidence for chronic persistence of posttraumatic SWD, which remain underestimated by patients. These results have clinical and medicolegal implications given that SWD can exacerbate other outcomes of traumatic brain injury, impair quality of life, and are associated with public safety hazards.
authors.affiliation: From the Departments of Neurology (L.L.I., F.B., P.O.V., T.L., A.M., E.W., C.R.B.) and Traumatology (J.F.S., L.M.), University Hospital Zurich; and Department of Neurology (C.L.B.), Inselspital Bern, Switzerland. lukas.imbach@usz.ch.
authors.forename: Lukas L
authors.initials: LL
authors.lastname: Imbach
authors.affiliation: From the Departments of Neurology (L.L.I., F.B., P.O.V., T.L., A.M., E.W., C.R.B.) and Traumatology (J.F.S., L.M.), University Hospital Zurich; and Department of Neurology (C.L.B.), Inselspital Bern, Switzerland.
authors.forename: Fabian
authors.initials: F
authors.lastname: Büchele
authors.affiliation: From the Departments of Neurology (L.L.I., F.B., P.O.V., T.L., A.M., E.W., C.R.B.) and Traumatology (J.F.S., L.M.), University Hospital Zurich; and Department of Neurology (C.L.B.), Inselspital Bern, Switzerland.
authors.forename: Philipp O
authors.initials: PO
authors.lastname: Valko
authors.affiliation: From the Departments of Neurology (L.L.I., F.B., P.O.V., T.L., A.M., E.W., C.R.B.) and Traumatology (J.F.S., L.M.), University Hospital Zurich; and Department of Neurology (C.L.B.), Inselspital Bern, Switzerland.
authors.forename: Tongzhou
authors.initials: T
authors.lastname: Li
authors.affiliation: From the Departments of Neurology (L.L.I., F.B., P.O.V., T.L., A.M., E.W., C.R.B.) and Traumatology (J.F.S., L.M.), University Hospital Zurich; and Department of Neurology (C.L.B.), Inselspital Bern, Switzerland.
authors.forename: Angelina
authors.initials: A
authors.lastname: Maric
authors.affiliation: From the Departments of Neurology (L.L.I., F.B., P.O.V., T.L., A.M., E.W., C.R.B.) and Traumatology (J.F.S., L.M.), University Hospital Zurich; and Department of Neurology (C.L.B.), Inselspital Bern, Switzerland.
authors.forename: John F
authors.initials: JF
authors.lastname: Stover
authors.affiliation: From the Departments of Neurology (L.L.I., F.B., P.O.V., T.L., A.M., E.W., C.R.B.) and Traumatology (J.F.S., L.M.), University Hospital Zurich; and Department of Neurology (C.L.B.), Inselspital Bern, Switzerland.
authors.forename: Claudio L
authors.initials: CL
authors.lastname: Bassetti
authors.affiliation: From the Departments of Neurology (L.L.I., F.B., P.O.V., T.L., A.M., E.W., C.R.B.) and Traumatology (J.F.S., L.M.), University Hospital Zurich; and Department of Neurology (C.L.B.), Inselspital Bern, Switzerland.
authors.forename: Ladislav
authors.initials: L
authors.lastname: Mica
authors.affiliation: From the Departments of Neurology (L.L.I., F.B., P.O.V., T.L., A.M., E.W., C.R.B.) and Traumatology (J.F.S., L.M.), University Hospital Zurich; and Department of Neurology (C.L.B.), Inselspital Bern, Switzerland.
authors.forename: Esther
authors.initials: E
authors.lastname: Werth
authors.affiliation: From the Departments of Neurology (L.L.I., F.B., P.O.V., T.L., A.M., E.W., C.R.B.) and Traumatology (J.F.S., L.M.), University Hospital Zurich; and Department of Neurology (C.L.B.), Inselspital Bern, Switzerland.
authors.forename: Christian R
authors.initials: CR
authors.lastname: Baumann
mesh_terms: D056044:Actigraphy; D000328:Adult; D000070642:Brain Injuries, Traumatic / Q000150:complications* / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology; D003700:Delta Rhythm; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D017286:Polysomnography; D015995:Prevalence; D011446:Prospective Studies; D012720:Severity of Illness Index; D012893:Sleep Wake Disorders / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology* / Q000503:physiopathology; D013997:Time Factors