Prospective evaluation of the nature, course, and impact of acute sleep abnormality following TBI

Available online 4 January 2013
Publication year: 2013
Source:Archives of Physical Medicine and Rehabilitation



Objective To prospectively characterize the prevalence, course, and impact of acute sleep abnormality among traumatic brain injury (TBI) neurorehabilitation admissions. Design Prospective observational study. Setting: Free-standing rehabilitation hospital. Participants Primarily severe TBI (Median emergency department GCS=7; N=205) who were mostly male (71%), and Caucasian (68%) evaluated during acute neurorehabilitation. Interventions None. Main Outcome Measure Delirium Rating Scale-Revised-98 (DelRS-R98) was administered weekly throughout rehabilitation hospitalization. DelRS-R98 Item 1 was used to classify severity of sleep-wake cycle disturbance (SWCD) as none, mild, moderate, and severe. SWCD ratings were analyzed both serially and at one-month post-injury. Results For entire sample, 66% (mild-severe) had SWCD at one-month post injury. Course of SWCD using a subset (N=152) revealed 84% having SWCD on rehabilitation admission with 63% having moderate to severe ratings (median 24 days post injury; DPI). By the third serial exam (Median 35 DPI), 59% remained with SWCD and 28% having moderate to severe ratings. Using General Linear Modeling and adjusting for age, ED-GCS, and DPI, presence of moderate to severe SWCD at one-month post injury made significant contributions in predicting duration of post-traumatic amnesia (p < .01) and rehabilitation hospital length of stay (p < .01). Conclusion Results suggest that sleep abnormalities after TBI are prevalent and decrease over time. However, a high percent remain with SWCD throughout the course of rehabilitation intervention. Given the brevity of inpatient neurorehabilitation, future studies may explore targeting SWCD to improve early outcomes such as cognitive functioning and economic impact following TBI.

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