Understanding Sleep Dysfunction after Traumatic Brain Injury
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BRAIN INJURY MEDICINE AND REHABILITATION (G GALANG, SECTION EDITOR)
Understanding Sleep Dysfunction after Traumatic Brain Injury Mark Linsenmeyer 1,2
&
Michael Guthrie 2 & Mary Miller Phillips 3
Accepted: 8 October 2020 # Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose of Review This paper aims to review the prevalence, pathophysiology, outcomes, evaluation, and management of sleep dysfunction after traumatic brain injury (TBI). Recent Findings Recent research has focused on the prevalence and effects of sleep disturbance in various age groups after TBI, the correlation of subjective complaints to objective sleep measurement, the use of actigraphy to monitor sleep in those with TBI, updates to our understanding of pathophysiology of sleep dysfunction across the spectrum of severity of TBI, and newly identified associations with sleep and outcomes. Summary Providers should continue to recognize and treat sleep dysfunction after TBI given its influence on recovery and function. We should be aware that subjective and objective measurements of sleep may not correlate and that actigraph-inferred sleep data should be interpreted with caution. Ongoing research will continue to inform our understanding of the evaluation and management of sleep dysfunction after TBI. Keywords Traumatic brain injury . Sleep . Insomnia . Actigraphy
Introduction Sleep dysfunction is common after traumatic brain injury (TBI) and may affect mood, cognition, behavior and pain. Sleep dysfunction may impair neural remodeling while worsening inflammation. It can also have negative effects on rehabilitation by prolonging the duration of post-traumatic amnesia and worsening agitation. This article will describe the prevalence, biology, assessment, and management of sleep after TBI with an emphasis on recent reports and findings.
This article is part of the Topical Collection on Brain Injury Medicine and Rehabilitation * Mark Linsenmeyer [email protected] 1
Sunnyview Rehabilitation Hospital, Schenectady, NY, USA
2
University of Pittsburgh Medical Center, Pittsburgh, PA, USA
3
Baylor Institute for Rehabilitation, Dallas, TX, USA
Prevalence of Sleep Dysfunction Following TBI Individuals who suffer TBI experience more sleep disturbances than the general population. Sleep disturbance following TBI ranges from 46 to 100% depending on sample selection, time from injury, severity of injury, comorbidities, and patient versus examiner assessment of sleep, compared with just 9–17% of the general population [1]. For example, one meta-analysis reported that 50% of TBI survivors experienced some type of sleep disturbance, with approximately 25% of patients being formally diagnosed with a specific sleep disorder such as insomnia, hypersomnia, or sleep related disordered breathing [2]. Those with mild TBI have been found to have more issues with sleep than in more severe cases, perhaps due to increased insight and ability to report symptoms [3, 4]. In the acute inpatient rehabilitation setting, the prevalence of p
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