Cited by 380Sleep and related disordersSleep and Wakefulness ResearchTraumatic Brain Injury Research

The DOI matches its Crossref record; 53 of the 53 references it cites were found in a registry or an index.

Sleep-wake disturbances 6 months after traumatic brain injury: a prospective study

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Abstract

Sleep-wake disturbances (SWD) are common after traumatic brain injury (TBI). In acute TBI, we recently found decreased CSF levels of hypocretin-1, a wake-promoting neurotransmitter. In the present study, we aimed to delineate the frequency and clinical characteristics of post-traumatic SWD, to assess CSF hypocretin-1 levels 6 months after TBI, and to identify risk factors for posttraumatic SWD. A total of 96 consecutive patients were enrolled within the first 4 days after TBI. Six months later, out of 76 TBI patients, who did not die and who did not move to foreign countries, we included 65 patients (86%, 53 males, mean age 39 years) in our study. Patients were examined using interviews, questionnaires, clinical examinations, computed tomography of the brain, laboratory tests (including CSF hypocretin-1 levels, and HLA typing), conventional polysomnography, maintenance of wakefulness and multiple sleep latency tests (MSLT) and actigraphy. Potential causes of post-traumatic SWD were assessed according to international criteria. New-onset sleep-wake disturbances following TBI were found in 47 patients (72%): subjective excessive daytime sleepiness (EDS; defined by the Epworth Sleepiness Scale > or = 10) was found in 18 (28%), objective EDS (as defined by mean sleep latency < 5 min on MSLT) in 16 (25%), fatigue (daytime tiredness without signs of subjective or objective EDS) in 11 (17%), post-traumatic hypersomnia 'sensu strictu' (increased sleep need of > or = 2 h per 24 h compared to pre-TBI) in 14 (22%) patients and insomnia in 3 patients (5%). In 28 patients (43% of the study population), we could not identify a specific cause of the post-traumatic SWD other than TBI. Low CSF hypocretin-1 levels were found in 4 of 21 patients 6 months after TBI, as compared to 25 of 27 patients in the first days after TBI. Hypocretin levels 6 months after TBI were significantly lower in patients with post-traumatic EDS. There were no associations between post-traumatic SWD and severity or localization of TBI, general clinical outcome, gender, pathological neurological findings and HLA typing. However, post-traumatic SWD correlated with impaired quality of life. These results suggest that sleep-wake disturbances, particularly EDS, fatigue and hypersomnia are common after TBI, and significantly impair quality of life. In almost one out of two patients, post-traumatic SWD appear to be directly related to the TBI. An involvement of the hypocretin system in the pathophysiology of post-traumatic SWD appears possible. Other risk factors predisposing towards the development of post-traumatic SWD were not identified.

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Crossref · 10.1093/brain/awm109

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  1. Danker-Hopfe H, Schaefer M, Dorn H, Anderer P, Saletu B, Gruber G, et al. Percentile reference charts for selected sleep parameters for 20-to 80-year-old healthy subjects from the SIESTA database. Somnologie 2005; 9: 3-14.

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Metadata

Authors
Baumann, C. R., Werth, E., Stocker, R., Ludwig, S., & Bassetti, C. L.
Affiliations
University Hospital Zurich (CH)
Venue
Brain
Published
2007-05-29
Volume
130
Issue
7
Pages
1873-1883
ISSN
  • 0006-8950 (ISSN-L)
  • 1460-2156
OpenAlex
W2145062984
Cited by
380
References
53
Citations by year
2026: 8 · 2025: 11 · 2024: 12 · 2023: 9 · 2022: 21 · 2021: 15 · 2020: 19 · 2019: 24 · 2018: 34 · 2017: 20 · 2016: 30 · 2015: 32 · 2014: 26 · 2013: 35 · 2012: 22
FWCI
17.55
Type
journal article
Language
en
Open access
Locations
  • Brain (publishedVersion)
  • PubMed (publishedVersion)
  • Zurich Open Repository and Archive (University of Zurich) (acceptedVersion, other-oa)
  • reroDoc Digital Library (submittedVersion)
  • Zurich Open Repository and Archive (University of Zurich) (submittedVersion, other-oa)
  • Zurich Open Repository and Archive (University of Zurich)
Topics
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
  • Life Sciences › Neuroscience › Cognitive Neuroscience › Sleep and Wakefulness Research
  • Health Sciences › Medicine › Clinical Neurology › Traumatic Brain Injury Research
Keywords
traumatic brain injury, sleep-wake disturbances, orexin-A, cerebrospinal fluid, excessive daytime sleepiness, insomnia, fatigue, risk factors, HLA typing, multiple sleep latency test, actigraphy, polysomnography, HLA-DR
MeSH terms
Orexins, Adolescent, Adult, Aged, Brain Injuries, Female, Humans, Male, Middle Aged, Neuropeptides, Prognosis, Prospective Studies, Quality of Life, Risk Factors, Polysomnography, Sleep Disorders, Circadian Rhythm, Glasgow Outcome Scale, Intracellular Signaling Peptides and Proteins

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