Increased sleep need and daytime sleepiness 6 months after traumatic brain injury: a prospective controlled clinical trial
Open accessAbstract
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.
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Up to 60% of TBI patients with otherwise excellent neurological recovery report chronic daytime sleepiness or hypersomnia.
“Even among TBI patients with otherwise excellent neurological recovery, up to 60% report chronic daytime sleepiness or hypersomnia (i.e., increased sleep need per 24 hours). 1”
From Damage to Arousal-Promoting Brainstem Neurons with Traumatic Brain Injury (2016) · cites this paper as [1]
The ‘Sleep state misperception after traumatic brain injury’ section reports that 57% of patients had objectively detected daytime sleepiness at six months, but only 19% reported it. The paper therefore makes the contrary point about patient reports; the cited passages also do not establish that these patients had otherwise excellent neurological recovery. (LLM, conf=0.87)
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- Authors
- Imbach, L. L., Valko, P. O., Li, T., Maric, A., Symeonidou, E.-R., Stover, J. F., Bassetti, C. L., Mica, L., Werth, E., & Baumann, C. R.
- Affiliations
- University Hospital Zurich (CH)
- University Hospital of Bern (CH)
- ORCID
- Venue
- Brain
- Publisher
- Oxford University Press (OUP)
- Published
- 2015-01-13
- Volume
- 138
- Issue
- 3
- Pages
- 726-735
- ISSN
- 0006-8950 (ISSN-L)
- 1460-2156
- PMC
- PMC4408434
- OpenAlex
- W2127200406
- Cited by
- 142
- References
- 30
- Citations by year
- 2026: 6 · 2025: 15 · 2024: 8 · 2023: 6 · 2022: 10 · 2021: 17 · 2020: 12 · 2019: 13 · 2018: 19 · 2017: 8 · 2016: 17 · 2015: 10
- FWCI
- 24.61
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Brain (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Zurich Open Repository and Archive (University of Zurich) (acceptedVersion, other-oa)
- reroDoc Digital Library (submittedVersion)
- Bern Open Repository and Information System (University of Bern) (submittedVersion, other-oa)
- Max Planck Digital Library (submittedVersion)
- MPG.PuRe (Max Planck Society) (submittedVersion)
- Zurich Open Repository and Archive (University of Zurich) (submittedVersion, other-oa)
- Zurich Open Repository and Archive (University of Zurich)
- Open Access CRIS of the University of Bern
- Funders
- National Science Foundation
- Schweizerischer Nationalfonds zur Förderung der Wissenschaftlichen Forschung (32003B, 125504)
- Universität Zürich
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
- Health Sciences › Medicine › Epidemiology › Traumatic Brain Injury Research
- Health Sciences › Medicine › Neurology › Traumatic Brain Injury and Neurovascular Disturbances
- Keywords
- traumatic brain injury, excessive daytime sleepiness, sleep-wake disturbances, actigraphy, sleep latency, slow-wave sleep, intracranial hemorrhage
- MeSH terms
- Adult, Analysis of Variance, Brain Injuries, Circadian Rhythm, Disability Evaluation, Epinephrine, Female, Humans, Disorders of Excessive Somnolence, Sleep Initiation and Maintenance Disorders, Male, Middle Aged, S100 Proteins, Prospective Studies, Retrospective Studies, Polysomnography, Actigraphy
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