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  Increased sleep need and daytime sleepiness 6 months after traumatic brain injury: a prospective controlled clinical trial

Imbach, L., Valko, P., Li, T., Maric, A., Symeonidou, E.-R., Stover, J., et al. (2015). Increased sleep need and daytime sleepiness 6 months after traumatic brain injury: a prospective controlled clinical trial. Brain, 138(3), 726-735. doi:10.1093/brain/awu391.

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Imbach, LL, Author
Valko, PO, Author
Li, T, Author
Maric, A, Author
Symeonidou, E-R1, Author           
Stover, JF, Author
Bassetti, CL, Author
Mica, L, Author
Werth, E, Author
Baumann, CR, Author
Affiliations:
1Department Human Perception, Cognition and Action, Max Planck Institute for Biological Cybernetics, Max Planck Society, ou_1497797              

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 Abstract: 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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 Dates: 2015-03
 Publication Status: Published in print
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 Identifiers: DOI: 10.1093/brain/awu391
BibTex Citekey: ImbachVLMSSBMWB2015
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Title: Brain
Source Genre: Journal
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Pages: - Volume / Issue: 138 (3) Sequence Number: - Start / End Page: 726 - 735 Identifier: -