0599 SLEEP APNEA SEVERITY IS ASSOCIATED WITH MOTOR RECOVERY AND PROCESSING SPEED IN ACUTE TBI REHABILITATION ADMISSIONS: A VA TBI MODEL SYSTEM STUDY

Abstract

During a time of critical neural repair, significant proportions of persons with traumatic brain injury (TBI) undergoing neuro-rehabilitation have significant sleep disruption. Recent reports indicate up to 37% of consecutive TBI rehabilitation admissions have undiagnosed sleep apnea (SA) that may hinder neurologic repair due to hypoxemia and sleep disruption. To date, no study has examined outcomes associated with SA in early stages of TBI recovery. This is a consecutive prospective observational cohort study with IRB-approved research participants part of the TBI Model Systems lifetime study and who received PSG during inpatient neurorehabilitation. The Functional Independence Measure (FIM, Cognitive and Motor Subscales) and Disability Rating Scale were rated on admission and discharge by clinical teams. A subset recovered sufficiently and underwent neuropsychological testing including measures of memory (CVLT-2) and processing speed (Trail Making Test). Sample (n=68) was primarily male (96%), white (87%), married (35%), with ≥ 12 years of education. The median age was 31 years (interquartile range [IQR], 25,50). The most common TBI mechanism was motor-related (68%) with most having a severe injury (Median Emergency Department Glasgow Coma Scale =3, IQR, 3,11). Half of the sample (43%) had SA that was primarily mild (62%) and obstructive type. Individuals were divided into SA severity groups based on AHI of ≤4 (none), 5–14 (mild), and ≥ 15 (moderate to severe). One-way between subjects ANOVA revealed group differences for FIM Motor (F, (2,64) = 3.86, p=.026) and Total scores (F, (2,64) = 3.18, p=.048) on rehabilitation admission. Post-hoc (Tukey) comparisons revealed worse scores for participants with moderate-severe SA compared to those with mild. SA severity was significantly correlated with processing speed (r=0.4, p=0.007) but not verbal memory during early TBI recovery. Greater SA severity was significantly associated with lower motor functioning and slower processing speed during inpatient rehabilitation. Earlier detection of SA may improve rehabilitation outcomes following TBI. VA TBI Model Systems Program of Research, Subcontract from General Dynamics Information Technology (W91YTZ-13-C-0015), Defense and Veterans Brain Injury Center; Defense Health Agency (DHA); and Department of Veterans Affairs grants (1 I50 HX001233-01, W81XWH-13-2-0095).