Risk factors associated with sleep disturbance following traumatic brain injury

Abstract

Introduction Sleep disturbance is very common following traumatic brain injury (TBI), which may initiate or exacerbate a variety of co-morbidities and negatively impact rehabilitative treatments. To date, there are paradoxical reports regarding the associations between inherent characteristics of TBI and sleep disturbance in TBI population. The current study was designed to explore the relationship between the presence of sleep disturbance and characteristics of TBI and identify the factors which are closely related to the presence of sleep disturbance in TBI population. Materials and methods 98 TBI patients (72 males, mean age SD, 47 13 years, range 18–70) were recruited. Severity of TBI was evaluated based on Glasgow Coma Scale (GCS). All participants were performed cranial computed tomography and examined on self-reported sleep quality, anxiety, and depression. Results 37 of 98 patients (38%) reported sleep disturbance following TBI. Insomnia was diagnosed in 28 patients (29%) and post-traumatic hypersomnia in 9 patients (9%). In TBI with insomnia group, 5 patients (18%) complained difficulty falling asleep only, 8 patients (29%) had difficulty maintaining sleep without difficulty in initial sleep and 15 patients (53%) presented both difficulty falling asleep and difficulty maintaining sleep. Risk factors associated with insomnia were headache and/or dizziness and more symptoms of anxiety and depression rather than GCS. In contrast, GCS was independently associated with the presence of hypersomnia following TBI. Furthermore, there was no evidence of an association between locations of brain injury and the presence of sleep disturbance after TBI. Conclusion Our data demonstrate that TBI patients with insomnia are prone to suffer from concomitant headache and/or dizziness and report more symptoms of anxiety and depression. Severe TBI patients are likely to experience hypersomnia. Acknowledgements We would like to express our appreciation to all the patients who have participated in this study and Drs. Zhongxin Zhao, Liuqing Huang and You Yin for their valuable comments on this manuscript.