Self-report instruments for assessing sleep dysfunction in an adult traumatic brain injury population: a systematic review

Abstract

Studies on sleep and TBI have shown that patients represent different sleep and wakefulness symptoms from an acute or chronic inability to sleep adequately at night (insomnia), chronic fatigue, sleepiness, disturbances of circadian rhythm to behavioral manifestations associated with sleep itself. The recognition of the importance of systematically assessing sleep difficulties in TBI population has been influencing clinical practice and research in the field of TBI recently. This reflects clinicians’ concern for better evaluation and treatment of persons with TBI who report significant disturbances of sleep/wake cycles post-injury. Self-reported questionnaires are often the instrument of first choice to assess sleep, given its cost effectiveness, ability to collect patient’s unique experience and the added privacy which can enhance the validity of the responses. Objectives of the study were: (1) to comprehensively assess a variety of the existing self-report sleep measures that have been applied to the evaluation of TBI adults’ impaired sleep and wakefulness; (2) to examine these instruments in terms of their fit in patients’ population; (3) to discuss the strengths and weaknesses of the self-report sleep measures when applied to TBI population. Comprehensive peer-reviewed literature search of Medline, Embase, PsychInfo, Cinahl and bibliographies of identified articles. All studies on TBI adult population that used a standardized patient-report sleep measure were considered for this review. Identified 16 self-report measures used in TBI research and clinical practice. Five were of generic nature, five were symptom-related and six were condition-specific measures. The Pittsburgh Sleep Quality Index and Epworth Sleepiness Scale have been partially validated in post-acute TBI. Although no instrument has been specifically developed for TBI patients, there are scientific benefits to using existing. Additional research is needed to examine their applicability to a TBI population. Designing an instrument that is able to triage sleep-related complaints between depressive, medical and primary sleep disorders, with part for a caregiver included, may assist in better identifying sleep dysfunction in persons with TBI. Whether the investigator selects or invents a questionnaire, consideration of which domains the measure must screen, diagnose or monitor should be given a priority. Polysomnography is recommended for the diagnosis of specific sleep disorders which cannot be fully disentangled by a self-report measure. Dr. Mollayeva was supported by the 2011–2013 Toronto Rehabilitation Institute Scholarship and the University of Toronto Open Award. We recognize the support of the Toronto Rehabilitation Institute Foundation and a grant to the Ministry of Health and Long Term Care to the Toronto Rehabilitation Institute.