Sleep disorders associated with traumatic brain injury.

OBJECTIVES

To investigate the frequency of sleep disorders in traumatic brain injury (TBI) patients with hypersomnia and to discern the relationship between posttraumatic sleep disorders and pretraumatic sleep symptoms.

DESIGN

Prospective cohort study using the criterion standard to diagnose sleep disorders in a consecutive sample of TBI patients.

SETTING

Academic medical center with level I trauma center, rehabilitative medicine services, and accredited sleep disorders center.

PATIENTS

Ten TBI patients with subjective excessive sleepiness.

INTERVENTION

Nocturnal polysomnography followed by Multiple Sleep Latency Test. Subjects who had overt sleep apnea on the first nocturnal polysomnography had a second nocturnal polysomnography with titration of nasal continuous positive airway pressure.

MAIN OUTCOME MEASURES

Diagnosis of sleep-disordered breathing, narcolepsy, and posttraumatic hypersomnia.

RESULTS

A diagnosis of treatable sleep disorder was made in all 10 subjects. Sleep-disordered breathing was found in 7 subjects: overt obstructive sleep apnea (OSA) was diagnosed in 5 subjects, rapid eye movement-related OSA in 1, and upper airway resistance syndrome (UARS) in 1. Narcolepsy was diagnosed in 2 subjects, and the diagnosis of posttraumatic hypersomnia was made in 1 subject. Three subjects had symptoms of hypersomnia before their injury (1 each with narcolepsy, OSA, UARS), and 2 of these were driving a car at the time of injury.

CONCLUSION

Treatable sleep disorders appear to be common in the sleepy TBI population, but may be largely undiagnosed and untreated.