Ma Hon-Ping, Ou Ju-Chi, Yeh Chun-Ting, Wu Dean, Tsai Shin-Han, Chiu Wen-Ta, Hu Chaur-Jong
Department of Emergency Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan.
BMJ Open. 2014 Jan 23;4(1):e004205. doi: 10.1136/bmjopen-2013-004205.
The detailed course of mental disorders at the acute and subacute stages of mild traumatic brain injury (mTBI), especially with regard to recovery from sleep disturbances, has not been well characterised. The aim of this study was to determine the course of depression, anxiety and sleep disturbance, following an mTBI.
We recruited patients with mTBI from three university hospitals in Taipei and healthy participants as control group for this study.
100 patients with mTBI (35 men) who were older than 20 years, with a Glasgow Coma Scale score of 13-15 and loss of consciousness for <30 min, completed the baseline and 6-week follow-up assessments. 137 controls (47 men) without TBI were recruited in the study. None of the participants had a history of cerebrovascular disease, mental retardation, previous TBI, epilepsy or severe systemic medical illness.
The Beck Anxiety Inventory (BAI), the Beck Depression Inventory II (BDI), the Epworth Sleepiness Scale (ESS) and the Pittsburgh Sleep Quality Index (PSQI) were assessed for the patients with mTBI at baseline and 6 weeks after mTBI and for the controls.
The ESS scores were not significantly different between the mTBI at baseline or at 6 weeks after mTBI and controls. Although the BAI, BDI and PSQI scores of the mTBI group were significantly different than those of the control group at baseline, all had improved significantly 6 weeks later. However, only the PSQI score improved to a level that was not significantly different from that of the control group.
Daytime sleepiness is not affected by mTBI. However, mTBI causes depression and anxiety and diminished sleep quality. Although all these conditions improve significantly within 6 weeks post-mTBI, only sleep quality improves to a pre-mTBI level. Thus, recovery from mTBI-induced sleep disturbance occurs more rapidly than that of mTBI-induced depression and anxiety.
轻度创伤性脑损伤（mTBI）急性和亚急性阶段精神障碍的详细病程，尤其是从睡眠障碍中恢复的情况，尚未得到充分描述。本研究的目的是确定mTBI后抑郁、焦虑和睡眠障碍的病程。
我们从台北的三家大学医院招募了mTBI患者，并招募健康参与者作为本研究的对照组。
100例年龄超过20岁、格拉斯哥昏迷量表评分为13 - 15分且意识丧失<30分钟的mTBI患者（35名男性）完成了基线和6周随访评估。本研究招募了137名无TBI的对照组（47名男性）。所有参与者均无脑血管疾病、智力发育迟缓、既往TBI、癫痫或严重全身性内科疾病史。
对mTBI患者在基线时、mTBI后6周以及对照组进行贝克焦虑量表（BAI）、贝克抑郁量表第二版（BDI）、爱泼华嗜睡量表（ESS）和匹兹堡睡眠质量指数（PSQI）评估。
mTBI患者基线时或mTBI后6周时的ESS评分与对照组无显著差异。虽然mTBI组的BAI、BDI和PSQI评分在基线时与对照组有显著差异，但6周后均有显著改善。然而，只有PSQI评分改善到与对照组无显著差异的水平。
白天嗜睡不受mTBI影响。然而，mTBI会导致抑郁、焦虑并降低睡眠质量。虽然所有这些情况在mTBI后6周内均有显著改善，但只有睡眠质量改善到mTBI前的水平。因此，mTBI引起的睡眠障碍的恢复比mTBI引起的抑郁和焦虑恢复得更快。
