Chan Lai Gwen, Feinstein Anthony
Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada (Dr Chan), and, Department of Psychological Medicine, Tan Tock Seng Hospital, Jalan Tan Tock Seng, Singapore (Dr Chan); and Department of Psychiatry, University of Toronto and Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada (Dr Feinstein).
J Head Trauma Rehabil. 2015 Nov-Dec;30(6):E67-75. doi: 10.1097/HTR.0000000000000119.
To investigate the effect of sleep disturbances on functional and social outcomes after mild traumatic brain injury.
Outpatient traumatic brain injury clinic in a tertiary trauma center.
A total of 374 mild traumatic brain injury patients were assessed within 3 months of injury and followed up every 3 months for 1 year.
Analysis of a historical cohort in a naturalistic clinical setting.
At each visit, symptoms of concussion and psychological distress and indices of functional and social outcomes were measured with the Rivermead Postconcussion Questionnaire, 28-item General Health Questionnaire, and Rivermead Head Injury Follow-up Questionnaire, respectively. Changes in outcome scores over time were explored using repeated measures analysis of variance and compared between subjects with persistent (SD) and recovered (SR) sleep disturbances. Predictors of functional/social outcome were determined using linear regression.
The percentages of subjects reporting sleep disturbances at each time point were 71.9%, 57.2%, 55.1%, and 53.7%, respectively. For functional and social outcomes, significant effects of time (F3,315 = 9.54; P < .001), group (SD vs SR) F1,317 = 5.32; P = .022, and time X group interaction F3,315 = 4.14; P = .007 were found. Persistent sleep disturbance (P = 0.011) and higher symptom burden at 6 months postinjury (P < .0001) were independent predictors of poorer outcome.
Sleep disturbance, independent of psychological distress, is an important prognostic factor of functional and social outcomes after mild traumatic brain injury.
探讨睡眠障碍对轻度创伤性脑损伤后功能和社会结局的影响。
三级创伤中心的门诊创伤性脑损伤诊所。
共有374例轻度创伤性脑损伤患者在受伤后3个月内接受评估，并每3个月随访1年。
在自然临床环境中对历史队列进行分析。
每次就诊时，分别使用Rivermead脑震荡后问卷、28项一般健康问卷和Rivermead头部损伤随访问卷测量脑震荡症状、心理困扰以及功能和社会结局指标。使用重复测量方差分析探讨结局分数随时间的变化，并在持续睡眠障碍（SD）和恢复睡眠障碍（SR）的受试者之间进行比较。使用线性回归确定功能/社会结局的预测因素。
在每个时间点报告睡眠障碍的受试者百分比分别为71.9%、57.2%、55.1%和53.7%。对于功能和社会结局，发现时间（F3,315 = 9.54；P <.001）、组（SD与SR）（F1,317 = 5.32；P = .022）以及时间×组交互作用（F3,315 = 4.14；P = .007）有显著影响。持续睡眠障碍（P = 0.011）和受伤后6个月时较高的症状负担（P <.0001）是结局较差的独立预测因素。
睡眠障碍独立于心理困扰，是轻度创伤性脑损伤后功能和社会结局的重要预后因素。
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