Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI.
Department of Emergency Medicine, University of Michigan Medical School, Ann Arbor, MI.
Sleep. 2018 Oct 1;41(10). doi: 10.1093/sleep/zsy147.
While disruptions in sleep are common after mild traumatic brain injury (TBI), the longitudinal relationships between sleep problems and global functioning after injury are poorly understood. Here, we prospectively investigate risk for functional impairment during the first 6 months of TBI recovery based on sleep onset insomnia symptoms and short sleep.
Patients presenting to the Emergency Department (ED) at Johns Hopkins Hospital within 24 hours of head injury and evaluated for TBI were eligible for our study. Demographic and injury-related information were collected in the ED. Patients then completed in-person surveys and phone interviews to provide follow-up data on global functioning, sleep, and depressive symptoms at 1, 3, and 6 months post-injury. A total of 238 patients provided sufficient data for analysis, and hypotheses were tested using mixed effects modeling.
Sleep quality and global functioning improved over the 6 months of TBI recovery, but patients were at increased risk for functional impairment when sleeping poorly (odds ratio [OR] = 7.69, p < .001). Sleep onset insomnia symptoms and short sleep both independently corresponded to poor global functioning. Functional impairment was highest among those with both insomnia and short sleep (43%-79%) compared to good sleepers (15%-25%) and those with short sleep (29%-33%) or insomnia alone (33%-64%). A bidirectional relationship between sleep quality and functioning was observed.
Functionally impaired patients diagnosed predominantly with mild TBI exhibit high rates of insomnia and short sleep, which may impede TBI recovery. Monitoring sleep after head injury may identify patients with poor prognoses and allow for early intervention to improve functional outcomes.
轻度创伤性脑损伤（TBI）后睡眠中断很常见，但睡眠问题与损伤后整体功能的纵向关系仍不清楚。在此，我们前瞻性研究了睡眠潜伏期失眠症状和睡眠时间短与伤后 6 个月内功能障碍风险的关系。
我们对在头部受伤后 24 小时内到约翰霍普金斯医院急诊部就诊并接受 TBI 评估的患者进行了研究。在急诊部收集人口统计学和与损伤相关的信息。然后，患者通过面访和电话访谈完成了关于整体功能、睡眠和抑郁症状的随访数据，时间分别为伤后 1、3 和 6 个月。共有 238 名患者提供了足够的数据进行分析，使用混合效应模型检验假设。
在 TBI 恢复的 6 个月期间，睡眠质量和整体功能都有所改善，但睡眠质量差的患者功能障碍风险增加（比值比[OR] = 7.69，p <.001）。睡眠潜伏期失眠症状和睡眠时间短都与整体功能不良独立相关。与睡眠良好者（15%-25%）和睡眠时间短者（29%-33%）或失眠者（33%-64%）相比，失眠和睡眠时间短者的功能障碍发生率最高（43%-79%）。睡眠质量和功能之间存在双向关系。
功能障碍患者主要诊断为轻度 TBI，表现出高发生率的失眠和睡眠时间短，这可能会阻碍 TBI 的恢复。头部损伤后监测睡眠可能会识别预后不良的患者，并允许早期干预以改善功能预后。
