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J Neurosci Nurs. 2019 Jun;51(3):134-141. doi: 10.1097/JNN.0000000000000441.
Uninterrupted nighttime sleep is associated with better cognition and functional outcomes in healthy adults, but the relationship between sleep and functional outcome in individuals hospitalized with severe traumatic brain injury (TBI) remains to be clarified.
The aims of this study were to (1) describe nighttime rest-activity variables-wake bouts (counts), total wake time (minutes), and sleep efficiency (SE) (percentage; time asleep/time in bed)-in people on a neuroscience step-down unit (NSDU) post-TBI and (2) describe the association between injury and nighttime rest-activity on post-TBI functional outcome (using Functional Independence Measure [FIM] at discharge from inpatient care).
This study is a cross-sectional, descriptive pilot study. We recruited participants from the NSDU (n = 17 [age: mean (SD), 63.4 (17.9)]; 82% male, 94% white) who wore wrist actigraphy (source of nighttime rest-activity variables) for up to 5 nights. For injury variables, we used Glasgow Coma Scale (GCS) score and Injury Severity Score (ISS). We used Spearman ρ and regression to measure associations.
Glasgow Coma Scale mean (SD) score was 8.8 (4.9), ISS mean (SD) score was 23.6 (6.7), and FIM mean (SD) score was 48 (14.5). Averages of nighttime rest-activity variables (8 PM-7 AM) were as follows: SE, 73% (SD, 16); wake bouts, 41 counts (SD, 18); total wake time, 74 minutes (SD, 47). Correlations showed significance between FIM and GCS (P = .005) and between SE and GCS (P = .015). GCS was the only statistically significant variable associated with FIM (P = .013); we eliminated other variables from the model as nonsignificant (P > .10). Sleep efficiency and FIM association was nonsignificant (P = .40). In a separate model (ISS, GCS, and SE [dependent variable]), GCS was significant (P = .04), but ISS was not (P = .25).
Patients with severe TBI on the NSDU have poor actigraphic sleep at night. GCS has a stronger association to functional outcome than nighttime rest-activity variables.
对于健康成年人，夜间不间断的睡眠与更好的认知和功能结果相关，但是睡眠与严重创伤性脑损伤（TBI）住院患者的功能结果之间的关系仍需阐明。
本研究的目的是：（1）描述 TBI 后神经科学下病房（NSDU）中人员的夜间休息-活动变量（觉醒次数、总觉醒时间和睡眠效率（SE）（百分比；入睡时间/卧床时间），（2）描述损伤与夜间休息-活动对 TBI 后功能结果（使用住院患者护理出院时的功能独立性测量[FIM]）的关联。
这是一项横断面、描述性的初步研究。我们从 NSDU 招募参与者（n = 17[年龄：平均值（标准差），63.4（17.9）]；82%为男性，94%为白人），他们佩戴腕部活动记录仪（夜间休息-活动变量的来源）最多 5 晚。对于损伤变量，我们使用格拉斯哥昏迷量表（GCS）评分和损伤严重程度评分（ISS）。我们使用 Spearman ρ 和回归来测量关联。
GCS 平均（标准差）评分为 8.8（4.9），ISS 平均（标准差）评分为 23.6（6.7），FIM 平均（标准差）评分为 48（14.5）。夜间休息-活动变量（8 PM-7 AM）的平均值如下：SE，73%（SD，16%）；觉醒次数，41 次（SD，18 次）；总觉醒时间，74 分钟（SD，47 分钟）。相关性显示 FIM 与 GCS（P =.005）和 SE 与 GCS（P =.015）之间存在显著相关性。GCS 是唯一与 FIM 有统计学显著关联的变量（P =.013）；我们将其他变量从模型中排除为不显著（P >.10）。SE 和 FIM 的关联无统计学意义（P =.40）。在另一个模型（ISS、GCS 和 SE[因变量]）中，GCS 是显著的（P =.04），但 ISS 不是（P =.25）。
在 NSDU 上的严重 TBI 患者夜间的活动记录仪睡眠质量较差。GCS 与功能结果的关联强于夜间休息-活动变量。
