RUBRIC (Research Unit on Brain Injury Rehabilitation), Department of Neurorehabilitation, Traumatic Brain Injury, Rigshospitalet, Copenhagen University Hospital, Kettegaard Allé 30, DK-2650 Hvidovre, Denmark; Research Unit for Nursing and Health Care, Health, Aarhus University, Denmark.
Department of Neurosurgery, Department of Anesthesiology and Intensive Care, North Section, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, DK-8200 Aarhus N, Denmark.
Aust Crit Care. 2021 Jan;34(1):76-82. doi: 10.1016/j.aucc.2020.05.006. Epub 2020 Jul 19.
Sleep disturbance and agitation are frequent conditions during the subacute period of recovery in moderate to severe traumatic brain injury (TBI). Clarity is needed regarding the association between the two conditions to improve fundamental nursing care.
The aim of our scoping review was to identify the evidence for potential associations between sleep disturbance and agitation during subacute inpatient rehabilitation of adult patients with moderate to severe TBI.
We conducted a five-step scoping review.
Sources of evidence were PubMed, CINAHL, PsycINFO, Cochrane, and Web of Science databases. Eligibility criteria were as follows: English or Scandinavian language articles describing sleep and/or agitation during inpatient rehabilitation of adult patients with moderate to severe TBI and published in the period 2000-2019.
We identified 152 articles of which we included six. The included articles were all affiliated with the USA using quantitative methodology. The association between sleep disturbance and agitation is highly complex, with disturbed sleep affecting cognitive and emotional functions. Sleep disturbance was associated with posttraumatic amnesia (PTA)/posttraumatic confusional state, cognitive function, and agitation. Our review suggested a bidirectional association between these symptoms during early TBI rehabilitation. We inferred that improved sleep might be a contributing factor to the resolution of PTA, cognitive impairment, and agitation.
The association between sleep disturbance and agitation is still undetermined, but we assume that improved sleep may protect against neuropsychiatric problems in patients with moderate to severe TBI. Larger controlled interventional studies are needed to provide the evidence of modifiable factors for improving sleep during inpatient TBI rehabilitation. Owing to the current lack of publications, it is probably too early to perform a systematic review on the topic.
We recommend systematic implementation of sleep hygiene during inpatient rehabilitation of patients with TBI to reduce PTA, agitation, and long-term neuropsychiatric problems.
在中重度创伤性脑损伤（TBI）的亚急性期康复过程中，睡眠障碍和激越常常同时发生。为了改善基本的护理，需要明确这两种情况之间的关联。
我们的范围综述旨在确定中度至重度 TBI 成年患者亚急性住院康复期间睡眠障碍与激越之间潜在关联的证据。
我们进行了一个五步范围综述。
证据来源是 PubMed、CINAHL、PsycINFO、Cochrane 和 Web of Science 数据库。纳入标准如下：描述中度至重度 TBI 成年患者住院康复期间睡眠和/或激越的英文或斯堪的纳维亚语文章，发表于 2000-2019 年期间。
我们确定了 152 篇文章，其中纳入了 6 篇。纳入的文章均来自美国，使用定量方法。睡眠障碍和激越之间的关联非常复杂，睡眠障碍会影响认知和情绪功能。睡眠障碍与创伤后遗忘症（PTA）/创伤后意识模糊状态、认知功能和激越有关。我们的综述表明，这些症状在早期 TBI 康复期间存在双向关联。我们推断，改善睡眠可能是解决 PTA、认知障碍和激越的一个促成因素。
睡眠障碍和激越之间的关联仍不确定，但我们假设改善睡眠可能有助于预防中重度 TBI 患者的神经精神问题。需要更大规模的对照干预研究来提供改善住院 TBI 康复期间睡眠的可调节因素的证据。由于目前缺乏出版物，因此对该主题进行系统综述可能还为时过早。
我们建议在 TBI 患者的住院康复期间系统实施睡眠卫生，以减少 PTA、激越和长期神经精神问题。
