Sleep disorders in patients with traumatic brain injury: a review

Richard J. Castriotta, MD, FCCP, FAASM

Professor and Director
Division of Pulmonary, Critical Care and Sleep Medicine
University of Texas Medical School at Houston
Medical Director, Memorial Hermann Hospital Sleep Disorders Center
Houston, Texas

Traumatic brain injury (TBI) is a global problem and causes long-term disability in millions of individuals. This is a major problem for both military- and civilian-related populations. The prevalence of sleep disorders in individuals with TBI is very high, yet mostly unrecognized. Approximately 46% of all chronic TBI patients have sleep disorders, which require nocturnal polysomnography and the Multiple Sleep Latency Test for diagnosis. These disorders include sleep apnoea (23% of all TBI patients), post-traumatic hypersomnia (11%), narcolepsy (6%) and periodic limb movements (7%). Over half of all TBI patients will have insomnia complaints, most often with less severe injury and after personal assault, and half of these may be related to a circadian rhythm disorder. Hypothalamic injury with decreased levels of wake-promoting neurotransmitters such as hypocretin (orexin) and histamine may be involved in the pathophysiology of excessive sleepiness associated with TBI. These sleep disorders result in additional neurocognitive deficits and functional impairment, which might be attributed to the original brain injury itself and thus be left without specific treatment. Most standard treatment regimens of sleep disorders appear to be effective in these patients, including continuous positive airway pressure for sleep apnoea, pramipexole for periodic limb movements and cognitive behavioural therapy for insomnia. The role of wake-promoting agents and CNS stimulants for TBI-associated narcolepsy, post-traumatic hypersomnia and excessive daytime sleepiness requires further study with larger numbers of patients to determine effectiveness and benefit in this population. Future research with multiple collaborating centres should attempt to delineate the pathophysiology of TBI-associated sleep disorders, including CNS-derived hypersomnia and circadian rhythm disturbances, and determine definitive, effective treatment for associated sleep disorders.

References

Would you like to comment? , or in if you are already a member.

Excessive daytime sleepiness and narcolepsy - An approach to investigation and management

Morrison I, Riha RL.
Department of Neurology, Ninewells Hospital, Dundee DD1 9SY, United...

An Investigation into the Relationship Between Sleep-Disordered Breathing, the Metabolic Syndrome, Cardiovascular Risk Profiles,

Brady EM, Davies MJ, Hall AP, C S Talbot D, Dick JL, Khunti K.
1 Department of Diabetes...

The Impact of Sleep-Disordered Breathing on Body Mass Index (BMI): The Sleep Heart Health Study (SHHS)

Brown MA, Goodwin JL, Silva GE, Behari A, Newman AB, Punjabi NM, Resnick HE, Robbins JA, Quan...

SLEEP DISTURBANCE IN MENOPAUSE

Ameratunga D, Goldin J, Hickey M.
Registrar Obstetrics & Gynecology, The Royal Women's...

Sleep and circadian misalignment for the hospitalist: A review

Schaefer EW, Williams MV, Zee PC.
Division of Hospital Medicine, Feinberg School of...