Sleep-wake disorders persist 18 months after traumatic brain injury but remain underrecognized

OBJECTIVE This study is a prospective, controlled clinical and electrophysiologic trial examining the chronic course of posttraumatic sleep-wake disturbances (SWD). METHODS We screened 140 patients with acute, first-ever traumatic brain injury of any severity and included 60 patients for prospective follow-up examinations. Patients with prior brain trauma, other neurologic or systemic disease, drug abuse, or psychiatric comorbidities were excluded. Eighteen months after trauma, we performed detailed sleep assessment in 31 participants. As a control group, we enrolled healthy individuals without prior brain trauma matched for age, sex, and sleep satiation. RESULTS In the chronic state after traumatic brain injury, sleep need per 24 hours was persistently increased in trauma patients (8.1 ± 0.5 hours) as compared to healthy controls (7.1 ± 0.7 hours). The prevalence of chronic objective excessive daytime sleepiness was 67% in patients with brain trauma compared to 19% in controls. Patients significantly underestimated excessive daytime sleepiness and sleep need, emphasizing the unreliability of self-assessments on SWD in trauma patients. CONCLUSIONS This study provides prospective, controlled, and objective evidence for chronic persistence of posttraumatic SWD, which remain underestimated by patients. These results have clinical and medicolegal implications given that SWD can exacerbate other outcomes of traumatic brain injury, impair quality of life, and are associated with public safety hazards.

United States-Latin American relations: some observations on the operation of the Alliance for Progress, the first six months.

At head of title: 87th Cong., 2d sess. Committee print.

Cruising among the Caribbees, summer days in winter months,

Mode of access: Internet.

Fresh fruit and vegetable unloads in western cities by commodities, states and months /

Mode of access: Internet.

Fresh fruit and vegetable unloads in southern cities by commodities, states, and months /

Mode of access: Internet.

The peak of the load; the waiting months on the hilltop from the entrance of the Stars and Stripes to the second victory of the Marne.

Mode of access: Internet.

The last months of Chaucer's earliest patron,

Chaucer served as page to Lionel, Duke of Clarence, third son of Edward III. of England.

Fatal accident reporting system. Report for the first nine months of 1976.

Mode of access: Internet.

Transportation safety information report. First 6 months, 1987.

Transportation Department, Washington, D.C.

Report of the National Advisory Council on International Monetary and Financial Problems. : Message from the President of the United States, transmitting report of the National Advisory Council on International Monetary and Financial Problems for the period of the last 6 months.

Caption title.

Hubble Space Telescope : update : 18 months in orbit.

Cover title.

Oregon's bottle bill: The first six months.

Cover title.

Haymaking: church and houses with harvesters in the foreground, The Months of June and July

Pieter Bruegel the Elder; oil on wood

Gloomy Day, Months of February and March

Pieter Bruegel the Elder; 3 ft. 10 29/64 in. x 5 ft. 4 11/64 in.; oil on wood

Twelve months work in the poultry yard, a short, boiled-down and up-to-date treatise on practical poultry keeping for busy people.

Mode of access: Internet.