Traumatic Brain Injuries Linked to Sleep, Fatigue Problems

A mild traumatic brain injury (mTBI) could have a reverberating impact on fatigue and sleep several months following the injury.

A team, led by Simon Berg Saksvik, Department of Psychology, Norwegian University of Science and Technology, determined the prevalence and stability of sleep-wake disturbance (SWD) and fatigue in patients suffering from mild traumatic brain injuries.

In the prospective, longitudinal study, the investigators examined 378 patients with mTBI between 16-60, as well as 82 matched trauma controls with orthopedic injuries and 83 matched community controls,

The team assessed increased sleep need, poor sleep quality, excessive daytime sleepiness, and fatigue at 2 weeks, 3 months, and 12 months following an injury and used mixed logistic regression models to evaluate clinically relevant group differences longitudinally. The prevalence of increased sleep need, poor sleep quality, and fatigue was ultimately higher in patients with mild traumatic brain injuries than in both the trauma controls and community controls at all time points measured.

The investigators also found more patients suffering from brain injuries reported problems with excessive daytime sleepiness when compared to the trauma control group. However, this group did not report more problems with excessive daytime sleepiness than the community control group at all of the measured time points.

Patients with complicated mTBI, which was categorized by intracranial findings on computed tomography or magnetic resonance imaging, had more fatigue problems compared to those with uncomplicated mild traumatic brain injuries at all 3 time points.

About half of patients with mTBI who experienced sleep-wake disturbances and fatigue 2 weeks following an injury still had problems at 3 months. Approximately 33% of this group also suffered problems at 12 months.

“Interestingly, we observed limited overlap between the different symptom measures; a large number of patients reported one specific problem with SWD or fatigue rather than several problems,” the authors wrote. “In conclusion, our results provide strong evidence that mTBI contributes significantly to the development and maintenance of SWDs and fatigue.”

Sleep-wake disturbance and fatigue are common symptoms following a mild traumatic brain injury and have been linked to a range of adverse consequences, including reduced cognitive functioning, emotional distress, and a reduced quality of life. Insomnia and hypersomnolence disorder are also common following an injury and are accompanied by daytime distress, often in the form of fatigue.

Recently, investigators found between 17-47% of all patients with a mild traumatic brain injury experience fatigue during the first 3 month post-injury and in another meta-analysis, 50% of TBI patients across all severities experienced some form of SWD after injury.

However, in past longitudinal studies with control groups. Patients with psychiatric problems have been excluded, which could have produced biases in these studies toward more homogeneous mTBI samples.

The study, “The Prevalence and Stability of Sleep-Wake Disturbance and Fatigue throughout the First Year after Mild Traumatic Brain Injury,” was published online in the Journal of Neurotrauma.