Sleep Disorders in Traumatic Brain Injury

Jacob F. Collen, MD; Christopher J. Lettieri, MD


May 24, 2011

In This Article

Evaluation of Sleep Disorders Following TBI

TBI clearly diminishes cognitive function. Unfortunately, few treatments for cognitive impairment have been consistently shown to be effective in patients with TBI. Cognitive impairment is also common in patients with sleep disorders. However, treatment of sleep disorders can markedly improve executive functioning. Given the high incidence of sleep complaints in patients with TBI and the potential therapeutic benefits of improved sleep, individuals sustaining head injuries should have a prompt and thorough investigation for underlying, concomitant sleep disorders.

TBI patients reporting daytime somnolence or disrupted nocturnal sleep require objective measures of sleep quality and/or sleepiness. Castriotta and coworkers[34] suggest that TBI patients should undergo polysomnography followed by MSLT. Polysomnography is accurate and reliable for the detection of underlying sleep-disordered breathing, but does not always explain daytime somnolence. Somnolent patients without SDB, or sleep apnea patients with persistent sleepiness despite adequate treatment should be evaluated with MSLT, because both post-traumatic narcolepsy and post-traumatic hypersomnia have been frequently reported, even following mTBI. In patients complaining of irregularities in their sleep-wake cycles, actigraphy and/or sleep logs can assist in identifying CRSDs.[7] The Morningness-Eveningness Questionnaire can be an effective screening tool for CRSD in this population.[19]


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