Sleep Disorders and Traumatic Brain Injuries
Researchers Say Treatment May Not Relieve Symptoms
Apr 24, 2009
A new study published in the April 15 issue of the Journal of Clinical Sleep Medicine takes a look at the potential benefits of treating a sleep disorder when a brain injury is involved. Dr. Castriotta, study leader at the University of Texas Health Science Center, and colleagues collected data on 57 adults with a traumatic brain injury. The participants averaged 39 years of age and had each suffered a traumatic brain injury at least three months earlier. Seventy-seven percent of the injuries were a result of a motor-vehicle accident, assault, a fall or being hit by a falling object.
Examining the Effects of Treating Sleep Disorders Resulting from Head Injury
The participants were evaluated during an overnight study to detect the presence of sleep disorders, and both objective and subjective tests were used to measure daytime sleepiness, mood, quality of life and cognitive performance.
Subjects who were diagnosed with obstructive sleep apnea (OSA) received individualized treatment with continuous positive airway pressure (CPAP) therapy, while those suffering from narcolepsy and post-traumatic hypersomnia received predetermined dosages of medications that were not adjusted after assessment.
Results of Sleep Study
Thirty-five of the subjects (61%) were free of a sleep disorder, while 13 patients (23%) had obstructive sleep apnea, four (7%) had periodic limb movements in sleep, three (5%) had narcolepsy and two (3%) had post-traumatic hypersomnia.
The brain-injured patients suffering from OSA underwent three months of treatment with continuous positive airway pressure (CPAP) therapy, which dramatically reduced the severity of OSA from 31.4 to 3.8 apneas and hypopneas per hour of sleep. However, there was no demonstrable improvement in measures of daytime sleepiness or neuropsychological function after treatment for a sleep disorder.
After three months, polysomnographic abnormalities were resolved in all patients with obstructive sleep apnea and periodic leg movements, and excessive or prolonged sleepiness was improved in two of the five patients suffering from post-traumatic hypersomnia and narcolepsy.
Further Continued Studies of Brain-injured Patients
According to Dr. Castriotta, the researchers were not surprised by the fact that patients with sleep disorders had more severe injuries, but the lack of improvement in excessive sleepiness and neuropsychological testing after treatment was unexpected. He also stated that the study illustrates how difficult it can be to measure the burden of sleep disorders in people with traumatic brain injuries.
The research team went on to characterize the study as a first attempt at evaluating sleep disorder treatments in brain-injured patients. They recommended that additional studies be conducted, using different methodologies.
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