Article

Sleep-wake disturbances are among the most persistent sequelae after
traumatic brain injury (TBI) and probably arise during the hospital stay
following TBI. These disturbances are characterized by difficulties sleeping at
night and staying awake during the day. Objective. The aim of the present study
was to document rest-activity cycle consolidation in acute moderate/severe TBI
using actigraphy and to assess its association with injury severity and outcome.
Methods. In all, 16 hospitalized patients (27.1 +/- 11.3 years) with
moderate/severe TBI wore actigraphs for 10 days, starting in the intensive care
unit (ICU) when continuous sedation was discontinued and patients had reached
medical stability. Activity counts were summed for daytime (7:00-21:59 hours) and
nighttime periods (22:00-6:59 hours). The ratio of daytime period activity to
total 24-hour activity was used to quantify rest-activity cycle consolidation. An
analysis of variance was carried out to characterize the evolution of the daytime
activity ratio over the recording period. Results. Rest-activity cycle was
consolidated only 46.6% of all days; however, a significant linear trend of
improvement was observed over time. Greater TBI severity and longer ICU and
hospital lengths of stay were associated with poorer rest-activity cycle
consolidation and evolution. Patients with more rapid return to consolidated
rest-activity cycle were more likely to have cleared posttraumatic amnesia and
have lower disability at hospital discharge. Conclusions. Patients with acute
moderate/severe TBI had an altered rest-activity cycle, probably reflecting
severe fragmentation of sleep and wake episodes, which globally improved over
time. A faster return to rest-activity cycle consolidation may predict enhanced
brain recovery.
CI - (c) The Author(s) 2013.

Langue : ANGLAIS