Article

Although fatigue and sleep disturbance are commonly reported
following traumatic brain injury (TBI), understanding of their nature and
treatment remains limited. OBJECTIVES: This article reviews a series of
investigations of the nature and causes of fatigue and sleep disturbance
following TBI. METHODS: A large cohort of community-based patients with TBI,
recruited from a TBI rehabilitation program, completed measures of subjective
fatigue and sleep disturbances, as well as attentional measures. A subgroup of
participants completed polysomnography and assessment of dim light melatonin
onset. RESULTS: Fatigue and sleep disturbance are common. Both are associated
with anxiety, depression, and pain. However, fatigue is also associated with
slowed information processing and the need for increased effort in performing
tasks. Sleep disturbances contribute to fatigue. Objective sleep studies show
reduced sleep efficiency, increased sleep onset latency, and increased time awake
after sleep onset. Depression and pain exacerbate but cannot entirely account for
these problems. There is increased slow-wave sleep. Individuals with TBI show
lower levels of evening melatonin production, associated with less rapid-eye
movement sleep. CONCLUSIONS: These findings suggest potential treatments
including cognitive behavior therapy supporting lifestyle modifications,
pharmacologic treatments with modafinil and melatonin, and light therapy to
enhance alertness, vigilance, and mood. Controlled trials of these interventions
are needed.

Langue : ANGLAIS