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Sleep Medicine pp 319-330 | Cite as

Sleep Disorders after Traumatic Brain Injury: Milestones in Perspective

  • Richard J. CastriottaEmail author
  • Mark C. Wilde

Abstract

This is a chronological review of our emerging knowledge about sleep/wake disorders associated with traumatic brain injury (TBI). The association of sleep/wake problems and TBI has been noted since the days of Hippocrates and Galen. During and after the First World War, there ensued a flurry of published reports concerning TBI and sleep disorders. As physicians and scientists learned about narcolepsy and cataplexy, there was an interest in “posttraumatic narcolepsy.” Then, as the new field of sleep medicine developed with electroencephalography and polysomnography, attention began to be directed to multiple types of sleep/wake disorders, which were either a consequence of TBI or a cause of it because of preexisting sleepiness. We now know that half of all TBI patients suffer from sleep/wake problems, which include insomnia, circadian rhythm disorders, obstructive sleep apnea, posttraumatic hypersomnia, narcolepsy, and recurrent hypersomnia. Some of these (e.g., sleep apnea) may be associated with neurocognitive defects more than what is seen with TBI alone. Modern objective diagnostic techniques (polysomnography, multiple sleep latency tests, actigraphy, etc.) are necessary to make a correct diagnosis, since there is poor correlation between objective and subjective methodologies in this patient population. Approximately 25 % of TBI patients have objectively defined excessive daytime sleepiness due to obstructive sleep apnea, posttraumatic hypersomnia, or narcolepsy. Insomnia is a common problem, especially in mild TBI, and some of these may be due to TBI-associated circadian rhythm disorders.

Keywords

Traumatic brain injury Sleep disorders Narcolepsy Hypersomnia Insomnia Sleep-disordered breathing Sleep apnea Circadian rhythm disorders Recurrent hypersomnia Head injury 

Abbreviations

CPAP

Continuous positive airway pressure

CSF

Cerebrospinal fluid

CT

Computerized tomography

DLMO

Dim-light melatonin onset

DSPS

Delayed sleep phase syndrome

EDS

Excessive daytime sleepiness

ESS

Epworth sleepiness scale

GCS

Glasgow coma scale

ICSD 1

International classification of sleep disorders, 1st edition

ICSD 2

International classification of sleep disorders, 2nd edition

MEQ

Morningness eveningness questionnaire

MSLT

Multiple sleep latency test

NPSG

Nocturnal polysomnography

OSA

Obstructive sleep apnea

PLMS

Periodic limb movements in sleep

PSQI

Pittsburgh sleep quality Index

PTH

Posttraumatic hypersomnia

PTSD

Posttraumatic stress disorder

RBD

REM sleep behavior disorder

SOREMP

Sleep-onset REM (rapid eye movement) sleep period

TBI

Traumatic brain injury

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© Springer Science+Business Media, LLC 2015

Authors and Affiliations

  1. 1.Division of Pulmonary and Sleep MedicineUniversity of Texas Medical School at HoustonHoustonUSA
  2. 2.Sleep Disorders CenterMemorial Hermann Hospital—Texas Medical CenterHoustonUSA
  3. 3.Department of Physical Medicine and RehabilitationUniversity of Texas Medical School at HoustonHoustonUSA

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