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Sleep Disorders after Traumatic Brain Injury: Milestones in Perspective

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Sleep Medicine

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.

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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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Authors and Affiliations

  1. Division of Pulmonary and Sleep Medicine, University of Texas Medical School at Houston, 6431 Fannin St., MSB 1.274, 77030, Houston, TX, USA

    Richard J. Castriotta MD

  2. Sleep Disorders Center, Memorial Hermann Hospital—Texas Medical Center, Houston, TX, USA

    Richard J. Castriotta MD

  3. Department of Physical Medicine and Rehabilitation, University of Texas Medical School at Houston, Houston, TX, USA

    Mark C. Wilde PsyD

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Correspondence to Richard J. Castriotta MD .

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Editors and Affiliations

  1. Department of Neurology, New Jersey Neuroscience Institute JFK Medical Center, Edison, New Jersey, USA

    Sudhansu Chokroverty

  2. Department of Neurology, Gui de Chauliac Hospital, Montpellier, France

    Michel Billiard

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Castriotta, R., Wilde, M. (2015). Sleep Disorders after Traumatic Brain Injury: Milestones in Perspective. In: Chokroverty, S., Billiard, M. (eds) Sleep Medicine. Springer, New York, NY. https://doi.org/10.1007/978-1-4939-2089-1_36

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