Citation

Duclos C, Dumont M, Arbour C, Paquet J, Blais H, Menon DK, de Beaumont L, Bernard F, Gosselin N. Neurology 2016; 88(3): 268-275.

Affiliation

From the Center for Advanced Research in Sleep Medicine (C.D., M.D., C.A., J.P., H.B., L.D.B., N.G.) and the Traumatology Program (F.B.), Hôpital du Sacré-Coeur de Montréal; Departments of Psychiatry (C.D., M.D.), Psychology (C.A., N.G.), and Medicine (F.B.), Université de Montréal, Canada; Division of Anaesthesia (D.K.M.), University of Cambridge, UK; and Department of Psychology (L.D.B.), Université du Québec à Trois-Rivières, Canada. nadia.gosselin@umontreal.ca.

Copyright

(Copyright © 2016, Lippincott Williams and Wilkins)

DOI

10.1212/WNL.0000000000003508

PMID

28003503

Abstract

OBJECTIVE: To investigate whether the progressive recuperation of consciousness was associated with the reconsolidation of sleep and wake states in hospitalized patients with acute traumatic brain injury (TBI).

METHODS: This study comprised 30 hospitalized patients (age 29.1 ± 13.5 years) in the acute phase of moderate or severe TBI. Testing started 21.0 ± 13.7 days postinjury. Consciousness level and cognitive functioning were assessed daily with the Rancho Los Amigos scale of cognitive functioning (RLA). Sleep and wake cycle characteristics were estimated with continuous wrist actigraphy. Mixed model analyses were performed on 233 days with the RLA (fixed effect) and sleep-wake variables (random effects). Linear contrast analyses were performed in order to verify if consolidation of the sleep and wake states improved linearly with increasing RLA score.

RESULTS: Associations were found between scores on the consciousness/cognitive functioning scale and measures of sleep-wake cycle consolidation (p < 0.001), nighttime sleep duration (p = 0.018), and nighttime fragmentation index (p < 0.001). These associations showed strong linear relationships (p < 0.01 for all), revealing that consciousness and cognition improved in parallel with sleep-wake quality. Consolidated 24-hour sleep-wake cycle occurred when patients were able to give context-appropriate, goal-directed responses.

CONCLUSIONS: Our results showed that when the brain has not sufficiently recovered a certain level of consciousness, it is also unable to generate a 24-hour sleep-wake cycle and consolidated nighttime sleep. This study contributes to elucidating the pathophysiology of severe sleep-wake cycle alterations in the acute phase of moderate to severe TBI.

© 2016 American Academy of Neurology.

Language: en