The Relationship Between Sleep-Wake Cycle Disturbance and Trajectory of Cognitive Recovery During Acute Traumatic Brain Injury

J Head Trauma Rehabil. Mar-Apr 2016;31(2):108-16. doi: 10.1097/HTR.0000000000000206.


Objective: Following traumatic brain injury, both sleep dysfunction and cognitive impairment are common. Unfortunately, little is known regarding the potential associations between these 2 symptoms during acute recovery. This study sought to prospectively examine the relationship between ratings of sleep dysfunction and serial cognitive assessments among traumatic brain injury acute neurorehabilitation admissions.

Methods: Participants were consecutive admissions to a free-standing rehabilitation hospital following moderate to severe traumatic brain injury (Median Emergency Department Glasgow Coma Scale = 7). Participants were assessed for sleep-wake cycle disturbance (SWCD) and cognitive functioning at admission and with subsequent weekly examinations. Participants were grouped on the basis of presence (SWCD+) or absence (SWCD-) of sleep dysfunction for each examination; groups were equivalent on demographic and injury variables. Individual Growth Curve modeling was used to examine course of Cognitive Test for Delirium performance across examinations.

Results: Individual Growth Curve modeling revealed a significant interaction between examination number (ie, time) and SWCD group (β = -4.03, P < .001) on total Cognitive Test for Delirium score. The SWCD+ ratings on later examinations were predicted to result in lower Cognitive Test for Delirium scores and greater cognitive impairment over time.

Conclusions: This study has implications for improving neurorehabilitation treatment, as targeting sleep dysfunction for early intervention may facilitate cognitive recovery.

Publication types

  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Adult
  • Brain Injuries, Traumatic / complications*
  • Brain Injuries, Traumatic / psychology*
  • Brain Injuries, Traumatic / rehabilitation
  • Cognition Disorders / etiology*
  • Female
  • Hospitalization
  • Humans
  • Male
  • Middle Aged
  • Prospective Studies
  • Recovery of Function
  • Sleep Wake Disorders / etiology*
  • Time Factors
  • Young Adult