Sleep, Sleep Disorders, and Mild Traumatic Brain Injury. What We Know and What We Need to Know: Findings from a National Working Group

Emerson M Wickwire; Scott G Williams; Thomas Roth; Vincent F Capaldi; Michael Jaffe; Margaret Moline; Gholam K Motamedi; Gregory W Morgan; Vincent Mysliwiec; Anne Germain; Renee M Pazdan; Reuven Ferziger; Thomas J Balkin; Margaret E MacDonald; Thomas A Macek; Michael R Yochelson; Steven M Scharf; Christopher J Lettieri

doi:10.1007/s13311-016-0429-3

Sleep, Sleep Disorders, and Mild Traumatic Brain Injury. What We Know and What We Need to Know: Findings from a National Working Group

Neurotherapeutics. 2016 Apr;13(2):403-17. doi: 10.1007/s13311-016-0429-3.

Authors

Emerson M Wickwire^{1

2}, Scott G Williams^{3

4}, Thomas Roth⁵, Vincent F Capaldi⁶, Michael Jaffe^{7

8

9}, Margaret Moline¹⁰, Gholam K Motamedi¹¹, Gregory W Morgan¹², Vincent Mysliwiec^{4

13}, Anne Germain¹⁴, Renee M Pazdan¹⁵, Reuven Ferziger¹⁶, Thomas J Balkin⁶, Margaret E MacDonald¹⁷, Thomas A Macek¹⁸, Michael R Yochelson^{19

20}, Steven M Scharf²¹, Christopher J Lettieri⁴

Affiliations

¹ Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, USA. ewickwire@medicine.umaryland.edu.
² Sleep Disorders Center, Division of Pulmonary and Critical Care, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA. ewickwire@medicine.umaryland.edu.
³ Department of Medicine, Walter Reed National Military Medical Center, Bethesda, MD, USA.
⁴ Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA.
⁵ Sleep Disorders and Research Center, Henry Ford Hospital, Detroit, MI, USA.
⁶ Department of Behavioral Biology, Walter Reed Army Institute of Research, Center for Military Psychiatry and Neuroscience Research, Silver Spring, MD, USA.
⁷ Department of Neurology, University of Florida, Gainesville, FL, USA.
⁸ Concussion and Sports Program, University of Florida Trauma, Gainesville, FL, USA.
⁹ UF Health Sleep Disorders Center, Gainesville, FL, USA.
¹⁰ Eisai, Inc., Woodcliff Lake, NJ, USA.
¹¹ Department of Neurology, Georgetown University Hospital, Washington, DC, USA.
¹² Sleep Disorders Center, National Intrepid Center of Excellence, Bethesda, MD, USA.
¹³ Department of Sleep Medicine, San Antonio Military Medical Center, San Antonio, TX, USA.
¹⁴ Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
¹⁵ U.S. Public Health Service, Fort Carson, CO, USA.
¹⁶ Merck and Co, Kenilworth, NJ, USA.
¹⁷ Defense and Veterans Brain Injury Center, (Contractor, General Dynamics Health Solutions), Evans Army Community Hospital, Fort Carson, CO, USA.
¹⁸ Department of Clinical Science, CNS, Takeda Development Center - Americas, Deerfield, IL, USA.
¹⁹ Medstar National Rehabilitation Network, Washington, DC, USA.
²⁰ Departments of Neurology and Rehabilitation Medicine, Georgetown University School of Medicine, Washington, DC, USA.
²¹ Sleep Disorders Center, Division of Pulmonary and Critical Care, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA.

Abstract

Disturbed sleep is one of the most common complaints following traumatic brain injury (TBI) and worsens morbidity and long-term sequelae. Further, sleep and TBI share neurophysiologic underpinnings with direct relevance to recovery from TBI. As such, disturbed sleep and clinical sleep disorders represent modifiable treatment targets to improve outcomes in TBI. This paper presents key findings from a national working group on sleep and TBI, with a specific focus on the testing and development of sleep-related therapeutic interventions for mild TBI (mTBI). First, mTBI and sleep physiology are briefly reviewed. Next, essential empirical and clinical questions and knowledge gaps are addressed. Finally, actionable recommendations are offered to guide active and efficient collaboration between academic, industry, and governmental stakeholders.

Keywords: Concussion; Insomnia; Sleep; Sleep apnea; Sleep disorders; Traumatic brain injury.

MeSH terms

Actigraphy
Animals
Brain Concussion / complications*
Brain Concussion / physiopathology
Brain Concussion / therapy
Clinical Trials as Topic
Humans
Polysomnography
Sleep / physiology
Sleep Wake Disorders / diagnosis
Sleep Wake Disorders / etiology*
Sleep Wake Disorders / physiopathology
Sleep Wake Disorders / therapy