Study objectives: To test whether the sleep-wake cycle disruption in patients hospitalized with traumatic brain injury (TBI) (1) is also found in patients with traumatic injuries other than TBI (non-TBI) and (2) is associated with a weaker or abnormal circadian clock signal.
Methods: Forty-two non-mechanically ventilated and non-sedated patients hospitalized for moderate-to-severe TBI were compared to 34 non-TBI patients. They wore wrist actigraphs for 9.4 ± 4.2 days, starting 19.3 ± 12.6 days post-injury. Of these, 17 TBI and 14 non-TBI patients had their urine collected every hour for 25 hours, starting 18.3 ± 12.3 days post-injury. We calculated urinary 6-sulfatoxymelatonin concentration to obtain total 24-hour excretion, excretion onset, offset, duration, amplitude, and acrophase. Using Student's t-tests, we compared groups on actigraphy (daytime activity ratio, nighttime total sleep time, and fragmentation index) and melatonin variables. We investigated associations between melatonin and actigraphy variables using Pearson's correlations.
Results: TBI patients had poorer daytime activity ratio (TBI: 77.5 ± 9.4%; non-TBI: 84.6 ± 6.9%), shorter nighttime total sleep time (TBI: 353.5 ± 96.6 min; non-TBI: 421.2 ± 72.2 min), and higher fragmentation index (TBI: 72.2 ± 30.0; non-TBI: 53.5 ± 23.6) (all p-values < 0.01). A melatonin rhythm was present in both groups, and no group differences were found on melatonin variables. No associations were found between melatonin and actigraphy variables in TBI patients.
Conclusion: Moderate-to-severe TBI patients have more serious sleep-wake disturbances than non-TBI patients hospitalized in the same environment, suggesting that the brain injury itself alters the sleep-wake cycle. Despite their deregulated 24-hour sleep-wake cycle, TBI patients have a normal circadian clock signal.
Keywords: actigraphy; acute care; circadian rhythms; melatonin; sleep; traumatic brain injury.
© Sleep Research Society 2019. Published by Oxford University Press on behalf of the Sleep Research Society. All rights reserved. For permissions, please e-mail email@example.com.
Rest-Activity Cycle Disturbances in the Acute Phase of Moderate to Severe Traumatic Brain Injury.Neurorehabil Neural Repair. 2014 Jun;28(5):472-82. doi: 10.1177/1545968313517756. Epub 2013 Dec 30. Neurorehabil Neural Repair. 2014. PMID: 24379082
Evolution of severe sleep-wake cycle disturbances following traumatic brain injury: a case study in both acute and subacute phases post-injury.BMC Neurol. 2016 Sep 27;16(1):186. doi: 10.1186/s12883-016-0709-x. BMC Neurol. 2016. PMID: 27677675 Free PMC article.
Circadian Melatonin Rhythm Following Traumatic Brain Injury.Neurorehabil Neural Repair. 2016 Nov;30(10):972-977. doi: 10.1177/1545968316650279. Epub 2016 May 23. Neurorehabil Neural Repair. 2016. PMID: 27221043
Postoperative circadian disturbances.Dan Med Bull. 2010 Dec;57(12):B4205. Dan Med Bull. 2010. PMID: 21122464 Review.
Sleep and wake disturbances following traumatic brain injury.Pathol Biol (Paris). 2014 Oct;62(5):252-61. doi: 10.1016/j.patbio.2014.05.014. Epub 2014 Aug 7. Pathol Biol (Paris). 2014. PMID: 25110283 Review.
Cited by 1 article
Validity of actigraphy for nighttime sleep monitoring in hospitalized patients with traumatic injuries.J Clin Sleep Med. 2020 Feb 15;16(2):185-192. doi: 10.5664/jcsm.8162. Epub 2020 Jan 13. J Clin Sleep Med. 2020. PMID: 31992412