Sleep Disorders in Traumatic Brain Injury

Jacob F. Collen, MD; Christopher J. Lettieri, MD

Traumatic Brain Injury and Sleep Disorders

Sleep disturbances occur with increased frequency in patients with traumatic brain injury (TBI) compared with the general population. These encompass sleep apnea syndromes, post-traumatic hypersomnia, insomnia, and related conditions. Poor sleep can have adverse impacts on cognition, attention, and judgment. In those with TBI, disrupted sleep has been shown to impair rehabilitation efforts and progression, and is associated with diminished quality of life measures. The current military conflicts in the Middle East have focused renewed attention on this topic, because many military veterans are affected by TBI. Given the youth of this demographic, management of TBI will be an ongoing challenge for the healthcare community for years to come.

Epidemiology of TBI and Sleep Disorders

The societal burden of TBI is tremendous. In the United States, the estimated yearly rate is 1.4 million persons per year,^[1] or 400-460 per 100,000 people sustaining TBI (all severities) each year. With respect to moderate-to-severe TBI, approximately 40 new cases per 100,000 people occur each year in the United States.^[2] The long-term morbidity is also staggering, with 3.3 million people in the United States living with long-term neurologic disability from their injuries.^[3]

Common mechanisms of TBI include motor vehicle accidents, falls, personal/domestic assaults, sports injuries,^[2] and, among military personnel, combat injuries and blast injuries from explosive devices.Men between the ages of 15 and 35 years old are most frequently affected, and TBI is the most common cause of death in people between 1 and 15 years old.^[4] TBI can have lasting consequences on cognition, functional capacity, ability to work, and quality of life.^[2] Complex interactions between the injury itself and comorbid conditions, polypharmacy and medication side effects, chronic pain, anxiety, depression, and sleep-wake disturbances further complicate evaluation, treatment and recovery/rehabilitation of patients who have experienced TBI.