Research Reports - Sleep features on EEG predict rehabilitation outcomes after traumatic brain injury

J Head Trauma Rehabil. 2016 Mar-Apr;31(2):101-7. doi:
10.1097/HTR.0000000000000217.

Sandsmark DK(1), Kumar MA, Woodward CS, Schmitt SE, Park S, Lim MM.

OBJECTIVE: Sleep characteristics detected by electroencephalography (EEG) may be
predictive of neurological recovery and rehabilitation outcomes after traumatic
brain injury (TBI). We sought to determine whether sleep features were associated
with greater access to rehabilitation therapies and better functional outcomes
after severe TBI.
METHODS: We retrospectively reviewed records of patients admitted with severe TBI
who underwent 24 or more hours of continuous EEG (cEEG) monitoring within 14 days
of injury for sleep elements and ictal activity. Patient outcomes included
discharge disposition and modified Rankin Scale (mRS).
RESULTS: A total of 64 patients underwent cEEG monitoring for a mean of 50.6
hours. Status epilepticus or electrographic seizures detected by cEEG were
associated with poor outcomes (death or discharge to skilled nursing facility).
Sleep characteristics were present in 19 (30%) and associated with better outcome
(89% discharged to home/acute rehabilitation; P = .0002). Lack of sleep elements
on cEEG correlated with a poor outcome or mRS > 4 at hospital discharge (P =
.012). Of those patients who were transferred to skilled nursing/acute
rehabilitation, sleep architecture on cEEG associated with a shorter inpatient
hospital stay (20 days vs 27 days) and earlier participation in therapy (9.8 days
vs 13.2 days postinjury). Multivariable analyses indicated that sleep features on
cEEG predicted functional outcomes independent of admission Glasgow Coma Scale
and ictal-interictal activity.
CONCLUSION: The presence of sleep features in the acute period after TBI
indicates earlier participation in rehabilitative therapies and a better
functional recovery. By contrast, status epilepticus, other ictal activity, or
absent sleep architecture may portend a worse prognosis. Whether sleep elements
detected by EEG predict long-term prognosis remains to be determined.

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