Research Reports - The relationship between sleep-wake cycle disturbance and trajectory of cognitive recovery during traumatic brain injury

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

Holcomb EM(1), Towns S, Kamper JE, Barnett SD, Sherer M, Evans C,
Nakase-Richardson R.

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. 

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