Research Reports - Traumatic brain injury and disturbed sleep and wakefulness

Neuromolecular Med. 2012 Sep;14(3):205-12

Baumann CR

Traumatic brain injury is a frequent condition worldwide, and sleep-wake
disturbances often complicate the course after the injuring event. Current
evidence suggests that the most common sleep-wake disturbances following
traumatic brain injury include excessive daytime sleepiness and posttraumatic
hypersomnia, that is, increased sleep need per 24 h. The neuromolecular basis of
posttraumatic sleep pressure enhancement is not entirely clear. First
neuropathological and clinical studies suggest that impaired hypocretin (orexin)
signalling might contribute to sleepiness, but direct or indirect traumatic
injury also to other sleep-wake modulating systems in the brainstem and the
mesencephalon is likely. Posttraumatic insomnia may be less common than
posttraumatic sleepiness, but studies on its frequency revealed conflicting
results. Furthermore, insomnia is often associated with psychiatric
comorbidities, and some patients with posttraumatic disruption of their circadian
rhythm may be misdiagnosed as insomnia patients. The pathophysiology of
posttraumatic circadian sleep disorders remains elusive; however, there is some
evidence that reduced evening melatonin production due to traumatic brain damage
may cause disruption of circadian regulation of sleep and wakefulness.

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