Research Reports - Rapid EEG activity during sleep dominates in mild traumatic brain injury patients with acute pain

J Neurotrauma. 2013 Apr 15;30(8):633-41

Khoury S, Chouchou F, Amzica F, Giguère JF, Denis R, Rouleau GA, Lavigne GJ

Abstract Chronic pain is a highly prevalent post-concussion symptom occurring in
a majority of patients with mild traumatic brain injury (mTBI). About half of
patients with mTBI report sleep-wake disturbances. It is known that pain can
alter sleep quality in this population, but the interaction between pain and
sleep is not fully understood. This study aimed to identify how pain affects
subjective sleep (Pittsburgh Sleep Quality Index [PSQI]), sleep architecture, and
quantitative electroencephalographic (qEEG) brain activity after mTBI.
Twenty-four mTBI patients complaining of sleep-wake disturbances, with and
without pain (8 and 16, respectively), were recruited 45 (±22.7) days post-trauma
on average. Data were compared with those of 18 healthy controls (no sleep or
pain complaints). The PSQI, sleep architecture, and qEEG activity were analyzed.
Pain was assessed using questionnaires and a 100-mm visual analogue scale.
Patients with mTBI reported three times poorer sleep quality than controls on the
PSQI. Sleep architecture significantly differed between patients with mTBI and
controls but was within normal range. Global qEEG showed lower delta (deep sleep)
and higher beta and gamma power (arousal) at certain EEG derivations in patients
with mTBI compared with controls (p<0.04). Patients with mTBI with pain, however,
showed greater increase in rapid EEG frequency bands, mostly during REM sleep,
and beta bands in non-REM sleep compared with patients with mTBI without pain and
controls (p<0.001). Pain in patients with mTBI was associated with more rapid
qEEG activity, mostly during REM sleep, suggesting that pain is associated with
poor sleep and is a critical factor in managing post-concussion symptoms.

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