Research Reports - Recovery from sleep disturbance precedes that of depression and anxiety following mild traumatic brain injury
BMJ Open. 2014 Jan 23;4(1)
Ma HP, Ou JC, Yeh CT, Wu D, Tsai SH, Chiu WT, Hu CJ
OBJECTIVES: The detailed course of mental disorders at the acute and subacute
stages of mild traumatic brain injury (mTBI), especially with regard to recovery
from sleep disturbances, has not been well characterised. The aim of this study
was to determine the course of depression, anxiety and sleep disturbance,
following an mTBI.
SETTING: We recruited patients with mTBI from three university hospitals in
Taipei and healthy participants as control group for this study.
PARTICIPANTS: 100 patients with mTBI (35 men) who were older than 20 years, with
a Glasgow Coma Scale score of 13-15 and loss of consciousness for <30 min,
completed the baseline and 6-week follow-up assessments. 137 controls (47 men)
without TBI were recruited in the study. None of the participants had a history
of cerebrovascular disease, mental retardation, previous TBI, epilepsy or severe
systemic medical illness.
PRIMARY OUTCOME MEASURES: The Beck Anxiety Inventory (BAI), the Beck Depression
Inventory II (BDI), the Epworth Sleepiness Scale (ESS) and the Pittsburgh Sleep
Quality Index (PSQI) were assessed for the patients with mTBI at baseline and 6
weeks after mTBI and for the controls.
RESULTS: The ESS scores were not significantly different between the mTBI at
baseline or at 6 weeks after mTBI and controls. Although the BAI, BDI and PSQI
scores of the mTBI group were significantly different than those of the control
group at baseline, all had improved significantly 6 weeks later. However, only
the PSQI score improved to a level that was not significantly different from that
of the control group.
CONCLUSIONS: Daytime sleepiness is not affected by mTBI. However, mTBI causes
depression and anxiety and diminished sleep quality. Although all these
conditions improve significantly within 6 weeks post-mTBI, only sleep quality
improves to a pre-mTBI level. Thus, recovery from mTBI-induced sleep disturbance
occurs more rapidly than that of mTBI-induced depression and anxiety.