Sleep disorders associated with traumatic brain injury

Objectives: To investigate the frequency of sleep disorders in traumatic brain injury (TBI) patients with hypersomnia and to discern the relationship between posttraumatic sleep disorders and pretraumatic sleep symptoms. Design: Prospective cohort study using the criterion standard to diagnose sleep disorders in a consecutive sample of TBI patients. Setting: Academic medical center with level I trauma center, rehabilitative medicine services, and accredited sleep disorders center. Patients: Ten TBI patients with subjective excessive sleepiness. Intervention: Nocturnal polysomnography followed by Multiple Sleep Latency Test. Subjects who had overt sleep apnea on the first nocturnal polysomnography had a second nocturnal polysomnography with titration of nasal continuous positive airway pressure. Main Outcome Measures: Diagnosis of sleep-disordered breathing, narcolepsy, and posttraumatic hypersomnia. Results: A diagnosis of treatable sleep disorder was made in all 10 subjects. Sleep-disordered breathing was found in 7 subjects: overt obstructive sleep apnea (OSA) was diagnosed in 5 subjects, rapid eye movement-related OSA in 1, and upper airway resistance syndrome (UARS) in 1. Narcolepsy was diagnosed in 2 subjects, and the diagnosis of posttraumatic hypersomnia was made in 1 subject. Three subjects had symptoms of hypersomnia before their injury (1 each with narcolepsy, OSA, UARS), and 2 of these were driving a car at the time of injury. Conclusion: Treatable sleep disorders appear to be common in the sleepy TBI population, but may be largely undiagnosed and untreated.