ABSTRACT
PRIMARY OBJECTIVE: To determine whether sleep disturbance in the acute post-traumatic brain injury (TBI) period predicts symptoms of depression, anxiety or apathy measured 6 and 12 months after TBI. RESEARCH DESIGN: Longitudinal, observational study. METHODS AND PROCEDURES: First time closed-head injury patients (n = 101) were recruited and evaluated within 3 months of injury and followed longitudinally, with psychiatric evaluations at 6 and 12 months post-injury. Pre- and post-injury sleep disturbances were measured via the Medical Outcome Scale (MOS) for Sleep. Subjects were also assessed for anxiety, depression, apathy, medical comorbidity and severity of TBI. MAIN OUTCOMES AND RESULTS: Sleep disturbance in the acute TBI period was associated with increased symptoms of depression, anxiety and apathy 12 months post-injury. CONCLUSIONS: Sleep disturbances experienced soon after trauma (i.e. <3 months after injury) predicted neuropsychiatric symptoms 1 year after injury, raising two important clinical questions: (1) Is sleep disturbance soon after trauma a prognostic marker of subsequent neuropsychiatric symptoms? and (2) Can early treatment of sleep disturbance during the post-TBI period reduce subsequent development of neuropsychiatric symptoms? Future studies with larger sample sizes and appropriate control groups could help to answer these questions, using evidence-based methods for evaluating and treating sleep disturbances.
Subject(s)
Brain Injuries/psychology , Head Injuries, Closed/psychology , Mental Disorders/diagnosis , Mental Disorders/etiology , Neuropsychological Tests , Sleep Wake Disorders/psychology , Anxiety/diagnosis , Anxiety/etiology , Apathy , Brain Injuries/complications , Brain Injuries/physiopathology , Comorbidity , Depression/diagnosis , Depression/etiology , Female , Glasgow Outcome Scale , Head Injuries, Closed/complications , Head Injuries, Closed/physiopathology , Humans , Longitudinal Studies , Male , Prevalence , Prognosis , Psychiatric Status Rating Scales , Severity of Illness Index , Sleep Wake Disorders/etiology , Sleep Wake Disorders/physiopathology , Time FactorsSubject(s)
Apathy , Brain Injuries/rehabilitation , Adult , Brain Injuries/physiopathology , Female , Humans , Linear Models , MaleABSTRACT
There are currently no known early neuroanatomical markers predictive of the development of major depression or depressive symptoms after mild traumatic brain injury (mTBI). The authors conducted a 1-year longitudinal pilot study to determine whether diffusion tensor imaging (DTI) measures collected within 1 month of mTBI could predict incident depression. Of the 14 subjects who met study inclusion criteria, 4 (28.6%) developed major depression over the follow-up period. Compared with the nondepressed group, those who developed depression had white-matter abnormalities in the fronto-temporal regions measured by DTI. These preliminary results highlight the need for additional studies, including studies using a larger sample and appropriate controls.
Subject(s)
Brain Injuries/complications , Brain/pathology , Depressive Disorder, Major/diagnosis , Depressive Disorder, Major/etiology , Diffusion Tensor Imaging , Adult , Anisotropy , Female , Follow-Up Studies , Glasgow Coma Scale , Humans , Image Processing, Computer-Assisted , Linear Models , Male , Middle Aged , Psychiatric Status Rating Scales , Young AdultSubject(s)
Anti-Anxiety Agents/therapeutic use , Anxiety Disorders/drug therapy , Sertraline/therapeutic use , Stroke/drug therapy , Adult , Aged , Aged, 80 and over , Anti-Anxiety Agents/adverse effects , Anxiety Disorders/complications , Female , Humans , Male , Middle Aged , Pilot Projects , Sertraline/adverse effects , Stroke/complications , Stroke/psychologyABSTRACT
Mild traumatic brain injury (mTBI) is a complex entity with no known objective diagnostic markers. To test the hypothesis that sleep disturbances in the acute mTBI period can serve as an indicator of brain injury, the authors compared sleep polysomnograms (PSG) and sleep EEG power spectra (PS) data in seven mTBI subjects with seven age- and race-matched healthy-control subjects. The two groups differed significantly on PS measures, suggesting that mTBI can result in a disruption of sleep microarchitecture and, in theory, could be of use as a marker for brain injury. These pilot findings need to be replicated on larger samples.
