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Published on: June 21, 2019
Sleep Features on Continuous Electroencephalography Predict Rehabilitation Outcomes After Severe Traumatic Brain
Danielle K Sandsmark1, Monisha A Kumar, Catherine S Woodward
1Department of Neurology, University of Pennsylvania, Philadelphia (Drs Sandsmark and Kumar); Departments of Neurology, Brigham and Women's Hospital & Massachusetts General Hospital, Boston, Massachusetts (Dr Woodward); Department of Neurology, Medical University of South Carolina, Charleston (Dr Schmitt); Department of Neurology, Columbia University, New York (Dr Park); and Veterans Affairs Portland Health Care System, Department of Medicine, Division of Pulmonary and Critical Care Medicine; Department of Neurology; Department of Behavioral Neuroscience; Oregon Health & Sciences University, and Oregon Institute of Occupational Health Sciences, Portland, Oregon (Dr Lim).
Objective:
Sleep characteristics detected by electroencephalography (EEG) may be predictive of neurological recovery and rehabilitation outcomes after traumatic brain injury (TBI). We sought to determine whether sleep features were associated with greater access to rehabilitation therapies and better functional outcomes after severe TBI.
Methods:
We retrospectively reviewed records of patients admitted with severe TBI who underwent 24 or more hours of continuous EEG (cEEG) monitoring within 14 days of injury for sleep elements and ictal activity. Patient outcomes included discharge disposition and modified Rankin Scale (mRS).
Results:
A total of 64 patients underwent cEEG monitoring for a mean of 50.6 hours. Status epilepticus or electrographic seizures detected by cEEG were associated with poor outcomes (death or discharge to skilled nursing facility). Sleep characteristics were present in 19 (30%) and associated with better outcome (89% discharged to home/acute rehabilitation; P = .0002). Lack of sleep elements on cEEG correlated with a poor outcome or mRS > 4 at hospital discharge (P = .012). Of those patients who were transferred to skilled nursing/acute rehabilitation, sleep architecture on cEEG associated with a shorter inpatient hospital stay (20 days vs 27 days) and earlier participation in therapy (9.8 days vs 13.2 days postinjury). Multivariable analyses indicated that sleep features on cEEG predicted functional outcomes independent of admission Glasgow Coma Scale and ictal-interictal activity.
Conclusion:
The presence of sleep features in the acute period after TBI indicates earlier participation in rehabilitative therapies and a better functional recovery. By contrast, status epilepticus, other ictal activity, or absent sleep architecture may portend a worse prognosis. Whether sleep elements detected by EEG predict long-term prognosis remains to be determined.
