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Updated: Jan 26, 2026
Controlled Cortical Impact Model for Traumatic Brain Injury
Published on: August 5, 2014
Injury, Sleep, and Functional Outcome in Hospital Patients With Traumatic Brain Injury
Ellita T Williams1, Diana Taibi Buchanan, Daniel J Buysse
1Questions or comments about this article may be directed to Ellita T. Williams, PhD RN, at ellitaw@pitt.edu. She is a Postdoctoral Scholar, Department of Health Promotion and Development, University of Pittsburgh School of Nursing, Pittsburgh, PA. Diana Taibi Buchanan, PhD RN, is Associate Professor, Department of Biobehavioral Nursing and Health Informatics, University of Washington School of Nursing, Seattle, WA. Daniel J. Buysse, MD, is Professor of Sleep Medicine, Psychiatry, and Clinical & Translational Science, Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA. Hilaire J. Thompson, PhD RN ARNP CNRN AGACNP-BC FAAN, is Professor, Department of Biobehavioral Nursing and Health Informatics, University of Washington School of Nursing, Seattle, WA.
Problem:
Uninterrupted nighttime sleep is associated with better cognition and functional outcomes in healthy adults, but the relationship between sleep and functional outcome in individuals hospitalized with severe traumatic brain injury (TBI) remains to be clarified.
Objective:
The aims of this study were to (1) describe nighttime rest-activity variables-wake bouts (counts), total wake time (minutes), and sleep efficiency (SE) (percentage; time asleep/time in bed)-in people on a neuroscience step-down unit (NSDU) post-TBI and (2) describe the association between injury and nighttime rest-activity on post-TBI functional outcome (using Functional Independence Measure [FIM] at discharge from inpatient care).
Methods:
This study is a cross-sectional, descriptive pilot study. We recruited participants from the NSDU (n = 17 [age: mean (SD), 63.4 (17.9)]; 82% male, 94% white) who wore wrist actigraphy (source of nighttime rest-activity variables) for up to 5 nights. For injury variables, we used Glasgow Coma Scale (GCS) score and Injury Severity Score (ISS). We used Spearman ρ and regression to measure associations.
Results:
Glasgow Coma Scale mean (SD) score was 8.8 (4.9), ISS mean (SD) score was 23.6 (6.7), and FIM mean (SD) score was 48 (14.5). Averages of nighttime rest-activity variables (8 PM-7 AM) were as follows: SE, 73% (SD, 16); wake bouts, 41 counts (SD, 18); total wake time, 74 minutes (SD, 47). Correlations showed significance between FIM and GCS (P = .005) and between SE and GCS (P = .015). GCS was the only statistically significant variable associated with FIM (P = .013); we eliminated other variables from the model as nonsignificant (P > .10). Sleep efficiency and FIM association was nonsignificant (P = .40). In a separate model (ISS, GCS, and SE [dependent variable]), GCS was significant (P = .04), but ISS was not (P = .25).
Conclusion:
Patients with severe TBI on the NSDU have poor actigraphic sleep at night. GCS has a stronger association to functional outcome than nighttime rest-activity variables.
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