Course of Fatigue and Sleep After Moderate to Severe Traumatic Brain Injury

Area of Science:

• Neuroscience
• Rehabilitation Medicine
• Psychology

Background:

• Traumatic brain injury (TBI) often leads to persistent fatigue and sleep disturbances, significantly impacting patient recovery and quality of life.
• Understanding the trajectory of these symptoms and their associated factors in the early post-injury period is crucial for effective clinical management.
• Previous research has highlighted the prevalence of fatigue and sleep issues post-TBI, but longitudinal data exploring their development and interrelations with other factors are limited.

Purpose of the Study:

• To investigate the progression of fatigue dimensions and sleep quality (both subjective and objective) over the first 18 months following moderate to severe TBI.
• To examine the associations between fatigue and sleep outcomes with processing speed, mood disturbances, and social participation restrictions.
• To provide insights into the complex interplay of factors influencing recovery trajectories after TBI.

Main Methods:

• A longitudinal, multicenter observational cohort study involving 42 participants with moderate to severe TBI.
• Data were collected at 3, 6, 12, and 18 months post-injury.
• Key measures included fatigue scales (FSS, DMFS), sleep quality (PSQI), objective sleep (actigraphy), processing speed (SDMT), mood (HADS), and participation restrictions (USER-P).

Main Results:

• Participants exhibited persistently high levels of fatigue and poor sleep quality throughout the 18-month study period, with no significant changes over time.
• Physical fatigue and total sleep time showed a decrease over the study duration.
• Increased mood problems were significantly associated with worse sleep quality, shorter total sleep time, and higher levels of both mental and physical fatigue. Restrictions in participation were linked to fatigue but not directly to sleep quality.

Conclusions:

• Moderate to severe TBI is associated with persistent high levels of fatigue and poor sleep quality in the initial 18 months post-injury.
• Mood disturbances emerged as a significant correlate of both fatigue and sleep problems.
• Clinical practice should incorporate routine assessment and treatment of fatigue and sleep issues following TBI, with a potential focus on mood interventions to improve outcomes.