Injury, Sleep, and Functional Outcome in Hospital Patients With Traumatic Brain Injury.
Ellita T Williams, Diana Taibi Buchanan, Daniel J Buysse and 1 others
PMID 30964844WHAT IT FOUND
Hospitalized patients with moderate or severe traumatic brain injury woke 41 times a night and were asleep for 73% of time in bed.
Sleep did not track discharge disability; injury severity did.
Key findings
01Average nighttime sleep was fragmented: participants woke 41 times, were awake for 1 hour and 14 minutes, and had sleep efficiency of 73%.
02Glasgow Coma Scale score on emergency admission was associated with discharge Functional Independence Measure score (p = 0.005).
03In the regression model with injury and sleep variables, Glasgow Coma Scale score was the only variable associated with functional outcome (p = 0.05); wake bouts, total wake time, and sleep efficiency were not significant.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The study included only 17 patients, so it cannot show what will happen in larger or different TBI populations. Patients needed a Rancho Los Amigos score of 5 or higher, so people with less purposeful movement or more severe impairment were not included. Functional outcome was measured only at discharge from the neuroscience step-down unit, not after rehabilitation or at home. Actigraphy was scored with algorithms developed for healthy people, and patients with severe brain injury may not produce the same movement patterns. Daytime naps were not measured, so total sleep during the hospital day is unknown. The sample was convenience recruited from one trauma center, and 13 of 17 participants needed a legally authorized representative to consent.
Declared interests
The authors declared no conflicts of interest. The paper does not state who funded the study.
The easy way to misread this
Do not conclude that poor sleep caused worse discharge disability. The study measured sleep and disability at one time point, and sleep variables were not associated with functional outcome in the regression model.