Sleep Disruption After Brain Injury Is Associated With Worse Motor Outcomes and Slower Functional Recovery.
Melanie K Fleming, Tom Smejka, David Henderson Slater and 4 others
PMID 32508249WHAT IT FOUND
Inpatients with more fragmented sleep showed slower recovery of functional independence and worse motor outcomes.
Sleep quality did not improve during rehabilitation. Screening for sleep disruption may identify patients at risk of poorer recovery, though causality is not proven.
Key findings
01Higher sleep fragmentation over the rehabilitation period was associated with worse motor impairment (FMA) and mobility (RMI) at discharge, even after accounting for baseline severity.
02Sleep fragmentation accounted for 12% of the variance in the rate of functional recovery (FIM), with more fragmented sleep linked to slower recovery.
03There was no significant improvement in objective or subjective sleep quality measures over the course of inpatient rehabilitation.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTs
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What it does not show
The study is observational, so it cannot prove that poor sleep causes worse outcomes; it only shows an association. Functional Independence Measure was only recorded at admission and discharge, so it was not possible to determine if patients had reached a recovery plateau. The sample size was relatively small (59 patients), and the study excluded those with pre-existing sleep disorders or those unable to consent, which may limit generalizability to more complex populations. Brain imaging data was not available to assess whether lesion location or extent influenced sleep disturbance.
Declared interests
The authors declared no potential conflicts of interest. The study was funded by the Wellcome Trust and supported by the National Institute for Health Research (NIHR) Oxford Biomedical Research Centre.
The easy way to misread this
Do not assume that improving sleep will automatically improve rehabilitation outcomes. This study shows an association between sleep fragmentation and slower recovery, but it did not test an intervention to improve sleep. The relationship is not proven to be causal.