Disorders of Sleep and Wakefulness among Persons with Traumatic Brain Injury: Prevalence and Impact

Disturbed sleep is a common complaint of persons with head trauma. While the disruption subsides relatively quickly for some, up to half of persons with traumatic brain injury (TBI) report chronic sleep disturbances, which can lead to serious impairments of daytime functioning, impede the rehabilitation process and the return to productive life. Ongoing sleep problems can also contribute to the development of new or exacerbation of pre-morbid medical and psychiatric disorders, constituting additional burden to the already compromised brain and bodily functions of the impacted individual. The scope and systematic reviews comprising this thesis aimed to summarize the current state of knowledge concerning disorders of sleep and wakefulness in the TBI population. The original research described in this thesis is cross-sectional in design and aimed to investigate the relevance of sleep dysfunction to TBI outcomes in Ontario workers with delayed recovery from mild TBI (mTBI). Based on the findings of the reviews, it is apparent early detection of sleep problems in persons with TBI by screening can potentially improve the health outcomes of those affected, and this approach may turn out to be economically beneficial. In a review of fatigue after TBI, fluctuations in frequency were observed over time and several potential risk factors were described. The consequences of posttraumatic fatigue were not entirely clear, however, a relationship between fluctuations in sleep quality and fluctuations in fatigue frequency was reported. The findings of the original research carried out show outcomes in workers with mTBI may differ based on the presence of absence of insomnia, head and/or neck pain, and marital status. Furthermore, insomnia was found to be highly prevalent in the studied population and factors associated with insomnia are clinical and non-clinical. The thesis emphasizes conceptual frameworks of community integration and sleep dysfunction in TBI, which provides a context for examining a problem, serves in developing future hypotheses, and constitutes a base for observations, research design, and interpretations. Most importantly, it serves as a guide for the systematic study of a precisely defined relationship between variables. The thesis concludes with a summary of the practical implications of the research findings.Ph.D