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Ramezani S, Yousefzadeh-Chabok S. Identification of Imaging and Clinical Markers Predicting Chronic Sleep Disturbances After Traumatic Brain Injury in Adults. Iran J Neurosurg 2018; 4 (3) :125-138
URL: http://irjns.org/article-1-141-en.html

Background and Aim: We aimed to determine the prognostic imaging and clinical markers of chronic Post-Traumatic Sleep-Wake Disorders (PTSWDs) with a special focus on the early cognitive and executive dysfunctions following Traumatic Brain Injury (TBI). The prevalence rate of Post-Traumatic Psychiatric Disorders (PTPDs) in various sleep disorders was also investigated. 
Methods and Materials/Patients: In the present longitudinal study, 165 qualified patients with closed TBI were studied. Demographic, imaging and clinical characteristics of the subjects were recorded. The presence of acute post-traumatic cognitive deficits, anxiety, depression, and headache were measured by standard scales at discharge. Executive functioning was scored by the verbal fluency test. Several subjective questionnaires were applied to screen the chronic PTSWDs at 6 months after the onset of TBI. All variables were compared between the patients as well as those with and without PTSWDs using appropriate statistical tests. 
Results: Of 146 patients remaining in the follow-up study, 35% manifested PTSWDs, with insomnia and Excessive Daytime Sleepiness (EDS) as the most prevalent types. A poor executive functioning was observed in all PTSWDs patients, compared to those without PTSWDs, with only insomnia and hypersomnia patients demonstrating acute depression. Hypersomnia was also significantly related to bilateral brain contusion. The insomnia mostly comorbid with fatigue was predicted by mild injury, cortical lesions in the frontal lobe and acute severe headache. However, the patients who experienced the brain stem and diffusion lesions of right hemisphere were prone to EDS that was mainly accompanied by aggression. 
Conclusion: The predictive role of acute executive dysfunction has been clarified in this study. It is suggested that early neurorehabilitative interventions targeting the impaired neural circuits of executive functioning and mood processing may accelerate and facilitate the optimal neurofunctional recovery leading to minimizing the persistent sleep disturbances.