Association of sleep with neurobehavioral impairments during inpatient rehabilitation after traumatic brain injury

Background: Sleep disturbance is a common sequela after traumatic brain injury (TBI). Many of the impairments following TBI may be exacerbated by impaired sleep-wake cycle regulation. Objectives: To investigate the relationship between total sleep time (TST), measured by wrist actigraphy and observational sleep logs, and neurobehavioral impairments during inpatient rehabilitation after TBI. Methods: Twenty-five subjects undergoing inpatient rehabilitation for traumatic brain injury were included. TST was measured using wrist actigraphy and observational sleep logs. Neurobehavioral impairments were assessed using the Neurobehavioral Rating Scale-Revised (NRS-R), a multidimensional clinician-based assessment. Results: Of 25 subjects enrolled, 23 subjects completed the study. A significant negative correlation was found between total NRS-R and TST calculated by observational sleep logs (r = -0.28, p = 0.007). The association between total NRS-R and TST, as calculated by actigraphy, was not significantly correlated (R = -0.01, p = 0.921). Conclusions: Sleep disturbance during inpatient rehabilitation is associated with neurobehavioral impairments after TBI. TST measured by actigraphy may be limited by sleep detection algorithms that have not been validated in certain patient populations. Considerations should be made regarding the feasibility of using wearable sensors in patients with cognitive and behavioral impairments. Challenges regarding actigraphy for sleep monitoring in the brain injury population are discussed.