Polysomnography in the evaluation of traumatic brain injury

BACKGROUND: Traumatic brain injury (TBI) is a common problem and leading causes of morbidity and mortality in the general population. Sleep disorders are a common finding after the acute and chronic phase of TBI. They result in daytime somnolence which in turn may lead to poor daytime performance, altered sleep-wake schedule, heightened anxiety, and poor individual sense of well-being, insomnia and depression. Studies underscore the importance of examining the architecture of sleep in TBI patients that can use as objective diagnostic or prognostic markers of injury. Posttraumatic hypersomnia, sleep apnea, narcolepsy, periodic limb movement disorder (PLMD), Insomnia and Parasomnia because of REM behavior disorder (RBD) are the most common sleep disorders in TBI patients. The neuropathology associated with TBI will depend on the nature and location of the underlying injury. Sleep polysomnography (PSG) analyses may provide a somewhat crude biomarker of injury as an initial step in the diagnostic work-up. If abnormalities in the PSG are observed, more detailed electroencephalographic methods, using electrodes at multiple locations (frontal, temporal, occipital) could be further used to localize the site of the most severe lesions. CONCLUSIONS: Additional research will be required to determine whether the location and severity of sleep PSG abnormalities can be used as a predictor for longer-term disability. The present study suggest that sleep measures may be a sensitive measure of brain injury after TBI and, in theory, could be used for determining the anatomy of brain injury. KEYWORDS: Traumatic brain injuries, Polysomnography, Sleep disorders