Rehabilitation is compromised by arousal and sleep disorders: Results of a survey of rehabilitation centres

Primary objective: To investigate the impact of disorders of arousal and sleep disturbance on everyday living and participation in rehabilitation. Research design: Survey of rehabilitation centres based on naturalistic observation. Method: One hundred and thirty-five adults with acquired brain injury were reported by rehabilitation staff in seven centres across the UK for presence of arousal and/or sleep disturbance, the impact on rehabilitation and daily living and treatment strategies in use. Outcomes: Disturbance of arousal or sleep patterns was reported in 47% of the sample, with significant adverse effect on activity evident in two-thirds of such cases. Prevalence of disordered arousal was consistent over time for up to 10 years post-injury. Concurrent psychiatric illness, but not epilepsy, was associated with arousal and sleep disorder. Non-pharmacological interventions and benzodiazepine/hypnotic drugs were in use in 34% and 20% of cases respectively. In all cases of prescribed hypnotic drugs, period of use exceeded recommended UK guidelines. Conclusions: Long-term outcome from severe brain injury can be compromised by enduring disturbance of arousal, most commonly evidenced as sleep disorder. Treatment should be based on judicious use of medication ( beyond hypnotic drugs) and greater emphasis on non-pharmacological management.