Subjective and objective measures of insomnia in the context of traumatic brain injury: A preliminary study

Background and purpose: To compare subjective and objective measures of sleep in traumatic brain injury patients (TBI) suffering from insomnia and in controls. Patients and methods: Fourteen patients with mild to severe TBI were compared to 14 healthy good sleepers. Subjective measures of insomnia were obtained from a sleep diary (morning questionnaire), and objective measures from two nights of polysomnography (PSG). Results: All subjective measures of sleep revealed significant sleep disturbance in the TBI group. TBI patients with insomnia have a tendency to overestimate their sleep disturbance compared to PSG measures of sleep. With PSG, 10 out of 14 participants with TBI could be defined as having objective insomnia. Nonetheless, when groups were compared, no significant differences were found on sleep continuity variables, although large effect sizes were seen for several measures suggesting sleep fragmentation. In terms of sleep architecture, no significant differences were found in the percentage of stage 2, slow-wave (stages 3 and 4), and rapid eye movement (REM) sleep, but a higher proportion of stage I sleep was found in the TBI participants. When patients using psychotropic medication were excluded, TBI patients were found to have more awakenings lasting longer than 5 min and a shorter REM sleep latency. Conclusions: These results are similar to those found in patients with either primary insomnia or insomnia related to depression. (C) 2006 Elsevier B.V. All rights reserved.