The impact of poor sleep on cognition and activities of daily living after traumatic brain injury : a review

Abstract

Background/aim : Patients frequently report sleep disrup-tions or insomnia during their hospital stay, particularlyafter a traumatic brain injury (TBI). The consequences ofthese sleep disturbances on everyday activities are not welldocumented and are therefore not considered in the evalu-ation of independence in activities of daily living (ADLs).The goal of this narrative review is to explore the conse-quences of poor sleep quality on cognition and ADLs inthe acute and subacute stages of a moderate and severeTBI, when patients are in acute care or inpatient rehabili-tation.Methods:We will present an overview of normal sleepand its role in cognitive functioning, and then present thefindings of studies that have investigated sleep characteris-tics in hospital settings and the consequences of sleep dis-turbances on ADLs.Results:During hospitalisation, TBI patients presentsevere sleep disturbances such as insomnia and sleepfragmentation, which are probably influenced by both themedical condition and the hospital or rehabilitation environ-ment. Sleep disruption is associated with several cognitivedeficits, including attention, memory and executive func-tion impairments. Poor quality and/or insufficient quantityof sleep in acute TBI probably affect general functioningand ADLs calling for these cognitive functions.Conclusions and Significance:The cognitive impair-ments present following TBI are probably exacerbated bypoor sleep quality and sleep deprivation during hospitali-sation, which in turn impact ADLs among this popula-tion. Health-care personnel should further consider sleepdisturbances among people with TBI and a sleep protocolshould be established.