An Investigation of Sleep and Neuropsychiatric Measures in Brain Injury Rehabilitation

Abstract

Background and aims This study aimed to investigate sleep, depression, anxiety and general function in daily life in individuals with ABI during and after hospital admission for rehabilitation. We hypothesized that participants would have a poorer quality of sleep when in the hospital. In addition, we hypothesized that poor sleep in the hospital would be associated with increased neuropsychiatric symptoms. Methods This study involved the collection of data at two timepoints. T1 = during in-patient rehabilitation and T2 = after discharge from the rehabilitation unit. Neuropsychiatric symptoms were assessed using the Beck Anxiety and Depression Inventories, Patient Health Questionnaire-9 and Montgomery-Asberg Depression Rating Scale. General functional ability was determined using the Global Assessment of Functioning scale. Sleep quality was assessed using the Consensus Sleep Diary and a section on the 9-item questionnaire specifically developed for this study. The influence of age, sex, napping habits, caffeine consumption habits, melatonin usage and step count were additionally analyzed. Results 19 participants were enrolled to date. Following hospital discharge, statistically significant increases were seen in sleep quality (t(17)=3.667, p=.002) and scores on the GAF (t(17) = 4.060, p<.001), while significant decreases were seen in scores on the BAI (Z(17) = -1.961, p=.050). Significant correlations were observed between sleep time and the number and duration of nightly awakenings, and between the different measures of neuropsychiatric and mental function. Step count showed a positive significant correlation with all measures of neuropsychiatric health and function in daily life only whilst participants were in the hospital. While higher levels of caffeine consumption were associated with better function in daily life in the hospital, late-day caffeine consumption had a negative impact on anxiety and sleep quality. Conclusions Brain-injury patients show worse levels of anxiety, general function in daily life and sleep quality whilst in the hospital. This indicates that the hospital environment could be better optimized to promote good sleep and reduce stress. Our findings indicate that increased activity programming may be one way to optimize recovery, as it may reduce neuropsychiatric symptoms in individuals with an ABI.