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Sleep–wake disturbances 3 years after traumatic brain injury
  1. Julia Kempf1,
  2. Esther Werth1,
  3. Philippe R Kaiser1,
  4. Claudio L Bassetti1,2,
  5. Christian R Baumann1
  1. 1Department of Neurology, University Hospital Zurich, Zurich, Switzerland
  2. 2Department of Neurology, Ospedale Civico, Lugano, Switzerland
  1. Correspondence to Christian R Baumann, Department of Neurology, University Hospital Zurich, Frauenklinikstrasse 26, 8091 Zurich, Switzerland; christian.baumann{at}


Background 6 months after traumatic brain injury (TBI), almost three out of four patients suffer from sleep–wake disturbances (SWD) such as post-traumatic hypersomnia (increased sleep need of ≥2 h compared with before injury), excessive daytime sleepiness (EDS), fatigue and insomnia. The long-term course of post-traumatic SWD, however, is unknown.

Objectives To assess the prevalence and characteristics of post-traumatic SWD 3 years after trauma.

Design Prospective longitudinal clinical study in 51 consecutive TBI patients (43 males, eight females, mean age 40±16 years).

Main outcome measures EDS (as assessed by the Epworth sleepiness scale), fatigue (fatigue severity scale), post-traumatic hypersomnia (sleep length per 24 h), insomnia, depression and anxiety.

Results Post-traumatic SWD were found in 34 patients (67%): post-traumatic hypersomnia in 14 (27%), EDS in six (12%), fatigue in 18 patients (35%) and insomnia in five patients (10%). SWD were not associated with severity or localisation of, or time interval since, TBI. Insomnia was linked to depressive symptoms.

Conclusions This prospective study shows that 3 years after TBI, two out of three patients suffer from residual SWD, particularly fatigue and post-traumatic hypersomnia. In 45% of TBI patients, SWD appear directly related to the trauma itself.

  • Sleep

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  • Funding This study has been supported by the Schweizerischer Versicherungsverband SVV, Zurich, Switzerland.

  • Competing interests None.

  • Patient consent Obtained.

  • Ethics approval Ethics approval was provided by the Ethical Committee, University of Zurich.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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