Evaluating the impact of treatment for sleep/wake disorders on recovery of cognition and communication in adults with chronic TBI

Figures & data

Figure 1. Study timeline.

Table I. Participant demographics and baseline characteristics.

ID #	Age	Sex	Glasgow coma scale	TBI severity	Time post-injury (years)	Marital status	Education (years)	Sleep diagnosis; major intervention	Participation status	Body Mass Index
1	18	F	3	Severe	2	Single	12	HS due to medical condition; modafinil	School with FT 1–1 Support; TBI rehab^a	25.4
2	19	M	3	Severe	1	In relationship	14	RLS and insufficient sleep time; pregabalin prescribed (declined) sleep hygiene programme^b	School PT with support; TBI rehab	23.3
3	28	F	3	Severe	2	Single	16	Insomnia due to medical condition; trazadone and sleep hygiene programme	Not working; TBI rehab	25.2
4	29	M	N/A	Severe	22	Married	14	RLS; gabapentin	Employed FT; Working on GED	21.1
5	31	M	5	Severe	1	Married	16	HS due to medical condition; modafinil and methylphenidate	Attempting RTW	21.3
6	32	M	N/A	mTBI with persistent symptoms	2	Single	18	HS due to medical condition; stimulating antidepressant (fluoxetine)	Not working; PT student with support; TBI rehab	22.1
7	37	F	N/A	Severe	2	Single	14	CRSD (delayed type) & PLMD; chronotherapy and iron	Not working; TBI Rehab	27.3
8	47	M	13	mTBI withpersistent symptoms	2	Married	21	OSA, CSA, RLS; CPAP and modafinil	Working	32.8
9	49	M	5	Severe	1	Divorced	10	RLS and insufficient sleep time; iron, pramipexole and sleep hygiene programme	Not working; TBI rehab	29.6
10	53	F	5	Severe	3	Married	18	HS due to medical condition; modafinil	Not working	29.2
11	55	F	3	Severe	18	Married	16	OSA; CPAP	Working	39.0
12	58	F	N/A	Severe	1.5	Widowed	18	OSA; CPAP	Not working	23.6

Note: Depression determined by physician diagnosis.

^aTBI rehab involved functional, individualized contextually-based therapy, not memory retraining or practice of cognitive strategies.

^bSleep hygiene programme involved providing participants with specific strategies to increase the likelihood of development of good sleep-promoting habits.

HS, hypersomnia; CRSD, Circadian Rhythm Sleep Disorder; PLMD, Periodic Limb Movement disorder; OSA, Obstructive sleep apnea; CSA, Central sleep apnea; RLS, Restless leg syndrome; CPAP, continuous positive airway pressure.

Figure 2. Group Average DCCASP Scores.

Table II. Statistical analysis of pre–post measures group data.

Test	Pre Median (range)	Post Median (range)	p-Value	Corrected p-value
Insomnia Severity Index (R)	17.0 (10.0–26.0)	8.5 (2.0–21.0)+	0.0005**	0.0003**
Insomnia Severity Index (S)	3.0 (2.0–4.0)	2.0 (1.0–4.0)+	0.0020**	0.0140*
Beck Anxiety Inventory (R)	15.0 (6.0–26.0)	5.0 (0.0–20.0)+	0.0142*	0.0990
Beck Anxiety Inventory (S)	2.0 (1.0–4.0)	1.0 (1.0–3.0)+	0.1563	1.0
Beck Depression Inventory (R)	26.0 (11.0–32.0)	15.0 (8.5–19.0)+	0.0044**	0.0310*
Beck Depression Inventory (S)	3.0 (1.0–4.0)	2.0 (1.0–4.0)+	0.0781	0.5470
Latrobe CQ	63.0 (43.0–70.0)	55.5 (46.5–60.0)+	0.1475	1.0
RBANS Attention	72.0 (64.0–132.0)	91.0 (60.0–118.0)+	0.0996	0.6930
RBANS Immediate Memory	81.0 (61.00–123.0)	101.5 (61.0–112.0)+	0.0480*	0.3360
RBANS Delayed Memory	83.0 (48.0–98.0)	94.0 (44.0–112.0)+	0.0500*	0.3710
RBANS Visual Spatial (*min change expected in response to > sleep)	72.0 (60.0–84.0)	79.5 (64.0–96.0)+	0.1621	1.0
RBANS Language	84.0 (47.0–100.0)	99.0 (85.0–108.0)+	0.0020**	0.0140*
RBANS Total Score	71.0 (62.0–104.0)	92.5 (62.0–109.0)+	0.0020**	0.0140*
RBANS Percentile Score	2.0 (1.0–61.0)	31.0 (1.0–73.0)+	0.0020**	0.0140*
SCOLP Speed	10.0 (1.0–48.0)	73.5 (28.0–99.0)+	0.0010**	0.0070**
SCOLP Word (*min change expected in response to > sleep)	25.0 (1.0–95.0)	25.0 (3.0–95.0) nc	0.8860	1.0
TEA aud sel working mem	15.0 (1.0–75.0)	50.5 (1.0–75.0)+	0.0310*	0.2170
TEA aud sel verbal mem	10.0 (4.0–99.0)	46.0 (2.0–90.0)+	0.1680	1.0
TEA div attn working mem	5.0 (1.0–99.0)	42.5 (3.0–99.0)+	0.1150	0.8050
TEA sel visual attention	6.0 (1.0–82.0)	10.0 (1.0–99.0)+	0.0630	0.4410
TEA sel visual Attn (1 min)	13.0 (1.0–84.0)	61.0 (2.0–92.0)+	0.0300*	0.2100
TEA sel visual Attn (2 min)	7.0 (1.0–84.0)	40.0 (2.0–92.0)+	0.0440*	0.3080
TEA sus aud attention (severity level) lower = better	1.0 (1.0–3.0)	1.0 (1.0–2.0) nc	0.1250	0.8750
TEA sus aud vigilance	10.0 (1.0–75.0)	50.0 (25.0–75.0)+	0.1270	0.8890
TEA vis attn switching accuracy	50.0 (5.0–75.0)	75.0 (5.0–753.0)+	0.5000	1.0
TEA vis attn switching speed	4.0 (1.0–99.0)	22.5 (1.0–99.0)+	0.3950	1.0

Note: Wilcoxon Signed Rank Test and Wilcoxon with Bonferroni Correction.

R, Raw Score; S, Severity Score.

*p < 0.05, **p < 0.01.

+ or – or nc (no change) indicates direction of change.

Table III. Mood and sleep raw scores.

ID #	BDI baseline	BDI post	BAI baseline	BAI post	ISI baseline	ISI post
1	28 (moderate)	9 (minimal)	20 (moderate)	6 (minimal)	17 (moderate)	2 (no clinical sig)
2	26 (moderate)	21 (moderate)	25 (moderate)	10 (mild)	22 (moderate)	9 (sub-threshold)
3	23 (moderate)	16 (mild)	6 (minimal)	10 (mild)	26 (severe)	13 (sub-threshold)
4	26 (moderate)	18 (mild)	16 (moderate)	20 (moderate)	14 (sub-threshold)	3 (no clinical sig)
5	29 (severe)	15 (mild)	15 (mild)	1 (minimal)	17 (moderate)	14 (subthreshold)
6	19 (mild)	7 (minimal)	15 (mild)	4 (minimal)	21 (moderate)	9 (subthreshold)
7	30 (severe)	15 (mild)	10 (mild)	13 (mild)	13 (sub-threshold)	8 (sub-threshold)
8	28 (moderate)	34 (severe)	14 (mild)	12 (mild)	22 (moderate)	21 (moderate)
9	19 (mild)	14 (mild)	21 (moderate)	1 (minimal)	25 (severe)	2 (no clinical sig)
10	24 (moderate)	20 (moderate)	9 (mild)	4 (minimal)	23 (severe)	20 (moderate)
11	11 (minimal)	1 (minimal)	7 (minimal)	0 (none)	17 (moderate)	2 (no clinical sig)
12	13 (minimal)	8 (minimal)	12 (mild)	5 (minimal)	10 (sub-threshold)	7 (no clinical sig)

Note: BDI: six improved classification; five remained same classification with improved raw scores; one became worse; BAI: eight improved classification; three remained same classification but two had raw scores improve, one had raw scores worsen; one worsened classification; ISI: 10 improved classification; two remained same classification but raw scores improved; one remained same.