Objective measures of sleep and wakefulness in patients with moderate to severe brain injury on an inpatient rehabilitation unit. Pearls and pitfalls of actigraph monitoring

Abstract

BACKGROUND:

As awareness of disrupted sleep in patients with traumatic brain injury (TBI) increases so does interest in finding objective measures of sleep. As a result, many clinicians are turning to actigraphs to monitor sleep in patients with altered consciousness. Actigraphs are accelerometers which have been used in sleep research for over four decades.

OBJECTIVE:

The purpose of the present study was to determine the best method for scoring actigraphs in a TBI population and to describe the benefits and pitfalls of using actigraphs with patients on a brain injury rehabilitation unit.

METHODS:

A retrospective chart review of 43 patients compared three different ways of scoring night time rest periods: autoscoring, manual scoring, and set interval scoring for the sleep parameters of sleep efficiency, wakefulness after sleep onset, and total sleep time. Nursing compliance with using the event marker on the device to set rest period was also analyzed.

RESULTS:

The autoscoring method of determining the rest interval showed an inflation of sleep efficiency. For each sleep parameter compared, the strongest correlations were observed between the manual and set interval scoring methods. Compliance using event markers to set rest interval was low (16.7%).

CONCLUSIONS:

Set interval scoring is the most efficient method to determine the rest interval in TBI patients. The use of event markers was an unreliable method to determine rest period.

Keywords

Brain injury traumatic brain injury sleep disruption actigraph actigraph scoring sleep rest interval sleep efficiency wakefulness after sleep onset total sleep time rehabilitation

Get full access to this article

View all access options for this article.

References

Alhola, P., & Polo-Kantola, P. (2007). Sleep deprivation: Impact on cognitive performance. Neuropsychiatric Disease and Treatment, 3(5), 553–567.

Ancoli-Israel, S., Martin, J. L., Blackwell, T., Buenaver, L., Liu, L., Meltzer, L. J., & Taylor, D. J. (2015). The SBSM Guide to actigraphy monitoring: Clinical and research applications. Behavioral Sleep Medicine, 13(S1), S4–S38.

Baumann, C., Werth, E., Stocker, R., Ludwig, S., & Bassetti, C. (2007). Sleep wake disturbances six months after traumatic brain injury: A prospective study. Brain, 130, 1873–1883.

Duclos, C., Dumont, M., Blais, H., Paquet, J., Laflamme, E., de Beaumont, L., & Gosselin, N. (2014). Rest-activity cycle disturbances in the acute phase of moderate to severe traumatic brain injury. Neurorehabilitation and Neural Repair, 28(5), 472–482.

Gardani, M., Morfiri, E., Thomson, A., O’Neill, B., & McMillan, T. M. (2015). Evaluation of sleep disorders in patients with severe traumatic brain injury during rehabilitation. Archives of Physical Medicine and Rehabilitation, 96(9), 1691–1697.

Kamper, J. E., Garofano, J., Schwartz, D. J., Silva, M. A., Zeitzer, J., Modarres, M., & Nakase-Richardson, R. (2016). Concordance of actigraphy with polysomnography in traumatic brain injury neurorehabilitation admissions. The Journal of Head Trauma Rehabilitation, 31(2), 117–125.

Makley, M., Johnson-Greene, L., Tarwater, P. M., Kreuz, A. J., Spiro, J., Rao, V., & Celnik, P. A. (2009). Return of memory and sleep efficiency following moderate to severe closed head injury. Neurorehabilitation and Neural Repair, 23(4), 320–326.

Makley, M. J., English, J. B., Drubach, D. A., Kreuz, A. J., Celnik, P. A., & Tarwater, P. M. (2008). Prevalence of sleep disturbance in closed head injury patients in a rehabilitation unit. Neurore-habilitation and Neural Repair, 22(4), 341–347.

Mathias, J. L., & Alvaro, P. K. (2012). Prevalence of sleep disturbances, disorders, and problems following traumatic brain injury: A meta-analysis. Sleep Medicine, 13(7), 898–905.

10.

Nakase-Richardson, R., Sherer, M., Barnett, S. D., Yablon, S. A., Evans, C. C., Kretzmer, T., & Modarres, M. (2013). Prospective evaluation of the nature, course, and impact of acute sleep abnormality after traumatic brain injury. Archives of Physical Medicine and Rehabilitation, 94(5), 875–882.

11.

Orff, H. J., Ayalon, L., & Drummon, S. P. A. (2009). Traumatic brain injury and sleep disturbance: A review of current research. Journal of Head Trauma Rehabilitation, 24(3), 155–165.

12.

Walker, M. (2017). Why we sleep: Unlocking the power of sleep and dreams.New York, NY: Simon & Schuster.