Examining Fatigue and Sleep in Traumatic Brain Injury

Research Objectives: To examine the discrepancy between perceived feelings of fatigue and measured sleep in individuals with traumatic brain injury (TBI).

Design: Secondary analysis as a part of an randomized controlled trial that included a sham device, we conducted a multiple linear regression analysis.

Setting: 3 Traumatic Brain Injury Model System (TBIMS) inpatient rehabilitation units.

Participants: 131 participants (mean age 40.9 years, SD (15.8), 68% male). All participants had moderate to severe TBI. No treatment for sleep disturbance with prescribed medications for the previous 72 hours. Additional demographics will be detailed.

Interventions: The intervention group (n = 65) received exposure to black white light to the face for 30 minutes each morning. Control group (n = 66) received red light for the same length of time. The planned intervention occurred 10 times or until participants were discharged. Given no difference was found between groups, it is presumed there were no effects.

Main Outcome Measures: Sleep duration as measured by total sleep time on actigraphic recording.

Results: Subjective fatigue as measured by the Karolinska Sleepiness Scale (b*i = 0.13 (p = 0.24) and subjective reporting as measured by Delirium Rating Scale Revised (DelRS-R98), item 1; report of sleep disturbance (b*i = -0.12 (p = 0.27). Further, overall fatigue as measured by the Barrow Neurological Institute Fatigue Scale (BNI-FS) subscale fatigue outcome (b*i = 0.50 (p = 0.70) and fatigue during the day as measured by BNI-FS item 3 (b*i = (-1.5 (p = 0.27). There were no differences between subjective measures of fatigue and objective measures on the primary outcome (total sleep time via actigraphic recording), perceived fatigue was not correlated with measured sleep.

Conclusions: There were no observed differences between subjective reporting of fatigue and measured sleep by an objective measure of sleep in individuals with moderate-severe TBI who were hospitalized and underwent acute rehabilitation. This is consistent with previous studies that have examined perceived fatigue and measured sleep duration in individuals without a TBI (Bianchi et al., 2013; Russell et al., 2016; Stanyte et al., 2024. ). Notably, given the growing interest in understanding sleep, fatigue, and its relationship with TBI determining how to accurately assess the experience of sleep and fatigue is essential. Further research is needed to explore the relationship between perception of fatigue compared to objective measures of sleep, and which should be utilized for evaluation of interventions aimed at improving sleep after TBI.

Author(s) Disclosures: None to disclose