23686: Sleep Characteristics after Acute Stroke Vs. Traumatic Brain Injury

Document Type


Publication Date


Publication Title

Journal of Neurologic Physical Therapy: Academy of Neurologic Physical Therapy Poster Presentations


Purpose/Hypothesis: Fatigue and sleep disturbances are reported in the majority of individuals following stroke and traumatic brain injury (TBI). Between these populations, abnormal sleep is associated with impaired cognitive and psychomotor functioning. Sleep characteristics have been described in these populations at both acute-hospital and chronic stages, however not during acute rehabilitation. Therefore, the purpose of this study was to describe and compare sleep characteristics in individuals with acute stroke versus acute TBI in an inpatient rehabilitation facility (IRF). Number of Subjects: Thirteen subjects (67.5±5.7 years) with acute stroke (n=10) or TBI (n=3) at an IRF completed the study. Materials and Methods: Subjects wore actigraph monitors, a valid alternative to polysomnography, to measure sleep characteristics over 10 days. Minutes of sleep during two time periods—lights-on (06:00-20:59) and nighttime (19:00-05:59)—and number of sleep/wake transitions were calculated for Days 1 and 10. Cognitive and motor Functional Independence Measure (FIM) scores were recorded to reflect functional severity of neurological injury. Non-parametric tests were used to compare differences in sleep characteristics between persons with acute stroke and TBI. Results: There were no significant differences in sleep measures from Day 1 to Day 10 for either group. Total mean sleep durations were 14.9h for the TBI group and 8.0h for the stroke group. Despite observed differences, increased daytime sleep was exhibited by both groups. The stroke group displayed appropriate sleep duration, however, with a mean of only 68.5% of sleep occurring during nighttime hours. Compared to the stroke group, the TBI group demonstrated an additional 3h 13min of nighttime sleep, 3h 20min more of lights-on sleep, and 14.2 more sleep/wake transitions (p<0.05). On Day 1, the TBI group exhibited significantly lower cognitive FIM scores, however this difference was not maintained on Day 10. Motor FIM scores were not significantly different between groups. Conclusions: Individuals with acute TBI demonstrated hypersomnia relative to those with acute stroke and compared to national recommended sleep durations (7-9h). Overall, there were no observed improvements in sleep characteristics following TBI or stroke during 10 days of inpatient rehabilitation. Clinical Relevance: Greater sleep impairments in individuals with acute TBI may be attributed to affected functional brain regions more involved in sleep/wake circuitry. Previous work identifies hypothalamic changes as a potential mechanism for abnormal sleep following TBI. Increased fatigue, demonstrated by hypersomnia and/or daytime sleepiness in persons with acute stroke or TBI, can interfere with participation in rehabilitation. Clinicians should consider sleep characteristics following stroke and TBI, given that previous work suggests functional and cognitive impairments associated with abnormal sleep in these populations. At present, there are no evidence-based protocols addressing sleep/wake disturbances in individuals with acute stroke or TBI.

Clinical Institute

Neurosciences (Brain & Spine)




Sleep Medicine