Aggravation of excessive daytime sleepiness concurrent with aggravation of an injured ascending reticular activating system in a patient with mild traumatic brain injury

Abstract Introduction We investigated differences in the ascending reticular activating system (ARAS) injuries between patients with mild traumatic brain injury (mTBI) and cerebral concussion by using diffusion tensor tractography (DTT). Methods Thirty-one patients with mTBI, 29 patients with concussion, and 30 control subjects were recruited. We used DTT to reconstruct the lower ventral and dorsal ARAS, and the upper ARAS. The fractional anisotropy (FA) value and the fiber number (FN) of the lower ventral and dorsal ARAS, and the upper ARAS were determined. Results Significant differences were observed in the FA values of the lower ventral and dorsal ARAS on both sides between the mTBI and control groups and between the concussion and control groups (p < 0.05). The FN value was significantly different in the lower ventral ARAS on both sides between the concussion and control groups and between the mTBI and concussion groups (p < 0.05). Conclusion Both the mTBI and concussion patients suffered injuries in the lower ventral and dorsal ARAS, with the concussion patients exhibiting more severe injury in the ventral ARAS than that in the mTBI patients. These results suggest that the terms mTBI and concussion should be used differentially, even though they have used interchangeably for a long time.

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Insufficient Sleep Following Pediatric Mild Traumatic Brain Injury Correlates With Neurocognitive Dysfunction

Neurology ◽

10.1212/wnl.0000000000013046 ◽

2021 ◽

Vol 98 (1 Supplement 1) ◽

pp. S1.1-S1

Author(s):

Bailey Hull ◽

Patrick Karabon ◽

Neal Alpiner

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Sleep Disturbance ◽

Mild Traumatic Brain Injury ◽

Daytime Sleepiness ◽

Epworth Sleepiness Scale ◽

Neurocognitive Function ◽

Neurocognitive Dysfunction ◽

Neurocognitive Test ◽

Test Outcomes

ObjectiveAnalyze the impact of sleep disturbance on neurocognitive function in children recovering from mild traumatic brain injury (mTBI).BackgroundSleep disturbance of any nature is reported in more than half of all mTBI patients. The pathophysiology of sleep disturbance following mTBI is associated with structural and functional disruptions of sleep circuitry and circadian rhythm. Specifically in the pediatric population, untreated sleep disturbance has been shown to delay mTBI recovery and compound other morbidities including neurocognitive dysfunction.Design/MethodsA retrospective chart review of 118 pediatric patients (mean age = 14.56 ± 2.03 years) recovering from mTBI was performed. Epworth Sleepiness Scale (SF-8) results were analyzed in relation to CNS Vital Signs (CNSVS) neurocognitive test outcomes. SF-8 is a subjective estimation of a patient's daytime sleepiness. CNSVS uses a multitude of domains to objectively evaluate the overall neurocognitive status of a patient. Pearson correlations were calculated using a type I error of p < 0.05 between variables.ResultsEpworth Sleepiness Scale (SF-8) results showed 28.82% of participants experienced excessive daytime sleepiness sufficient enough to recommend medical attention. Upon further analysis, there was a significant negative correlation between SF-8 and CNSVS neurocognitive test outcomes including complex attention (r = −0.37; p = 0.0004), cognitive flexibility (r = −0.24; p = 0.0151), executive function (r = −0.21; p = 0.0350), and simple attention (r = −0.36; p = 0.0003) scores. This means as SF-8 scores increased (participants defined as excessively sleepy), neurocognitive function scores in these domains decreased. There was not enough evidence to conclude a significant correlation between other CNSVS domains and SF-8 (all p > 0.05).ConclusionsOur findings support the concern of neurocognitive dysfunction among pediatric mTBI patients with sleep disturbance. Further analysis is needed to determine if mTBI is the primary source or an exacerbating factor of sleep disturbance within this population. Nonetheless, these findings suggest a need for thorough evaluation when treating sleep concerns, irrespective of a history of childhood mTBI.

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0066 Disrupted Thalamocortical Connectivity following Mild Traumatic Brain Injury: Associations with Daytime Sleepiness

SLEEP ◽

10.1093/sleep/zsz067.065 ◽

2019 ◽

Vol 42 (Supplement_1) ◽

pp. A27-A28

Author(s):

Natalie S Dailey ◽

Brieann C Satterfield ◽

Adam C Raikes ◽

Michael J Strong ◽

Brittany Forbeck ◽

...

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Mild Traumatic Brain Injury ◽

Daytime Sleepiness

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Modafinil ameliorates excessive daytime sleepiness after traumatic brain injury

Neurology ◽

10.1212/wnl.0b013e3181fd62a2 ◽

2010 ◽

Vol 75 (20) ◽

pp. 1780-1785 ◽

Cited By ~ 89

Author(s):

P. R. Kaiser ◽

P. O. Valko ◽

E. Werth ◽

J. Thomann ◽

J. Meier ◽

...

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Excessive Daytime Sleepiness ◽

Daytime Sleepiness

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A Randomized Trial of Modafinil for the Treatment of Fatigue and Excessive Daytime Sleepiness in Individuals with Chronic Traumatic Brain Injury

Journal of Head Trauma Rehabilitation ◽

10.1097/01.htr.0000308721.77911.ea ◽

2008 ◽

Vol 23 (1) ◽

pp. 52-63 ◽

Cited By ~ 89

Author(s):

Amitabh Jha ◽

Alan Weintraub ◽

Amanda Allshouse ◽

Clare Morey ◽

Chris Cusick ◽

...

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Randomized Trial ◽

Excessive Daytime Sleepiness ◽

Daytime Sleepiness

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The relationship between consciousness and the ascending reticular activating system in patients with traumatic brain injury

10.21203/rs.3.rs-46161/v2 ◽

2020 ◽

Author(s):

Sung Ho Jang ◽

YOUNGHYEON KWON

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Control Group ◽

Impaired Consciousness ◽

Patient Subgroup ◽

Chronic Stage ◽

Ascending Reticular Activating System ◽

Reticular Activating System ◽

Gcs Score ◽

The Relationship

Abstract Background: We investigated the relationship between consciousness and the ascending reticular activating system(ARAS) by using diffusion tensor tractography(DTT) in patients with traumatic brain injury(TBI).Methods: Twenty-six patients with TBI and 13 healthy control subjects were recruited for this study. Glasgow Coma Scale(GCS) scores were used for evaluation of subject consciousness state at the chronic stage of TBI(at DTT scanning), According to the GCS score, the patient group was divided into two subgroups: A(14 patients;impaired consciousness:GCS score<15, and B(12 patients;intact consciousness;GCS score=15). Fractional anisotropy(FA) and tract volume(TV) values were assessed in the lower dorsal and upper ARAS.Results: The FA values of the lower dorsal ARAS and the upper ARAS in patient subgroup A were significantly lower than those in patient subgroup B and the control group(p<0.05). However, the FA and TV values for the lower dorsal ARAS and the upper ARAS were not significantly different between patient subgroup B and the control group(p>0.05). The FA value of the lower dorsal ARAS(r=0.473,p<0.05) and the TV of upper ARAS(r=0.484,p<0.05) had moderate positive correlations with the GCS score. The FA value of the upper ARAS had a strong positive correlation with the GCS score of the patient group(r=0.780,p<0.05).Conclusions: We detected a close relationship between consciousness at the chronic stage of TBI and injuries of the lower dorsal and upper ARAS(especially, the upper ARAS) in patients who showed impaired consciousness at the onset of TBI. We believe that our results can be useful during the development of therapeutic strategies for patients with impaired consciousness following TBI.

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