A Patient with the Disrupted Sleep-Wake Rhythm after Traumatic Brain Injury

Eunji Kim; Seongheon Kim; Jung Hie Lee

doi:10.4306/jknpa.2019.58.3.252

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Kim, Kim, and Lee: A Patient with the Disrupted Sleep-Wake Rhythm after Traumatic Brain Injury

Case Report

Journal of Korean Neuropsychiatric Association 2019; 58(3): 252-258.

Published online: 31 August 2019

DOI: https://doi.org/10.4306/jknpa.2019.58.3.252

A Patient with the Disrupted Sleep-Wake Rhythm after Traumatic Brain Injury

Eunji Kim, MD¹, Seongheon Kim, MD², Jung Hie Lee, MD, PhD^1,³

¹Department of Psychiatry, Kangwon National University Hospital, Chuncheon, Korea.

²Department of Neurology, Kangwon National University Hospital, Chuncheon, Korea.

³Department of Psychiatry, Kangwon National University School of Medicine, Chuncheon, Korea.

Address for correspondence: Jung Hie Lee, MD, PhD. Department of Psychiatry, Kangwon National University Hospital, 156 Baekryung-ro, Chuncheon 24289, Korea. Tel +82-33-258-2000, Fax +82-33-258-9436, jhielee@kangwon.ac.kr

Received 1 April 2019 Revised 13 May 2019 Accepted 6 June 2019

Korean Neuropsychiatric Association

Abstract

Many patients with a traumatic brain injury (TBI) experience a range of sleep problems. Although some studies investigated the pathophysiology of sleep-wake cycle disturbances in TBI patients, it has not been clarified. This paper presents a middle aged female patient who showed sleep deprivation and sleep-wake cycle disturbances for approximately three months after TBI. The improvement in the subjective and objective sleep quality was shown by the sleep diary and actigraphy during this period. Moreover, the dim light melatonin onset (DLMO) had been delayed before returning to the normal range in 3 months. In addition, the patient showed an improvement in the neurocognitive function, including attention, memory and language function, along with a consolidation of the sleep-wake cycle. This case showed that the sleep disturbance following a TBI was probably caused by the disrupted melatonin rhythm based on the abnormality of the DLMO. In addition, the cognitive dysfunction after TBI could be associated with sleep-wake cycle disturbances because its gradual improvement occurred as the sleep disturbance diminished. Further studies on the change in circadian rhythm after a brain injury related to neurocognitive impairment are required.

Keywords: Traumatic brain injury, Sleep-wake rhythm, Neurocognitive function

Figures and Tables

Fig. 1

Brain MRI of accident day. Initial diffusion weighted MRI (A), T2 flair MRI (B), gradient echo MRI (C) revealed diffusion axonal injury in bilateral hemisphere, subdural hemorrhage in posterior falx and multifocal cortical subarachnoid hemorrhage.

Fig. 2

Actogram from the actigraphy data for 7 days. Sleep periods are represented by dark gray rectangles. Periods without recording are represented by black rectangles. PID: Post-injury day.

Fig. 3

Sleep diary from PID 42 to PID 48 (A) and sleep diary from PID 63 to PID 69 (B). The time in bed is represented by gray box, nocturnal sleep by black box, daytime nap by stained gray box, and drug administration time by white circle. PID: Post-injury day.

Fig. 4

Salivary melatonin profiles at PID 45 (A) and PID 80 (B). Dim light melatonin onset was 19:19 (B). PID: Post-injury day.

Table 1

Patient's medication history during hospitalization and OPD follow up

^*: Total duration of valproic acid, ^†: Duration of maximum dose. OPD: Outpatient department, PID: Post-injury day

Table 2

Changes in neurocognitive function

SNSB: Seoul Neuropsychologic Screening Battery, PID: post-injury day, K-MMSE: Korean-Mini Mental State Examination

Notes

^{Conflicts of Interest} The authors have no financial conflicts of interest.

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