Sleep Apnea After TBI

Sleep apnea is a disorder that involves brief periods of not breathing when the individual enters deeper sleep stages. When breathing stops, the individual becomes short of oxygen and partially wakes up again, which causes them to resume breathing. However, these respiratory events disrupt deep sleep throughout the night, and this can cause daytime drowsiness, cognitive impairment, auto and work-related accidents, and increased blood pressure and risk of stroke and heart attack.

In the general population, sleep apnea is most common in middle-aged men, particularly those who are overweight. The Moss Rehabilitation Research Institute recently participated in a multi-center study on sleep apnea after TBI, led by Risa Nakase-Richardson at the Tampa Veterans Administration Hospital, and funded by the Patient Centered Outcomes Research Institute (PCORI). In this study, patients in acute rehab following a moderate or severe TBI completed several sleep apnea risk questionnaires, and then participated in an overnight sleep study (“polysomnography”) where their breathing and their sleep stages were measured by special equipment. Whereas less than a quarter of healthy individuals are thought to have sleep apnea, about one-third of TBI patients had moderate or severe sleep apnea and over two-thirds had at least mild sleep apnea. Many of the people with sleep apnea didn’t fit the profile of middle-aged overweight men.

Sleep apnea is usually treated by wearing a pressurized breathing mask (“C-PAP”) overnight while sleeping. Many healthy people have trouble sleeping with the mask, and it may be that individuals early after TBI may be even less tolerant of the mask. Therefore, the next steps in this research are to try to assess the benefits of early treatment of sleep apnea on cognitive recovery, and to find ways of treating sleep apnea that patients can tolerate.

This article was originally published in The MossRehab Traumatic Brain Injury Model System’s Fall 2019 Edition of Brain E-News. 

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