Sleep Apnea Fix No Panacea for Brain-Injured Patients

Sleep Apnea Fix No Panacea for Brain-Injured Patients
By John Gever, Senior Editor, MedPage Today
Published: April 15, 2009
Reviewed by Dori F. Zaleznik, MD; Associate Clinical Professor of Medicine, Harvard Medical School, Boston.

WHEELING, W.Va., April 15 -- Sleep apnea treatment may reduce breathing disturbances treatment in brain-injured patients, but daytime sleepiness and other clinical symptoms are likely to continue, researchers said. Action Points
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Explain to interested patients that sleep apnea and other sleep disorders are common in patients after brain injury.


Explain that this study found that although the breathing abnormalities associated with sleep apnea in these patients were treated successfully with CPAP, the daytime symptoms associated with the condition did not resolve.


Explain that a key outcome in the study, sleep latency for daytime naps, may not have adequately measured the daytime ability to stay awake.


Explain that the study had a small number of patients and the findings need to be confirmed in a larger sample.

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In 13 patients with obstructive sleep apnea following traumatic brain injury, continuous positive airway pressure (CPAP) eliminated episodes of apnea, hypopnea, and snoring.


But scores on daytime sleepiness and neuropsychological function tests remained indicative of poor sleep, according to Richard J. Castriotta, M.D., of the University of Texas Health Science Center in Houston, and colleagues.


"There may be some permanent deficits in obstructive sleep apnea that are not reversed by CPAP," the researchers reported in the April 15 Journal of Clinical Sleep Medicine.


However, they also noted that their outcome measure for daytime sleepiness might have been flawed.


The study began with 57 patients examined at least three months after suffering traumatic brain injury.


Confirming results of earlier studies, the researchers found high rates of sleep disorders: Thirteen (23%) had obstructive sleep apnea, and nine had other sleep abnormalities such as narcolepsy, post-traumatic hypersomnia, or limb movements during sleep.


Multiple sleep latency scores in the patients with sleep apnea -- reflecting mean sleep latency for five daytime naps in a sleep lab -- averaged 10.3 minutes (SD 6.2) at baseline.


After at least three months of CPAP treatment, those with sleep apnea showed declines in the hourly rate of apnea-hypopnea episodes from a mean of 31.4 at baseline to 3.8 (P=0.001).


But multiple sleep latency scores failed to change significantly, increasing to 12.1 minutes (SD 5.1) with treatment.


Moreover, researchers found only minimal improvement in neuropsychological function, as measured with a psychomotor vigilance test and the Functional Outcome of Sleep Questionnaire, the researchers said.


Patients with other types of sleep disorders received drug treatments appropriate to the condition: pramipexole (Mirapex) for limb movements and modafinil (Provigil) for narcolepsy and hypersomnia.


However, there were too few patients with these diagnoses to yield statistically significant findings on the outcomes.


Dr. Castriotta and colleagues noted that there are questions about the validity of multiple sleep latency tests as a measure of treatment response in sleep disorders.


Earlier studies have found that scores on these tests fail to improve despite otherwise successful treatment of sleep disorders, including narcolepsy as well as apnea.


The researchers said daytime sleep latency reflects a sleep-related process and may not correlate with the ability to stay awake.


Dr. Castriotta and colleagues conceded that a more direct measure of daytime wakefulness might be more appropriate in studies of sleep disorder treatments.


On the other hand, they said, the lack of improvement in neuropsychological measures they found is consistent with residual daytime sleepiness.


Overall, they characterized the study as a first attempt at evaluating sleep disorder treatments in brain-injured patients. They recommended that additional studies be conducted, using different methodologies.


The study was funded by the Moody Foundation and Cephalon.

No potential conflicts of interest other than the research funding were reported.




Primary source: Journal of Clinical Sleep Medicine
Source reference:
Castriotta R, et al "Treatment of sleep disorders after traumatic brain injury" J Clin Sleep Med 2009; 5: 137-44.

Babette wrote:That would explain alot about me.

I'm gonna claim brain injury from now on, instead of sleep deprivation!
B.