Course of Fatigue and Sleep After Moderate to Severe Traumatic Brain Injury.

Objective: To examine the development of different dimensions of fatigue and subjective and objective measures of sleep in the first 18 months post moderate to severe traumatic brain injury (TBI), and explore the association with biological (processing speed), psychological (mood), and social (restrictions in participation) factors across time.

Participants: Forty-two participants with moderate-severe TBI (45 ± 16 years old, 33% female).

Design: Longitudinal multicenter observational cohort study with 4 measurements (3, 6, 12, and 18 months post-injury).

Main measures: Dimensions of fatigue (Fatigue Severity Scale, FSS; Dutch Multifactor Fatigue Scale, DMFS), subjective (Pittsburgh Sleep Quality Index, PSQI) and objective sleep (actigraphy), processing speed (Symbol Digit Modalities Task, SDMT), mood (Hospital Anxiety and Depression Scale, HADS), and restrictions in participation (Utrecht Scale for Evaluation and Rehabilitation-Participation, USER-P).

Results: Results showed reduced sleep quality (PSQI: poor sleep quality at 3 months 41%; 6 months 43%; 12 months 56%; 18 months 43%) and high levels of fatigue (FSS: severe fatigue at 3 months 41%; 6 months 38%; 12 months 33%; 18 months 34%) with no significant changes over time. Physical fatigue (DMFS: β = -0.11, P = .007) and total sleep time (β = -0.14, P = .015) decreased over time. More mood problems were associated with worse sleep quality (PSQI; β = 0.35, P = .021), shorter total sleep time (β = 0.14, P = .046), and higher levels of fatigue (FSS: β = 0.20, P = .036; DMFS-mental: β = 0.36, P = .028; DMFS-physical: β = 0.36, P = .029). Restrictions in participation were associated with fatigue but not with sleep.

Conclusions: High and stable levels of fatigue and poor sleep quality in the first 18 months following moderate-severe TBI were found. These symptoms were associated with mood problems. Assessment and treatment of fatigue and sleep problems should be included in clinical practice. In line with other studies, we suggest that mood interventions might aid the treatment for fatigue and sleep quality.