Simultaneous non-invasive assessment of arterial stiffness and haemodynamics - a validation study

The purpose of the study was to estimate the reliability of whole-body impedance cardiography (ICGWB)-derived pulse wave velocity (PWV) and stroke volume index to pulse pressure (SI/PP) measurements. The repeatability and reproducibility of ICGWB parameters were also determined. Agreement between the impedance and Doppler ultrasound-based PWV measurements was estimated in 25 healthy subjects in two consecutive measurements. Impedance-derived SI/PP (SIICG/PP) estimates were compared with simultaneously measured SI/PP based on thermodilution (SITD/PP) and direct Fick (SIFICK/PP) methods in 30 surgical patients. PWV measured between the aortic arch and popliteal artery using the impedance technique with selective electrode configuration (PWVIS) agreed well with the Doppler ultrasound method (PWVDOPP), the bias (PWVDOPP - PWVIS) and precision (+/- SD of differences) being 0.00 and 0.79 m s-1, respectively. PWV derived from the whole-body and popliteal impedance plethysmograms (PWVICG) overestimated slightly PWVDOPP values. The repeatability value for PWVIS was excellent, being 0.54 m s-1. The reproducibility values for PWVDOPP and PWVIS were very similar (2.17 and 2.42 m s-1, respectively). Changes in PWVIS correlated strongly with changes in PWVDOPP (r=0.74; P<0.0001), indicating that both methods reflected the true physiological variation in PWV. The agreement between SIICG/PP and SITD/PP or SIFICK was almost identical to the agreement between the SITD/PP and SIFICK/PP. In conclusion,whole-body impedance cardiography provides handy and reliable means of evaluating arterial stiffness on the basis of PWV and SI/PP simultaneously with conventional haemodynamic parameters. The method is highly repeatable and reproducible.     

射血分数保留的心力衰竭患者心肌纵向收缩力与动脉僵硬度关系的初步研究

目的 探讨射血分数保留的心力衰竭（HFpEF）患者心肌纵向收缩力与动脉僵硬度的关系。方法 选取我院收治的HFpEF患者29例（HFpEF组）,以及年龄、性别与之匹配的健康受试者53例（对照组）。应用上臂袖带波技术获取两组动脉波速指数（AVI）;超声心动图获取两组室间隔舒张末期厚度（IVSD）、左室后壁舒张末期厚度（LVPWD）、二尖瓣口舒张早期和晚期血流速度峰值（E、A）、E与二尖瓣环侧壁瓣环舒张早期运动速度峰值（e’）的比值（E/e’）、左室射血分数（LVEF）、左室整体纵向应变（GLS）和整体环向应变（GCS）,比较两组上述指标的差异。应用Pearson相关分析法分析AVI与超声心动图指标的相关性;Logistic回归分析筛选发生HFpEF的危险因素。结果 HFpEF组AVI大于对照组,差异有统计学意义（P<0.05）;与对照组比较,HFpEF组IVSD、LVPWD、E/e’均增大,E/A、E、e’及GLS均减低,差异均有统计学意义（均P<0.05）。相关性分析显示,AVI与GCS呈负相关（r=-0.241,P<0.05）,与E/e’呈正相关（r=0.288,P&...     

Sex disparity in the association between hypertriglyceridemic waist phenotype and arterial stiffness in Chinese healthy subjects

Objective: To investigate the association between hypertriglyceridemic waist (HTGW) phenotype and arterial stiffness in a Chinese population without hypertension, diabetes and cardiovascular diseases.

Methods: A total number of 3028 subjects aged 40 years and over were enrolled in this cross-sectional study. All participants provided a clinical history and underwent a physical examination. Brachial-ankle pulse wave velocity (baPWV) was used to evaluate arterial stiffness. HTGW phenotype was defined as the simultaneous presence of waist circumference ≥90/80 cm and triglycerides ≥2.0/1.5 mmol/L in men/women.

Results: The prevalence of HTGW phenotype was 7.5% among healthy participants in China (Beijing), 7.4% in men and 7.5% in women. Women with HTGW phenotype had a higher level of baPWV compared with normal WC and normal triglyceride (NWNT) group (P < 0.05), but no significant difference was observed in men (P > 0.05). Multiple logistic regression analysis showed HTGW phenotype was significantly associated with baPWV after controlling for multiple factors in women. However, no significant relationship was observed in men.

Conclusions: The present study supports that HTGW phenotype is associated with increased arterial stiffness in women but not in men.     

The effects of exercise training on arterial stiffness in coronary artery disease patients: a state‐of‐the‐art review

The purpose of this state‐of‐the‐art review was to examine the effects of exercise training on arterial stiffness (AS) in patients with coronary artery disease (CAD). A PubMed and SCOPUS literature search was conducted up to March of 2013. Two authors performed the selection of the studies and the subsequent data extraction (e.g. information on study design, exercise programme characteristics and outcome measures). Of 34 papers identified, only five studies met the inclusion criteria, with no one being a randomized controlled trial. Within the selected studies, the sample size varied between 28 and 119 patients, with mean ages ranging from 48 to 67 years old in patients with CAD after an acute myocardial infarction, coronary artery bypass graft or percutaneous transluminal coronary angioplasty. Although all studies utilized the aerobic exercise mode, the other characteristics of the exercise programmes varied largely between the studies: programme length (from 6 to 20 weeks), exercise duration (15–20 to 50 min) and exercise intensity, which was based on heart rate reserve (40 to 85%) or heart rate at anaerobic threshold or ventilatory threshold. All the three studies evaluating pulse wave velocity, as well as one of two studies that assessed the augmentation index, reported significant reductions on those variables after exercise training. Results indicated that the majority of the AS and related measures improved after the different exercise training programmes. However, these results need to be confirmed in future randomized clinical studies controlling potential confounders.     

Relationship between lifestyle factors and hyperhomocysteinemia in general Chinese population: a cross-sectional study

Objectives: Hyperhomocysteinemia (Hhcy) is a known cardiovascular disease (CVD) risk factor. Observational studies had supported the role of lifestyle factors such as physical activity, diet and alcohol consumption in CVD prevention. Our study aimed to determine the relationship between Hhcy and lifestyle factors in general Chinese population.

Methods: In this cross-sectional study, a total of 7135 adults (3320 men and 3815 women) aged 35 years or older were recruited from the rural Northeast China. Data on lifestyle factors, such as physical activities, sleep duration, current smoking and drinking status, dietary habits and familial factors were collected in interviews and laboratory examinations were performed by well-trained personnel.

Results: Plasma total homocysteine (tHcy) level was higher in men than in women, and greater in the elderly than in other age groups. Subjects with Hhcy were more likely to be current smokers (men: OR 1.328, 95% CI 1.143–1.543, p<0.001; women: OR 1.465, 95% CI 1.214–1.767, p<0.001). Separately, men with Hhcy were more likely to have an education of primary school or below (OR 1.251, 95% CI 1.068–1.465, p=0.006) and less likely to eat more vegetables (OR 0.927, 95% CI 0.863–0.996, p=0.037) than the normal-tHcy participants. In women, participants with Hhcy were more likely to have longer sleeping time (>9h/d) (OR 1.677, 95% CI 1.292–2.177, p<0.001), low physical activity (OR 1.721, 95% CI 1.197–2.475, p=0.044) and increased diet score (OR 1.126, 95% CI 1.007–1.259, p=0.037) and less likely to be current drinkers (OR 0.488, 95% CI 0.297–0.802, p=0.005) than the normal-tHcy participants.

Conclusion: Our study revealed that physical activity and current drinking status were not significantly associated with Hhcy in males, but inversely associated in females. In both genders, current smoking status and dietary habits were significantly associated with Hhcy. Our study supports existing recommendations for Chinese to maintain a physically active behaviors and healthy lifestyle habits.     

Site-specific association between distal aortic pulse wave velocity and peripheral arterial stenosis severity: a prospective cardiovascular magnetic resonance study

Background

Vascular disease expression in one location may not be representative for disease severity in other vascular territories, however, strong correlation between disease expression and severity within the same vascular segment may be expected. Therefore, we hypothesized that aortic stiffening is more strongly associated with disease expression in a vascular territory directly linked to that aortic segment rather than in a more remote segment. We prospectively compared the association between aortic wall stiffness, expressed by pulse wave velocity (PWV), sampled in the distal aorta, with the severity of peripheral arterial occlusive disease (PAOD) as compared to atherosclerotic markers sampled in remote vascular territories such as PWV in the proximal aorta and the normalized wall index (NWI), representing the vessel wall thickness, of the left common carotid artery.

Methods

Forty-two patients (23 men; mean age 64±10 years) underwent velocity-encoded cardiovascular magnetic resonance (CMR) in the proximal and distal aorta, whole-body contrast-enhanced MR angiography (CE-MRA) and carotid vessel wall imaging with black-blood CMR in the work-up for PAOD. Strength of associations between aortic stiffness, carotid NWI and peripheral vascular stenosis grade were assessed and evaluated with multiple linear regression.

Results

Stenosis severity correlated well with PWV in the distal aorta (Pearson r_P=0.64, p<0.001, Spearman r_S=0.65, p<0.001) but to a lesser extent with PWV in the proximal aorta (r_P=0.48, p=0.002, r_S=0.22, p=0.18). Carotid NWI was not associated with peripheral stenosis severity (r_P=0.17, p=0.28, r_S=0.14, p=0.37) nor with PWV in the proximal aorta (r_P=0.22, p=0.17) nor in the distal aorta (r_P=0.21, p=0.18). Correlation between stenosis severity and distal aortic PWV remained statistically significant after correction for age and gender.

Conclusions

Distal aortic wall stiffness is more directly related to peripheral arterial stenosis severity than markers from more remote vascular territories such as proximal aortic wall stiffness or carotid arterial wall thickness. Site-specific evaluation of vascular disease may be required for full vascular risk estimation.     

Reliability of arterial stiffness indices at rest and following a single bout of moderate‐intensity exercise in older adults

Short‐term changes in arterial stiffness with exercise are proposed to better reflect vascular impairments than resting measures alone and are suggested as a prognostic indicator of cardiovascular risk in older adults. Arterial stiffness indices are reliable at rest, but the time‐course and reliability of postexercise changes in arterial stiffness in older adults are unknown. The precision of postexercise changes in arterial stiffness should be determined prior to their use in large prospective trials. This study assessed the between‐day reliability of the changes in pulse wave velocity (PWV), augmentation index (AIx75) and reflection magnitude (RM) following an exercise bout in older adults. Ten older adults (71 ± 5 years) were tested on three separate days, 7 days apart. PWV, AIx75 and RM were assessed at rest, immediately post and at 20, 40 and 60 min during recovery after moderate‐intensity cycling. Intraclass correlation coefficient (ICC) and reliability coefficient (RC) were used to assess the relative and absolute reliability of arterial stiffness responses. PWV increased, and RM decreased immediately after exercise (P<0·05), and returned to baseline during recovery. AIx decreased during recovery (P<0·001). Resting ICC values were 0·91 (PWV), 0·72 (AIx75) and 0·40 (RM). Reliability of the immediate changes following exercise was high for PWV (ICC:0·87, RC:1·9 m s^?1) and moderate for AIx75 (ICC:0·64, RC:7%) and RM (ICC:0·59, RC:9%). Reliability of the postexercise responses was similar to that at rest for all measures of arterial stiffness. These findings indicate that postexercise changes in arterial stiffness indices are reliable in healthy older adults and supports further investigation of the prognostic value of these responses.     

The relationship between tissue Doppler imaging and seric NTproBNP levels in sinus rhythm patients: a prospective study

N-terminal pro-brain natriuretic peptide (NTproBNP) correlates with left ventricular (LV) filling pressure. The ratio between early diastolic transmitral velocity and early mitral annular diastolic velocity (E/Ea) reflects LV filling pressure in a variety of cardiac diseases. However this relationship was not validated in some categories of patients. Our aim was to evaluate the correlation between tissue Doppler velocities of the mitral annulus and NTproBNP levels in sinus rhythm patients. Methods Echocardiography was performed in 111 consecutive patients simultaneously with NTproBNP measurement. E/Ea and E/(Ea × Sa) were calculated (Sa is the maximal systolic velocity of mitral annulus); the average of the velocities of septal and lateral mitral annulus was used. Results Simple regression analysis demonstrated a significant linear correlation between E/(Ea × Sa) and NTproBNP (r = 0.71, P < 0.0001), superior to E/Ea correlation (r = 0.58, P < 0.0001). Significant but weaker correlations were found between NTproBNP and Sa, pulmonary artery systolic pressure, Ea, mitral E/A (early/late diastolic transmitral velocity), E wave, mitral E deceleration time and LV ejection fraction (LVEF). The optimal E/(Ea × Sa) cut-off for prediction of NTproBNP levels > 900 pg/ml was 1.5 (sensitivity = 81%, specificity = 70%). Among analyzed parameters, E/(Ea × Sa) was best correlated with NTproBNP levels in patients with LVEF ≥ 50% (r = 0.80, P < 0.0001), with depressed LVEF (<50%) (r = 0.66, P < 0.0001), with regional wall motion abnormalities (r = 0.75, P < 0.0001), and with E/Ea 8 to 15 (r = 0.58, P < 0.0001). Conclusions E/(Ea × Sa) strongly correlates with NTproBNP, regardless of LVEF, and can be a simple and accurate echocardiographic index in patients in sinus rhythm, particularly in those with regional wall motion abnormalities or intermediate E/Ea.     

新疆维吾尔族健康及冠心病人群中体质指数、腰围与动脉僵硬程度相关性研究

目的研究新疆地区维吾尔族健康及冠心病人群中体质指数(BMI)、腰围与动脉僵硬程度相关性。方法本研究纳入新疆地区冠心病患者113例,健康人92人。测量其体质指数、腰围、臂踝脉搏波传导速度(PWV)及各项生化指标。分别在健康人群与冠心病人群中,用体质指数、腰围与PWV做线性相关性分析,并对PWV的影响因素进行校正。结果在健康人群中,PWV与BMI无相关性(r=0.076,P>0.05),PWV与腰围呈正相关(r=0.218,P<0.05)。在冠心病患者中,PWV与BMI存在正相关(r=0.232,P<0.05),PWV与腰围呈正相关(r=0.256,P<0.01)。经过对年龄,性别及其他心血管危险因素的校正,在冠心病人群中,BMI每增加1 kg/m2可能会伴随着PWV增加0.053 m/s,腰围每增加1 cm可能伴随着PWV增加0.027 m/s。结论无论在维吾尔族冠心病患者中或健康人群中,腹部肥胖的测量指标(腰围)、全身肥胖的测量指标(BMI)与PWV所反映的动脉僵硬程度呈正相关。     

The relationship between the implementation and effectiveness of a nationwide physical activity telephone counseling service for adults with spinal cord injury

Purpose: Get in Motion (GIM) is an evidence-based telephone counseling service that promotes leisure-time physical activity (LTPA) among Canadian adults with spinal cord injury (SCI). The first phase of GIM sustained intentions for, and increased participation in, LTPA; however, it is unclear how GIM led to these outcomes. The purpose of this study was to explore the implementation correlates of change in LTPA intentions and behavior in the second phase of GIM.

Methods: The frequency, duration, and content of counseling sessions were tailored to meet clients’ (N?=?46; 50.0% male; 50.0% paraplegia; 51.46 (SD 12.36) years old) needs and preferences. Intervention dose and content were monitored using Counseling Session Checklists. Clients self-reported their intentions for and actual aerobic and strength-training LTPA participation at baseline, 2-, 4-, and 6-months, and their perceptions of service quality at 6-months.

Results: The second phase of GIM effectively sustained LTPA intentions and increased time spent on moderate-to-vigorous strength-training and total LTPA. Increases in clients’ moderate-to-vigorous aerobic LTPA were significantly positively related to intervention dose, intervention content (both informational and behavioral strategies), and clients’ perceptions of service credibility.

Conclusions: This study identified intervention dose and content as key implementation variables for an LTPA telephone counseling service for adults with SCI.

• Implications for Rehabilitation

• An evidence- and theory-based telephone counseling service can effectively sustain LTPA intentions and increase LTPA behavior among adults with SCI.

• The first two months of the service are a critical period for enhancing LTPA participation and for minimizing dropouts.

• The provision of both informational and behavioral strategies is important for increasing aerobic LTPA levels among adults with SCI.

     

臂踝脉搏波速度和代谢综合征危险因素的相关性

目的 探讨臂踝脉搏波速度(BaPWV)和代谢综合征危险因素的相关性.方法 入选2 753例体检者,年龄25～82岁,平均(44.7±9.6)岁,进行BaPWV、身高、体重、心率、血压的测量,收集空腹血糖、总胆固醇、甘油三酯、HDL和LDL.根据代谢综合征危险因素的个数分为4组,比较4组之间BaPWV的差异.其中将具有2个及2个以上危险因素的人群视为代谢综合征高危人群.结果 4组之间采用方差分析,组与组之间在基本资料和BaPWV方面均有显著差异,具有统计学意义(P<0.05),多元线性回归显示年龄、HR、BMI、血糖、甘油三酯、HDL、PP、SBP是代谢综合征高危人群BaPWV的相关因素(R2=0.566),而SBP、年龄、HR、血糖、BMI是影响BaPWV的独立相关因素.结论 BaPWV随着代谢综合征的危险因素个数增加而升高,SBP、年龄、HR、血糖、BMI是BaPWV的独立影响因素.     

The influence of meaningful activities in the quality of life and functional autonomy of adults with intellectual disability: A prospective study during the COVID-19 pandemic

Background

The COVID-19 pandemic might negatively impact the quality of life and functional autonomy of Spanish adults with intellectual disability, and meaningful activities could prevent this negative progression.

Methods

This is a prospective cohort study in Spanish adults with intellectual disability during the COVID-19 pandemic. Quality of life, functional autonomy and functional independence were measured. The meaningful activities studied were structured-leisure, community self-management, and occupational and physical activities.

Results

Seventy-three participants were included in the study. Quality of life and functional autonomy significantly deteriorated during the COVID-19 pandemic (all p > .001). Greater participation in community self-management activities before COVID-19 was associated with less detriment to quality of life (ß = −.312; p = .008), while greater participation in occupational and physical activities was associated with less detriment to the performance of instrumental activities (ß = −.317; p = .016; and ß = −.285; p = .030, respectively).

Conclusion

People with intellectual disability living in residential homes experienced a decrease in their quality of life and functional autonomy during the COVID-19 pandemic. Their involvement in community self-management activities and physical and occupational activities before the pandemic had preventive effects on the detriment to the quality of life and functional autonomy.     

The relationship between labour cost per patient and the size of intensive care units: a multicentre prospective study

Objective We examined the relationship between major ICU characteristics and labour cost per patient.Design Four-week prospective data collection, in which the hours spent by each physician and nurse on both in-ICU and extra-ICU activities were collected.Setting Eighty Italian adult ICUs.Measurements and results The cost of the time actually spent by ICU staff on ICU patients (labour cost) was computed for each participating unit, by applying to the average annual salaries the proportions of in-ICU activity working time for physicians and nurses. Multiple regression analysis was used to identify ICU characteristics that predict labour costs per patient. Labour cost per patient was positively correlated with ICU mortality and patients average length of stay (slopes =0.67, p =0.048 and 0.09, p <0.0001, respectively). Labour cost per patient decreases almost linearly as the number of beds increases up to about eight, and it remains nearly constant above about twelve beds. The number of patients admitted per physician (not per nurse) increases with the number of beds (Spearman correlation coefficient =0.567, p <0.0001).Conclusions Our findings suggest that ICUs with less than about 12 beds are not cost-effective.The authors appear on behalf of the GiViTI group [Gruppo Italiano per la Valutazione degli Interventi in Terapia Intensiva (Italian Group for the Evaluation of Interventions in Intensive Care Medicine)]. A complete list of study participants appears in the Appendix     

The relationship between smoking and quality of life in advanced lung cancer patients: a prospective longitudinal study

Purpose

Smoking is a major cause of lung cancer, and continued smoking may compromise treatment efficacy and quality of life (health-related quality of life (HRQoL)) in patients with advanced lung cancer. Our aims were to determine (i) preference for treatments which promote quality over length of life depending on smoking status, (ii) the relationship between HRQoL and smoking status at diagnosis (T1), after controlling for demographic and clinical variables, and (iii) changes in HRQoL 6 months after diagnosis (T2) depending on smoking status.

Methods

Two hundred ninety-six patients with advanced lung cancer were given questionnaires to assess HRQoL (EORTC QLQ-C30), time-trade-off for life quality versus quantity (QQQ) and smoking history (current, former or never smoker) at diagnosis (T1) and 6 months later (T2). Medical data were extracted from case records.

Results

Questionnaires were returned by 202 (68.2 %) patients at T1 and 114 (53.3 %) at T2. Patients favoured treatments that would enhance quality of life over increased longevity. Those who continued smoking after diagnosis reported worse HRQoL than former smokers or those who never smoked. Smoking status was a significant independent predictor of coughing in T1 (worse in smokers) and cognitive functioning in T2 (better in never smokers).

Conclusions

Smoking by patients with advanced lung cancer is associated with worse symptoms on diagnosis and poorer HRQoL for those who continue smoking. The results have implications to help staff explain the consequences of smoking to patients.

     

血小板相对变化度与脓毒症患者病情严重程度及预后的关系

目的:探讨外周血血小板计数的变化度与脓毒症患者病情及预后的关系。方法:收集2015年3月至2016年6月复旦大学附属中山医院重症医学科(ICU)收治的102例脓毒症患者的相关临床资料。比较血小板相对变化度高低患者相关临床特征的差异,分析血小板相对变化度与病情严重程度及患者死亡率的关系。结果:患者的血小板相对变化度与患者入ICU时的急性生理与慢性健康评分Ⅱ(r=-0.397,P0.001)、脓毒症相关性器官功能衰竭评分(r=-0.317,P=0.001)评分负相关。多因素回归分析显示,血小板相对变化度是脓毒症患者ICU死亡的独立预测因素(OR=0.174,95%CI 0.040~0.758,P=0.02)。结论:脓毒症患者外周血血小板计数的变化程度能较好地反映疾病严重程度,且与患者ICU死亡率密切相关。     

Intensity of industrial noise and the incidence of arterial hypertension (according to data from a prospective epidemiological study of organized female populations in Moscow

A prospective epidemiological study of women at textile mills (a study group) working under the conditions of intense industrial noise (85-105 dBA) and at bakeries without such noise (a control group) was conducted. In the study group 353 (80%) women and 450 (71%) controls were repeatedly examined after 4.9 and 4.2 yrs, respectively. In the presence of such factors as borderline AH, smoking, aggravated heredity with respect to AH, MI and cerebral stroke, noise increased 3-fold, on an average, the risk of AH development as compared to its absence. Therefore noise can be defined as a "decisive" factor for the action of other AH risk factors.     

Walking activity of children with cerebral palsy and children developing typically: a comparison between the Netherlands and the United States

Abstract

Purpose: To compare walking activity of children with and without cerebral palsy (CP) between the Netherlands and the United States. Methods: A cross-sectional analysis on walking activity data from an international retrospective comparison study including a convenience sample of 134 walking children aged 7–12 years with spastic CP, classified as Gross Motor Function Classification System (GMFCS) level I (N?=?64), II (N?=?49) or III (N?=?21), and 223 typically developing children (TDC) from the Netherlands and the United States. Walking activity was assessed during a one-week period using a StepWatch? activity monitor. Outcomes were the daily number of strides, daily time being inactive and spent at low (0–15 strides/min), moderate (16–30 strides/min) and high stride rate (31–60 strides/min). Walking activity was compared between countries using multiple linear regression analyses. Results: Walking activity of TDC was not significantly different between countries. Compared to their American counterparts, Dutch children in GMFCS level I and II showed less walking activity (p?<?0.05), whereas Dutch children in GMFCS level III showed more walking activity (p?<?0.05). Conclusion: The absence of differences in walking activity between Dutch and American TDC, and the presence of differences in walking activity between Dutch and American children with CP suggest that between-country differences affect walking activity differently in children with CP.

• Implications for Rehabilitation

• Physical activity of children with CP should be promoted in both the United States and the Netherlands.

• The between-country differences in walking activity illustrate that apart from the severity of the CP walking activity seems to be influenced by environmental aspects.

• In the promotion of physical activity, practitioners should pay attention to environmental barriers that families may experience for increasing physical activity.

     

The effects of sleep on the relationship between brain injury severity and recovery of cognitive function: A prospective study

Background

Disturbed sleep pattern is a common symptom after head trauma and its prevalence in acute traumatic brain injury (TBI) is less discussed. Sleep has a profound impact on cognitive function recovery and the mediating effect of disturbed sleep on cognitive function recovery has not been examined after acute TBI.

Objectives

To identify the prevalence of disturbed sleep in mild, moderate, and severe acute TBI patients, and to determine the mediating effects of sleep on the relationship between brain injury severity and the recovery of cognitive function.

Design

A prospective study design.

Setting

Neurosurgical wards in a medical center in northern Taiwan.

Participants

Fifty-two acute TBI patients between the ages of 18 and 65 years who had received a diagnosis of TBI for the first time, and were admitted to the neurosurgical ward.

Method

The severity of brain injury was initially determined using the Glasgow Coma Scale. Each patient wore an actigraphy instrument on a non-paralytic or non-dominated limb for 7 consecutive days. A 7-day sleep diary was used to facilitate data analysis. Cognitive function was assessed on the first and seventh day after admission based on the Rancho Los Amigos Levels of Cognitive Functioning.

Results

The mild (n = 35), moderate (n = 7) and severe (n = 10) TBI patients exhibited poorer sleep efficiency, and longer total sleep time (TST) and waking time after sleep onset, compared with the normative values for the sleep-related variables (P < .05 for all). The severe and moderate TBI patients had longer daytime TST than the mild TBI patients (P < .001), and the severe TBI patients had longer 24-h TST than the mild TBI patients (P = .001). The relationship between the severity of brain injury and the recovery of cognition function was mediated by daytime TST (t = −2.65, P = .004).

Conclusions

Poor sleep efficiency, prolonged periods of daytime sleep, and a high prevalence of hypersomnia are common symptoms in acute TBI patients. The duration of daytime sleep mediates the relationship between the severity of brain injury and the recovery of cognition function.