OBJECTIVE: The purpose was to identify the characteristics predictive of sleep disorder in
a sample of traumatic brain injury (TBI) patients, twelve months or more following
DESIGN: A between-subject design explored the relationship between the participant's
sleep disturbance and the severity of TBI. A within-subjects design investigated
reliability of the sleep disorder self-report and explored differences between ratings of the
participant and a significant other. In addition, qualitative analysis based on content
analysis, investigated themes relating to sleep experiences generated by a semi-structured
PARTICIPANTS: Eighteen males and 15 significant others were recruited from patients who
were admitted to The Scottish Brain Injury Unit (SBIRS) between June 2002 and June
1997. The participants were predominantly in tire severe TBI category.
MEASURES: The following were the factors measured, and the instruments used for this
purpose: sleep quality (The Pittsburgh Sleep Index; PSQI), psychological distress
(Hamilton rating Scale for Depression, HRSD; Hospital Anxiety and Depression Scale,
HADS) and fatigue (Bentall fatigue inventory and a Visual Analogue Scale, VAS-F).
Significant others completed only the PSQI.
RESULTS: Fifty per cent of the sample reported poor sleep quality and 22 per cent of the
participants had insomnia. Among the demographic, affective and injury variables
examined, the strongest relationship with sleep quality was linked to depression. The
significant other ratings were no different to the participant's self-ratings. Interestingly,
sleep quality rather than TBI severity appeared linked to depression
CONCLUSIONS: This sample has reported slightly lower rates of sleep disturbance than a
comparable post acute population but this is still more than double the rate of sleep
disturbance in the normal population. There was evidence that links may be between poor
sleep quality and depression, perhaps even depression secondary to insomnia, rather than
TBI. In addition TBI is considered as a model for depression. The importance of
evaluating treatments for insomnia in this group is discussed.