Abstract
Background.
Sleep is important for consolidation of motor learning, but brain
injury may affect sleep continuity and therefore rehabilitation
outcomes.
Objective.
This study aims to assess the relationship
between sleep quality and motor recovery in brain injury patients
receiving inpatient rehabilitation.
Methods.
Fifty-nine patients
with brain injury were recruited from 2 specialist inpatient
rehabilitation units. Sleep quality was assessed (up to 3 times)
objectively using actigraphy (7 nights) and subjectively using the Sleep
Condition Indicator. Motor outcome assessments included Action Research
Arm test (upper limb function), Fugl-Meyer Assessment (motor
impairment), and the Rivermead Mobility Index. The Functional
Independence Measure (FIM) was assessed at admission and discharge by
the clinical team. Fifty-five age- and gender-matched healthy controls
completed one assessment. Results. Inpatients demonstrated lower self-reported sleep quality (P < .001) and more fragmented sleep (P
< .001) than controls. For inpatients, sleep fragmentation explained
significant additional variance in motor outcomes, over and above that
explained by admission FIM score (P < .017), such that more
disrupted sleep was associated with poorer motor outcomes. Using
stepwise linear regression, sleep fragmentation was the only variable
found to explain variance in rate of change in FIM (R2adj = 0.12, P = .027), whereby more disrupted sleep was associated with slower recovery. Conclusions.
Inpatients with brain injury demonstrate impaired sleep quality, and
this is associated with poorer motor outcomes and slower functional
recovery. Further investigation is needed to determine how sleep quality
can be improved and whether this affects outcome.
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