Sleep disturbances affect up to 70 percent of individuals with traumatic brain injury (TBI). These changes can be largely detrimental to everyday life in individuals with TBI, who may begin to experience increased daytime sleepiness, poor sleep efficiency, and poor sleep quality. While some sleep disturbances only occur in the acute phase of TBI recovery, these problems may persist in certain individuals for months or years, diminishing their quality of life while also impairing the TBI recovery process. Nursing staff in inpatient rehabilitation settings typically use sleep logs to keep track of this important aspect of TBI patients’ lives. These data are used used by clinicians to direct treatment toward improving sleep in patients who experience sleep disruptions.
While sleep logs are a standard practice for TBI patients who are unable to tolerate polysomnography, a more reliable type of comprehensive sleep test that tracks multiple physiological activities overnight, there is a lack of robust evidence regarding the accuracy of these logs. To strengthen this area of research, a team of sleep experts designed a study of 30 patients with moderate-to-severe TBI, comparing their total hours of sleep reported by sleep logs to that reported by actigraphy watches, a less invasive alternative technology to polysomnography. Like polysomnography, actigraphy watches collect data about a person’s sleep/wake cycle overnight, enabling the researchers to compare actual biometric data with the sleep patterns reported subjectively in the sleep logs.
The results showed that, across all measurements, sleep logs overestimated total sleep time by an average of 60 minutes. Individuals’ sleep was observed for 210 consecutive days, and there was high variability between sleep logs and actigraphs. Only half of participants’ sleep logs recorded total sleep time within one hour of actigraphy measurements, and less than one-quarter of sleep logs were accurate within 30 minutes.
Overall, these findings demonstrate a lack of correspondence between inpatient sleep logs and sleep times measured using actigraphy devices. This is consistent with the idea that sleep/wake cycle disturbances may be underreported by sleep logs. Accordingly, clinicians should use sleep logs with caution, especially when making decisions regarding sleep disorder interventions for individuals with TBI. Going forward, research on biometric sleep measurement devices may offer lower-cost, less invasive technologies to objectively monitor sleep quality among TBI patients.
Weppner J, Hillaker E, Boomgaardt J, et al. Actigraphic and nursing sleep log measurements in moderate-to-severe traumatic brain injury: Identifying discrepancies in total sleep time. PM&R. (December 2022).