Optimized Sleep After Brain Injury (OSABI): A Pilot Study of a Sleep Hygiene Intervention for Individuals With Moderate to Severe Traumatic Brain Injury

Michael J. Makley; Don Gerber; Jody K. Newman; Angie Philippus; Kimberley R Monden; Jennifer Biggs; Eric Spier; Patrick Tarwater; Alan Weintraub

doi:10.1177/1545968319895478

Optimized Sleep After Brain Injury (OSABI): A Pilot Study of a Sleep Hygiene Intervention for Individuals With Moderate to Severe Traumatic Brain Injury

Michael J. Makley, Don Gerber, Jody K. Newman, Angie Philippus, Kimberley R Monden, Jennifer Biggs, Eric Spier, Patrick Tarwater, Alan Weintraub

Research output: Contribution to journal › Article › peer-review

17 Scopus citations

Abstract

Background. Disrupted sleep is common after traumatic brain injury (TBI) particularly in the inpatient rehabilitation setting where it may affect participation in therapy and outcomes. Treatment of sleep disruption in this setting is varied and largely unexamined. Objective. To study the feasibility of instituting a sleep hygiene intervention on a rehabilitation unit. Methods. Twenty-two individuals admitted to a brain injury unit were enrolled and allocated, using minimization, to either a sleep hygiene protocol (SHP) or standard of care (SOC). All participants wore actigraphs, underwent serial cognitive testing, and had light monitors placed in their hospital rooms for 4 weeks. Additionally, participants in the SHP received 30 minutes of blue-light therapy each morning, had restricted caffeine intake after noon, and were limited to 30-minute naps during the day. SHP participants had their lights out time set according to preinjury sleep time preference. Both groups were treated with the same restricted formulary of centrally acting medications. Results. Of 258 patients screened, 27 met all study inclusion criteria of whom 22 were enrolled. Nine participants in each group who had at least 21 days of treatment were retained for analysis. The protocol was rated favorably by participants, families, and staff. Actigraph sleep metrics improved in both groups during the 4-week intervention; however, only in the SHP was the change significant. Conclusions. Sleep hygiene is a feasible, nonpharmacologic intervention to treat disrupted sleep in a TBI inpatient rehabilitation setting. A larger study is warranted to examine treatment efficacy. ClinicalTrials.gov Identifier: NCT02838082.

Original language	English (US)
Pages (from-to)	111-121
Number of pages	11
Journal	Neurorehabilitation and Neural Repair
Volume	34
Issue number	2
DOIs	https://doi.org/10.1177/1545968319895478
State	Published - Feb 1 2020
Externally published	Yes

Bibliographical note

Funding Information:
https://orcid.org/0000-0002-9038-7856 Makley Michael J. MD 1 2 3 Gerber Don PsyD, ABPP 1 Newman Jody K. MA, CC-SLP 1 Philippus Angie MS 1 https://orcid.org/0000-0002-5207-0452 Monden Kimberley R. PhD 1 3 Biggs Jennifer RN, MSN, CNRN, NEA-BC 1 Spier Eric MD 1 2 3 Tarwater Patrick PhD 4 Weintraub Alan MD 1 2 3 1 Craig Hospital, Englewood, CO, USA 2 CNS Medical Group, Englewood, CO, USA 3 University of Colorado School of Medicine, Aurora, CO, USA 4 Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA Michael J. Makley, Craig Hospital, CNS Medical Group, 3425 South Clarkson Street, Englewood, CO 80113, USA. Email: mmakley@craighospital.org 12 2019 1545968319895478 © The Author(s) 2019 2019 American Society of Neurorehabilitation Background . Disrupted sleep is common after traumatic brain injury (TBI) particularly in the inpatient rehabilitation setting where it may affect participation in therapy and outcomes. Treatment of sleep disruption in this setting is varied and largely unexamined. Objective . To study the feasibility of instituting a sleep hygiene intervention on a rehabilitation unit. Methods . Twenty-two individuals admitted to a brain injury unit were enrolled and allocated, using minimization, to either a sleep hygiene protocol (SHP) or standard of care (SOC). All participants wore actigraphs, underwent serial cognitive testing, and had light monitors placed in their hospital rooms for 4 weeks. Additionally, participants in the SHP received 30 minutes of blue-light therapy each morning, had restricted caffeine intake after noon, and were limited to 30-minute naps during the day. SHP participants had their lights out time set according to preinjury sleep time preference. Both groups were treated with the same restricted formulary of centrally acting medications. Results . Of 258 patients screened, 27 met all study inclusion criteria of whom 22 were enrolled. Nine participants in each group who had at least 21 days of treatment were retained for analysis. The protocol was rated favorably by participants, families, and staff. Actigraph sleep metrics improved in both groups during the 4-week intervention; however, only in the SHP was the change significant. Conclusions . Sleep hygiene is a feasible, nonpharmacologic intervention to treat disrupted sleep in a TBI inpatient rehabilitation setting. A larger study is warranted to examine treatment efficacy. ClinicalTrials.gov Identifier: NCT02838082. sleep disorders traumatic brain injury (TBI) actigraphy sleep hygiene rehabilitation circadian disorders sleep/wake cycle disorders Craig Hospital Foundation MindSource edited-state corrected-proof typesetter ts1 The authors would like to acknowledge the contributions of Dr Richard Allen from Johns Hopkins School of Medicine, Dr Jeanine Duffy of Harvard School of Medicine, and Dr Simon Beaulieu-Bonneau from Laval University for their valuable input on the development of the protocol. The authors would also like to acknowledge the involvement and support of the caring and dedicated rehabilitation nursing and therapy staff of Craig Hospital’s Brain Injury Unit as well as the patients and families who participated in this study. Supplementary material for this article is available on the Neurorehabilitation & Neural Repair website at https://journals.sagepub.com/home/nnr . Declaration of Conflicting Interests The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. Funding The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This work was supported by the Craig Hospital Foundation and MINDSOURCE—Brain Injury Network, formerly the Colorado Brain Injury Trust Program, under grant number NCT02838082 ORCID iDs Michael J. Makley https://orcid.org/0000-0002-9038-7856 Kimberley R. Monden https://orcid.org/0000-0002-5207-0452

Funding Information:
The authors would like to acknowledge the contributions of Dr Richard Allen from Johns Hopkins School of Medicine, Dr Jeanine Duffy of Harvard School of Medicine, and Dr Simon Beaulieu-Bonneau from Laval University for their valuable input on the development of the protocol. The authors would also like to acknowledge the involvement and support of the caring and dedicated rehabilitation nursing and therapy staff of Craig Hospital?s Brain Injury Unit as well as the patients and families who participated in this study. The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This work was supported by the Craig Hospital Foundation and MINDSOURCE?Brain Injury Network, formerly the Colorado Brain Injury Trust Program, under grant number NCT02838082

Publisher Copyright:
© The Author(s) 2019.

Keywords

actigraphy
circadian disorders
rehabilitation
sleep disorders
sleep hygiene
sleep/wake cycle disorders
traumatic brain injury (TBI)

PubMed: MeSH publication types

Clinical Trial
Journal Article
Research Support, Non-U.S. Gov't

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10.1177/1545968319895478

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Cite this

Makley, M. J., Gerber, D., Newman, J. K., Philippus, A., Monden, K. R., Biggs, J., Spier, E., Tarwater, P., & Weintraub, A. (2020). Optimized Sleep After Brain Injury (OSABI): A Pilot Study of a Sleep Hygiene Intervention for Individuals With Moderate to Severe Traumatic Brain Injury. Neurorehabilitation and Neural Repair, 34(2), 111-121. https://doi.org/10.1177/1545968319895478

Makley, MJ, Gerber, D, Newman, JK, Philippus, A, Monden, KR, Biggs, J, Spier, E, Tarwater, P & Weintraub, A 2020, 'Optimized Sleep After Brain Injury (OSABI): A Pilot Study of a Sleep Hygiene Intervention for Individuals With Moderate to Severe Traumatic Brain Injury', Neurorehabilitation and Neural Repair, vol. 34, no. 2, pp. 111-121. https://doi.org/10.1177/1545968319895478

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title = "Optimized Sleep After Brain Injury (OSABI): A Pilot Study of a Sleep Hygiene Intervention for Individuals With Moderate to Severe Traumatic Brain Injury",

abstract = "Background. Disrupted sleep is common after traumatic brain injury (TBI) particularly in the inpatient rehabilitation setting where it may affect participation in therapy and outcomes. Treatment of sleep disruption in this setting is varied and largely unexamined. Objective. To study the feasibility of instituting a sleep hygiene intervention on a rehabilitation unit. Methods. Twenty-two individuals admitted to a brain injury unit were enrolled and allocated, using minimization, to either a sleep hygiene protocol (SHP) or standard of care (SOC). All participants wore actigraphs, underwent serial cognitive testing, and had light monitors placed in their hospital rooms for 4 weeks. Additionally, participants in the SHP received 30 minutes of blue-light therapy each morning, had restricted caffeine intake after noon, and were limited to 30-minute naps during the day. SHP participants had their lights out time set according to preinjury sleep time preference. Both groups were treated with the same restricted formulary of centrally acting medications. Results. Of 258 patients screened, 27 met all study inclusion criteria of whom 22 were enrolled. Nine participants in each group who had at least 21 days of treatment were retained for analysis. The protocol was rated favorably by participants, families, and staff. Actigraph sleep metrics improved in both groups during the 4-week intervention; however, only in the SHP was the change significant. Conclusions. Sleep hygiene is a feasible, nonpharmacologic intervention to treat disrupted sleep in a TBI inpatient rehabilitation setting. A larger study is warranted to examine treatment efficacy. ClinicalTrials.gov Identifier: NCT02838082.",

keywords = "actigraphy, circadian disorders, rehabilitation, sleep disorders, sleep hygiene, sleep/wake cycle disorders, traumatic brain injury (TBI)",

author = "Makley, {Michael J.} and Don Gerber and Newman, {Jody K.} and Angie Philippus and Monden, {Kimberley R} and Jennifer Biggs and Eric Spier and Patrick Tarwater and Alan Weintraub",

note = "Funding Information: https://orcid.org/0000-0002-9038-7856 Makley Michael J. MD 1 2 3 Gerber Don PsyD, ABPP 1 Newman Jody K. MA, CC-SLP 1 Philippus Angie MS 1 https://orcid.org/0000-0002-5207-0452 Monden Kimberley R. PhD 1 3 Biggs Jennifer RN, MSN, CNRN, NEA-BC 1 Spier Eric MD 1 2 3 Tarwater Patrick PhD 4 Weintraub Alan MD 1 2 3 1 Craig Hospital, Englewood, CO, USA 2 CNS Medical Group, Englewood, CO, USA 3 University of Colorado School of Medicine, Aurora, CO, USA 4 Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA Michael J. Makley, Craig Hospital, CNS Medical Group, 3425 South Clarkson Street, Englewood, CO 80113, USA. Email: mmakley@craighospital.org 12 2019 1545968319895478 {\textcopyright} The Author(s) 2019 2019 American Society of Neurorehabilitation Background . Disrupted sleep is common after traumatic brain injury (TBI) particularly in the inpatient rehabilitation setting where it may affect participation in therapy and outcomes. Treatment of sleep disruption in this setting is varied and largely unexamined. Objective . To study the feasibility of instituting a sleep hygiene intervention on a rehabilitation unit. Methods . Twenty-two individuals admitted to a brain injury unit were enrolled and allocated, using minimization, to either a sleep hygiene protocol (SHP) or standard of care (SOC). All participants wore actigraphs, underwent serial cognitive testing, and had light monitors placed in their hospital rooms for 4 weeks. Additionally, participants in the SHP received 30 minutes of blue-light therapy each morning, had restricted caffeine intake after noon, and were limited to 30-minute naps during the day. SHP participants had their lights out time set according to preinjury sleep time preference. Both groups were treated with the same restricted formulary of centrally acting medications. Results . Of 258 patients screened, 27 met all study inclusion criteria of whom 22 were enrolled. Nine participants in each group who had at least 21 days of treatment were retained for analysis. The protocol was rated favorably by participants, families, and staff. Actigraph sleep metrics improved in both groups during the 4-week intervention; however, only in the SHP was the change significant. Conclusions . Sleep hygiene is a feasible, nonpharmacologic intervention to treat disrupted sleep in a TBI inpatient rehabilitation setting. A larger study is warranted to examine treatment efficacy. ClinicalTrials.gov Identifier: NCT02838082. sleep disorders traumatic brain injury (TBI) actigraphy sleep hygiene rehabilitation circadian disorders sleep/wake cycle disorders Craig Hospital Foundation MindSource edited-state corrected-proof typesetter ts1 The authors would like to acknowledge the contributions of Dr Richard Allen from Johns Hopkins School of Medicine, Dr Jeanine Duffy of Harvard School of Medicine, and Dr Simon Beaulieu-Bonneau from Laval University for their valuable input on the development of the protocol. The authors would also like to acknowledge the involvement and support of the caring and dedicated rehabilitation nursing and therapy staff of Craig Hospital{\textquoteright}s Brain Injury Unit as well as the patients and families who participated in this study. Supplementary material for this article is available on the Neurorehabilitation & Neural Repair website at https://journals.sagepub.com/home/nnr . Declaration of Conflicting Interests The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. Funding The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This work was supported by the Craig Hospital Foundation and MINDSOURCE—Brain Injury Network, formerly the Colorado Brain Injury Trust Program, under grant number NCT02838082 ORCID iDs Michael J. Makley https://orcid.org/0000-0002-9038-7856 Kimberley R. Monden https://orcid.org/0000-0002-5207-0452 Funding Information: The authors would like to acknowledge the contributions of Dr Richard Allen from Johns Hopkins School of Medicine, Dr Jeanine Duffy of Harvard School of Medicine, and Dr Simon Beaulieu-Bonneau from Laval University for their valuable input on the development of the protocol. The authors would also like to acknowledge the involvement and support of the caring and dedicated rehabilitation nursing and therapy staff of Craig Hospital?s Brain Injury Unit as well as the patients and families who participated in this study. The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This work was supported by the Craig Hospital Foundation and MINDSOURCE?Brain Injury Network, formerly the Colorado Brain Injury Trust Program, under grant number NCT02838082 Publisher Copyright: {\textcopyright} The Author(s) 2019.",

year = "2020",

month = feb,

day = "1",

doi = "10.1177/1545968319895478",

language = "English (US)",

volume = "34",

pages = "111--121",

journal = "Neurorehabilitation and Neural Repair",

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TY - JOUR

T1 - Optimized Sleep After Brain Injury (OSABI)

T2 - A Pilot Study of a Sleep Hygiene Intervention for Individuals With Moderate to Severe Traumatic Brain Injury

AU - Makley, Michael J.

AU - Gerber, Don

AU - Newman, Jody K.

AU - Philippus, Angie

AU - Monden, Kimberley R

AU - Biggs, Jennifer

AU - Spier, Eric

AU - Tarwater, Patrick

AU - Weintraub, Alan

N1 - Funding Information: https://orcid.org/0000-0002-9038-7856 Makley Michael J. MD 1 2 3 Gerber Don PsyD, ABPP 1 Newman Jody K. MA, CC-SLP 1 Philippus Angie MS 1 https://orcid.org/0000-0002-5207-0452 Monden Kimberley R. PhD 1 3 Biggs Jennifer RN, MSN, CNRN, NEA-BC 1 Spier Eric MD 1 2 3 Tarwater Patrick PhD 4 Weintraub Alan MD 1 2 3 1 Craig Hospital, Englewood, CO, USA 2 CNS Medical Group, Englewood, CO, USA 3 University of Colorado School of Medicine, Aurora, CO, USA 4 Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA Michael J. Makley, Craig Hospital, CNS Medical Group, 3425 South Clarkson Street, Englewood, CO 80113, USA. Email: mmakley@craighospital.org 12 2019 1545968319895478 © The Author(s) 2019 2019 American Society of Neurorehabilitation Background . Disrupted sleep is common after traumatic brain injury (TBI) particularly in the inpatient rehabilitation setting where it may affect participation in therapy and outcomes. Treatment of sleep disruption in this setting is varied and largely unexamined. Objective . To study the feasibility of instituting a sleep hygiene intervention on a rehabilitation unit. Methods . Twenty-two individuals admitted to a brain injury unit were enrolled and allocated, using minimization, to either a sleep hygiene protocol (SHP) or standard of care (SOC). All participants wore actigraphs, underwent serial cognitive testing, and had light monitors placed in their hospital rooms for 4 weeks. Additionally, participants in the SHP received 30 minutes of blue-light therapy each morning, had restricted caffeine intake after noon, and were limited to 30-minute naps during the day. SHP participants had their lights out time set according to preinjury sleep time preference. Both groups were treated with the same restricted formulary of centrally acting medications. Results . Of 258 patients screened, 27 met all study inclusion criteria of whom 22 were enrolled. Nine participants in each group who had at least 21 days of treatment were retained for analysis. The protocol was rated favorably by participants, families, and staff. Actigraph sleep metrics improved in both groups during the 4-week intervention; however, only in the SHP was the change significant. Conclusions . Sleep hygiene is a feasible, nonpharmacologic intervention to treat disrupted sleep in a TBI inpatient rehabilitation setting. A larger study is warranted to examine treatment efficacy. ClinicalTrials.gov Identifier: NCT02838082. sleep disorders traumatic brain injury (TBI) actigraphy sleep hygiene rehabilitation circadian disorders sleep/wake cycle disorders Craig Hospital Foundation MindSource edited-state corrected-proof typesetter ts1 The authors would like to acknowledge the contributions of Dr Richard Allen from Johns Hopkins School of Medicine, Dr Jeanine Duffy of Harvard School of Medicine, and Dr Simon Beaulieu-Bonneau from Laval University for their valuable input on the development of the protocol. The authors would also like to acknowledge the involvement and support of the caring and dedicated rehabilitation nursing and therapy staff of Craig Hospital’s Brain Injury Unit as well as the patients and families who participated in this study. Supplementary material for this article is available on the Neurorehabilitation & Neural Repair website at https://journals.sagepub.com/home/nnr . Declaration of Conflicting Interests The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. Funding The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This work was supported by the Craig Hospital Foundation and MINDSOURCE—Brain Injury Network, formerly the Colorado Brain Injury Trust Program, under grant number NCT02838082 ORCID iDs Michael J. Makley https://orcid.org/0000-0002-9038-7856 Kimberley R. Monden https://orcid.org/0000-0002-5207-0452 Funding Information: The authors would like to acknowledge the contributions of Dr Richard Allen from Johns Hopkins School of Medicine, Dr Jeanine Duffy of Harvard School of Medicine, and Dr Simon Beaulieu-Bonneau from Laval University for their valuable input on the development of the protocol. The authors would also like to acknowledge the involvement and support of the caring and dedicated rehabilitation nursing and therapy staff of Craig Hospital?s Brain Injury Unit as well as the patients and families who participated in this study. The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This work was supported by the Craig Hospital Foundation and MINDSOURCE?Brain Injury Network, formerly the Colorado Brain Injury Trust Program, under grant number NCT02838082 Publisher Copyright: © The Author(s) 2019.

PY - 2020/2/1

Y1 - 2020/2/1

N2 - Background. Disrupted sleep is common after traumatic brain injury (TBI) particularly in the inpatient rehabilitation setting where it may affect participation in therapy and outcomes. Treatment of sleep disruption in this setting is varied and largely unexamined. Objective. To study the feasibility of instituting a sleep hygiene intervention on a rehabilitation unit. Methods. Twenty-two individuals admitted to a brain injury unit were enrolled and allocated, using minimization, to either a sleep hygiene protocol (SHP) or standard of care (SOC). All participants wore actigraphs, underwent serial cognitive testing, and had light monitors placed in their hospital rooms for 4 weeks. Additionally, participants in the SHP received 30 minutes of blue-light therapy each morning, had restricted caffeine intake after noon, and were limited to 30-minute naps during the day. SHP participants had their lights out time set according to preinjury sleep time preference. Both groups were treated with the same restricted formulary of centrally acting medications. Results. Of 258 patients screened, 27 met all study inclusion criteria of whom 22 were enrolled. Nine participants in each group who had at least 21 days of treatment were retained for analysis. The protocol was rated favorably by participants, families, and staff. Actigraph sleep metrics improved in both groups during the 4-week intervention; however, only in the SHP was the change significant. Conclusions. Sleep hygiene is a feasible, nonpharmacologic intervention to treat disrupted sleep in a TBI inpatient rehabilitation setting. A larger study is warranted to examine treatment efficacy. ClinicalTrials.gov Identifier: NCT02838082.

AB - Background. Disrupted sleep is common after traumatic brain injury (TBI) particularly in the inpatient rehabilitation setting where it may affect participation in therapy and outcomes. Treatment of sleep disruption in this setting is varied and largely unexamined. Objective. To study the feasibility of instituting a sleep hygiene intervention on a rehabilitation unit. Methods. Twenty-two individuals admitted to a brain injury unit were enrolled and allocated, using minimization, to either a sleep hygiene protocol (SHP) or standard of care (SOC). All participants wore actigraphs, underwent serial cognitive testing, and had light monitors placed in their hospital rooms for 4 weeks. Additionally, participants in the SHP received 30 minutes of blue-light therapy each morning, had restricted caffeine intake after noon, and were limited to 30-minute naps during the day. SHP participants had their lights out time set according to preinjury sleep time preference. Both groups were treated with the same restricted formulary of centrally acting medications. Results. Of 258 patients screened, 27 met all study inclusion criteria of whom 22 were enrolled. Nine participants in each group who had at least 21 days of treatment were retained for analysis. The protocol was rated favorably by participants, families, and staff. Actigraph sleep metrics improved in both groups during the 4-week intervention; however, only in the SHP was the change significant. Conclusions. Sleep hygiene is a feasible, nonpharmacologic intervention to treat disrupted sleep in a TBI inpatient rehabilitation setting. A larger study is warranted to examine treatment efficacy. ClinicalTrials.gov Identifier: NCT02838082.

KW - actigraphy

KW - circadian disorders

KW - rehabilitation

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KW - sleep hygiene

KW - sleep/wake cycle disorders

KW - traumatic brain injury (TBI)

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Optimized Sleep After Brain Injury (OSABI): A Pilot Study of a Sleep Hygiene Intervention for Individuals With Moderate to Severe Traumatic Brain Injury

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