Is there a link between alertness and fatigue in patients with traumatic brain injury?
Neurology. 2008-11-10; 71(20): 1609-1613
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1. Neurology. 2008 Nov 11;71(20):1609-13. doi: 10.1212/01.wnl.0000334753.49193.48.
Is there a link between alertness and fatigue in patients with traumatic brain
Chaumet G(1), Quera-Salva MA, Macleod A, Hartley S, Taillard J, Sagaspe P, Mazaux
JM, Azouvi P, Joseph PA, Guilleminault C, Bioulac B, Léger D, Philip P.
(1)Université Bordeaux 2, CNRS UMR-5227, CHU Pellegrin (GENPPHASS), Place Amélie
Raba-Léon, 33076 Bordeaux Cedex, France.
OBJECTIVES: Many patients with traumatic brain injury (TBI) report chronic
fatigue, and previous studies showed a potential relationship between sleepiness
and fatigue in these patients. Our study first looked at the impact of objective
and subjective sleepiness on fatigue in patients with TBI. We then investigated
how fatigue could affect driving performance in these patients.
METHODS: Nocturnal polysomnography, the Fatigue Severity Scale (FSS), the Epworth
Sleepiness Scale (ESS), and five 40-minute maintenance of wakefulness tests (MWT)
were collected in 36 patients with TBI. Fitness to drive was assessed in a
subsample of 22 patients compared to 22 matched controls during an hour simulated
RESULTS: In patients with TBI, FSS, ESS, and mean MWT scores (+/-SD) were 27 +/-
10, 8 +/- 4, and 35 +/- 7 minutes vs 15 +/- 2.5, 5 +/- 3, and 37 +/- 5 minutes in
controls. Patients with TBI reported more chronic fatigue (W = 99, p < 0.001)
than controls, and, unlike in controls, the level of chronic fatigue was
correlated to their MWT scores. Patients' driving performances were worse than
the controls' (W = 79, p < 0.001). The best predictive factors of driving
performance were fatigue scores and body mass index (multiple R = 0.458, 41.8% of
CONCLUSION: In patients with TBI, chronic fatigue is significantly related to
subjective and objective levels of alertness, even though these levels are not
highly pathologic. This might suggest that a small level of sleepiness (i.e., MWT
scores between 33 and 39 minutes) worsens fatigue in these patients. Chronic
fatigue and body mass index could predict driving simulator performance in
patients with TBI.
PMID: 19001250 [Indexed for MEDLINE]