Slow wave activity moderates the association between new learning and traumatic brain injury severity

Abstract

Study objectives: Sleep-wake complaints and difficulties in making new learning are among the most persistent and challenging long-term sequelea following moderate to severe traumatic brain injury (TBI). Yet, it is unclear whether, and to what extent, sleep characteristics during the chronic stage of TBI contribute to sleep-wake and cognitive complaints. We aimed to characterize sleep architecture in chronic moderate to severe TBI adults and assess whether non-rapid eye movement slow wave activity (SWA) is associated to next day performance in episodic memory tasks according to TBI severity.

Methods: Forty-two moderate to severe TBI participants, 12-47 months post-injury, and 38 healthy controls were tested with one night of in-laboratory polysomnography, followed the next morning by questionnaires (sleep quality, fatigue, and sleepiness) and neuropsychological assessment. We used multiple regression analyses to assess the moderator effect of SWA power on TBI severity and next-day memory performance.

Results: We found that TBI participants reported worse sleep quality and fatigue, and had worse cognitive performance than controls. No between group differences were found on macro- and micro-architecture of sleep. However, SWA significantly interacted with TBI severity to explain next-day memory performance: higher SWA was more strongly associated to better memory performance in more severe TBI compared to milder TBI.

Conclusions: This study provides evidence that the injured brain is able to produce macro- and micro-architecture of sleep comparable to what is seen in healthy controls. However, with increasing TBI severity, lower non-rapid eye movement SWA power is associated with reduced ability to learn and memorise new information the following day.

Keywords: brain injury; cognition; episodic memory; polysomnography; sleep; slow wave activity.

Figure 1.

Learning-memory performance and PTA degree (−1 SD: short, mean: average, +1 SD: long) according to absolute NREM SWA power levels (−1 SD: low, mean: average, +1 SD: high). BVMT-R, Brief Visuospatial Memory Test-Revised; HVLT, Hopkins Verbal Learning Test; PTA, post-traumatic amnesia; SWA, slow wave activity.