Hypersomnia after head-neck trauma - A medicolegal dilemma

Objectives: To evaluate the severity of daytime sleepiness in patients with a history of head trauma who complain of daytime somnolence, to investigat e polygraphic abnormalities during nocturnal sleep, and to determine whethe r daytime sleepiness was the cause or consequence of the head trauma, Metho ds: The authors performed a systematic evaluation of 184 patients comprised of clinical interviews, sleep disorders questionnaires, sleepiness and dep ression scales, medical and neurologic evaluations, sleep logs with actigra phy, nocturnal polysomnography, and the Multiple Sleep Latency Test (MSLT), Assessments of sleepiness before the accident were based on bed partner in terviews, coworker and employer reports, health reports, driving records, a nd employment history that included absenteeism. Results: Post-traumatic co mplaint of somnolence was associated with variable degrees of impaired dayt ime functioning in more than 98% of patients. Patients who were in a coma f or 24 hours, who had a head fracture, or who had immediate neurosurgical in terventions were likely to have scores > 16 points on the Epworth Sleepines s Scale (ESS) and less than or equal to 5 minutes on the MSLT. Pain at nigh t was an important factor in nocturnal sleep disruption and daytime sleepin ess. Sleep-disordered breathing was a common finding and was the only findi ng in whiplash patients with daytime sleepiness. Extensive evaluation of pr etrauma behavior supported the conclusion that the onset of symptomatic sle ep-disordered breathing was associated with the trauma. The patients who sh owed a "compulsive presleep behavior" were severely impaired in performing their daily activities. Conclusions: A systematic approach is required when dealing with patients complaining of hypersomnia following a head-neck tra uma.