Sleep disturbance and agitation are common after acquired brain injury (ABI). Weighted blankets may help these symptoms in other conditions, but have not been trialed in ABI. We aimed to determine acceptability and feasibility of weighted blankets to aid sleep and agitation after ABI. We recruited participants into a non-blinded, randomized controlled study in an NHS inpatient neurorehabilitation unit. Participants were randomized 1:1 to weighted blanket or standard hospital linen. Participants underwent observation of sleep (including actigraphy) and behavior over 11 nights. Of 10 participants randomized, seven participants completed the study. Only 1 participant tolerated the weighted blanket throughout and only three wore the actigraph for all nights of the study. Participants found the weighted blanket hot, heavy and uncomfortable. The study was terminated early due to poor tolerance. Delivery of a definitive trial in this format would not be feasible.

Feasibility of delivering a randomized controlled trial of weighted blanket intervention to help agitation and disturbed sleep after brain injury

INTRODUCTION
Sleep disturbances are common in patients with Traumatic Brain Injury (TBI). In an inpatient rehabilitation setting, clinicians often use information from sleep logs filled out by trained nurses to identify and treat sleep disturbances. However, there is limited data related to accuracy of sleep logs, and patient-reported sleep diaries are poor predictors of total sleep time, which raises concern about the accuracy of sleep logs filled out by a third party.


OBJECTIVE
This study examines the reliability of sleep logs for participants with TBI by comparing total sleep time determined by sleep logs versus actigraphy.


DESIGN
This is a prospective, cross-sectional study that compares widely used sleep logs to a more objective measurement of sleep (actigraphy).


SETTING
Free-standing, academic inpatient rehabilitation facility.


PARTICIPANTS
30 individuals (n=30) participated in the study. Inclusion criteria were: (1) diagnosis of moderate-to-severe TBI; (2) age ≥ 18 years at the time of TBI; and (3) participating in inpatient rehabilitation with no prior inpatient rehabilitation admissions.


INTERVENTIONS
Actigraph monitoring using ActiGraph GT9X Link devices was initiated within 72 hours of admission and continued for 7 consecutive days. Sleep logs were concurrently filled out by trained nurses.


MAIN OUTCOME MEASURES
Sleep parameter correspondence between actigraphy and sleep logs in moderate-to-severe TBI.


RESULTS
51.4% of participants' sleep logs and actigraph total sleep time measurements were within one hour of each other, and only 23.8% were within 30 minutes. On average, sleep logs overestimated actigraphy-determined total sleep time by 60 minutes compared to actigraphic measurement.


CONCLUSIONS
For those with moderate-to-severe TBI undergoing inpatient rehabilitation, sleep logs are poor predictors of sleep time because they overestimate total sleep time compared to actigraphy. Therefore, clinicians should use caution when using sleep log data to make decisions regarding treatment for sleep disturbances in TBI.

Actigraphic and Nursing Sleep Log Measures in Moderate-to-Severe Traumatic Brain Injury: Identifying Discrepancies in Total Sleep Time.

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Actigraphic and Nursing Sleep Log Measures in Moderate-to-Severe Traumatic Brain Injury: Identifying Discrepancies in Total Sleep Time.