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Tbi And Sleep Apnea

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Traumatic brain injury ( TBI ) can sometimes be the cause of a sleep disorder, (i.e, obstructive sleep apnea aka OSA ). Does anyone have any knowledge or information about this? Any VA compensation claims won on this issue would be helpful.

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  • HadIt.com Elder


Copyright © 2001 The American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation. All rights reserved.


Sleep apnea in adults with traumatic brain injury: A preliminary investigation*1

Joseph B. Webster MD, Kathleen R. Bell MD, John D. Hussey RRT, Theresa K. Natale BS and Sambasiva Lakshminarayan MD

From the Department of Rehabilitation Medicine, University of Washington (Webster, Bell); Department of Respiratory Therapy (Hussey), Department of Pulmonary Medicine (Lakshminarayan), VA Puget Sound Health Care System; and University of Washington, Seattle, WA (Natale). Webster is now with the Department of Physical Medicine and Rehabilitation, East Carolina University Medical Center, Greenville, NC.

Available online 9 May 2002.

References and further reading may be available for this article. To view references and further reading you must purchase this article.


Webster JB, Bell KR, Hussey JD, Natale TK, Lakshminarayan S. Sleep apnea in adults with traumatic brain injury: a preliminary investigation. Arch Phys Med Rehabil 2001;82:316-21. Objective: To determine the occurrence and nature of sleep-related breathing disorders in adults with traumatic brain injury (TBI). Design: Prospective, observational, consecutive sample enrollment of subjects admitted for rehabilitation after TBI. Setting: Inpatient rehabilitation and subacute rehabilitation units of a tertiary care university medical system. Participants: Subjects (n = 28) included adults with TBI and a Rancho Los Amigos Scale level of 3 or greater who were less than 3 months postinjury and admitted for comprehensive inpatient rehabilitation. Interventions: Overnight sleep study using portable 6-channel monitoring system. Main Outcome Measure: Respiratory disturbance index (RDI), which is the number of apneic and hypopneic episodes per hour of sleep. Results: Evidence of sleep apnea was found in 10 of 28 (36%) subjects as measured by a RDI level of 5 or greater and in 3 of 28 (11%) subjects as measured by a RDI level of 10 or greater. This rate of sleep apnea is significantly (p = .002) higher than would be predicted based on population norms. No correlation was found between the occurrence of significant sleep apnea and measures of TBI severity or other demographic variables. Sleep-related breathing disorders were primarily central though obstructive apneas were also noted. Conclusion: In this preliminary investigation, sleep-related breathing disorders as defined by a respiratory disturbance index of 5 or greater appears to be common in adult subjects with TBI.


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  • HadIt.com Elder

J Clin Sleep Med. 2007 June 15; 3(4): 349–356. PMCID: PMC1978308

Copyright © 2007 American Academy of Sleep Medicine

Prevalence and Consequences of Sleep Disorders in Traumatic Brain Injury


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  • HadIt.com Elder

Collaboration in Research Involving Traumatic Brain Injury and Sleep Disorders.

Response to Agrawal A. et al. Traumatic brain injury and sleep disturbances. J.

Clin Sleep Med 2008;4:xxx-xxx

Richard J. Castriotta, M.D.

University of Texas Medical School at Houston, Houston, TX

Address correspondence to: Richard J. Castriotta, MD, Pulmonary, Critical Care and

Sleep Medicine Division, University of Texas Medical School at Houston, 6431 Fannin

St. MSB 1.274, Houston, TX. Tel: (713) 500-6823; Fax: (713)-500-6829; E-mail:


In our recent paper published here,1 we reported on the prevalence and consequences of

sleep disorders after traumatic brain injury (TBI) based on data collected in a multicenter

project. In this study, we found a high prevalence of sleep disorders (obstructive sleep

apnea [OSA], narcolepsy and post-traumatic hypersomnia [PTH]) in an unselected

sample of TBI patients who underwent nocturnal polysomnography. We also found that

TBI patients with a sleep disorder or excessive daytime sleepiness (EDS) as determined

by objective measurement through the multiple sleep latency test (MSLT), had more

difficulties with sustained attention. In a follow-up paper2 we documented that those

patients with TBI and OSA have more impairment in sustained attention and memory

than TBI patients without OSA.

While these findings are intriguing in that they point to the potential impact of sleep

disorders on TBI outcome and general quality of life, much more work is necessary to

elucidate these relations and find effective treatments. As in all emerging areas, careful

study will require much effort and many resources. These can best be brought to bear

through collaborative efforts across multiple centers. Thus, we enthusiastically concur

with Agrawal et al3 and hope that our investigations and those of others might spur on

such collaborative efforts to elucidate the causes, foster early diagnosis, and develop

optimal treatment for these problems. Perhaps an international conference bringing

together diverse investigators involved in these fields might be helpful in promoting this



1 Castriotta RJ, Wilde MC, Lai JM, Atanasov S, Masel BE, Kuna ST. Prevalence and

consequences of sleep disorders in traumatic brain injury. J Clin Sleep Med 2007; 3:349-


2 Wilde MC, Castriotta RJ, Lai JM, Atanasov S, Masel BE, Kuna ST. Cognitive

impairment in patients with traumatic brain injury (TBI) in obstructive sleep apnea. Arch

Phys Med Rehabil 2007;88:1284-8.

3 Agrawal A, Cincu R, Joharapurkar SR. Traumatic brain injury and sleep disturbances. J.

Clin Sleep Med 2008;4:


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  • HadIt.com Elder

Searchs for COVA cases turned up nothing.............


Service Connection for Sleep Apnea Disorder

The appellant seeks entitlement to service connection for sleep

apnea disorder, a condition which he believes was caused by his

service-connected head trauma disability. 38 U.S.C.A. § 1110

(West 1991). Under pertinent VA regulations, service connection

may be granted for a disability which is proximately due to or

the result of a service-connected disease or injury. 38 C.F.R.

§ 3.310(a) (1993).

The Board has concluded that the preponderance of the evidence of

record indicates that appellant's sleep apnea disorder, first

clinically identified in 1988, is causally and medically unrelated

to his service-connected head trauma disability. An etiological

relationship is not shown; while post service medical records

reflect treatment for complaints of headaches associated with his

in-service head injury, no medical relationship between those

complaints and his sleep apnea disorder has been affirmatively

established. Indeed, a VA neurologist concluded in April 1994

that considering the fact that sleep apnea is not a neurologic

disorder, "... it is very unlikely that this patient's sleep apnea

is related to his head injury." No additional medical evidence

reveals any connection between these conditions. In summary, no

medical evidence of record affirmatively establishes any

etiological relationship between his service-connected residuals

of head trauma and the claimed sleep apnea disorder, and

accordingly, the evidence does not form a basis to warrant service

connection. 38 C.F.R. § 3.310 (1993). The Board cannot entertain

unsupported lay speculation on medical issues. See Espiritu v.

Derwinski, 2 Vet.App. 492 (1992). The evidence in this case is

not so evenly balanced so as to allow application of the benefit

of the doubt rule as set forth under 38 U.S.C.A. § 5107(:P (West



An increased disability evaluation for residuals of head trauma

is denied.

Service connection for sleep apnea disorder, claimed as secondary

to the service-connected head trauma disability, is denied.


Member, Board of Veterans' Appeals

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