If you missed the talk, here is a summary contributed by Tatyana Mollayeva

Sleep promotes brain repair, including axonal sprouting, synapto-, neuro-, and angiogenesis after traumatic brain injury, said Dr. Risa Nakase Richardson during her talk at the KITE Toronto Rehabilitation Institute University Health Network on April 25, 2021. Almost 85% of patients with acute traumatic brain injury admitted to rehabilitation experienced sleep-wake cycle disturbance, with more than 30% of these patients classified as having moderate-severe sleep-wake cycle disturbances throughout their rehabilitation and upon discharge into the community [https://pubmed.ncbi.nlm.nih.gov/23296143/]. This is problematic as sleep disturbances in patients with traumatic brain injury have been shown to adversely affect neuronal recovery, patients’ ability to actively engage in rehabilitation interventions, their cognitive and physical outcomes, disability levels, and necessitate greater financial resources long after the injury.

Assessment and management of sleep disturbances is not an easy undertaking, Dr. Nakase-Richardson says. The impact of other pathologies in patients with traumatic brain injury contributes to sleep disturbances and their evolution, including but not limited to comorbid medical and psychiatric disorders, and pharmacological management of these disorders, as well as environmental influences, both in-hospital and in-home environments. It is also essential to recognize sleep disorders such as sleep apnea, obstructive and central, insomnias, circadian rhythm sleep disorders, and other sleep disorders, to which patients with traumatic brain injury are highly susceptible.

Given the complexity of sleep disturbances and their impact on rehabilitation outcomes, Dr. Nakase-Richardson and her colleagues at the TBI Models System Knowledge Translation Center [https://msktc.org/tbi/model-system-centers] developed a framework on how to formally assess sleep function in patients with traumatic brain injury, based on the input of stakeholders including clinicians and scientists, patients and their families, and representatives from the Agency for Healthcare Research and Quality. Dr. Nakase-Richardson and her colleagues start with the detection of sleep disorders for which there are established clinical practice guidelines by the American Academy of Sleep Medicine [https://aasm.org/clinical-resources/practice-standards/practice-guidelines/]. One of the categories of sleep disorders of great relevance to patients with traumatic brain injury is sleep-related breathing disorders. Obstructive and central sleep apneas fall within this category of sleep disorders.

Dr. Nakase-Richardson presented compelling evidence on the 2015 economic impact of sleep apnea in the US, where the estimated cost of diagnosing and treating every American adult who has obstructive sleep apnea (OSA) would cost $49. 5 billion, while the cost of undiagnosed OSA would cost three times more – almost $149,6 billion! [https://pubmed.ncbi.nlm.nih.gov/27448424/] Dr. Nakase-Richardson and her colleagues are focusing on developing and evaluating sleep assessment strategies to maximize rehabilitation, participation, and outcomes of patients with traumatic brain injury.

Research translation into practice is not an easy undertaking. Only 14% of research from randomized controlled trials reaches the patient’s bedside, and it takes on average 17 years to do so; the rest, 86%, is lost in the translation

Risa Nakase-Richardson, Ph.D., FACRM is a Clinical Research Neuropsychologist at the James A. Haley Veterans Hospital and Professor and Research Director in the Morsani College of Medicine, Pulmonary and Sleep Medicine Division, at the University of South Florida. She has worked in neuro-rehabilitation in both clinical and research capacities since 1998. She is a Fellow of the American Congress of Rehabilitation Medicine and National Academy of Neuropsychology. She has over 100 publications and over 200 presentations at scientific meetings. She has served as PI or Investigator on 19 grants funded by various federal agencies and private organizations including VA, DOD, PCORI, NIH, NIDILRR, and NAN. She has worked at the VA Polytrauma Rehabilitation Center in Tampa Florida since 2008.

You can also view the presentation at https://youtu.be/TGZrhTv4Bsw