- Email: [email protected]
Sleep architecture following treatment of patients with middle-of-the-night insomnia with buffered sublingual zolpidem compared to placebo
Abstracts / Sleep Medicine 14S (2013) e165–e238
insomnia that target diminishing pre-sleep cognitive arousal or worry. Although reading is a popular method of getting to sleep, it is recommended in stimulus control not to read in bed. Guided imagery is considered a way of dealing with cognitive pre sleep arousal. Our aim is to compare the effect on pre-sleep worry from reading and guided imagery added to insomnia treatment. Materials and methods: Eighty volunteer participants were divided in reading (n = 42; 30 females; mean age = 52.1 years) and imagery (n = 38; 27 females; mean age = 53.3 years) groups after two baseline weeks. Treatment lasted 3 weeks and after 4 weeks follow-up was made during one week. Pre-sleep arousal scale (PSAS) was measured at baseline, post treatment and follow-up. PSAS is a 16-item scale that measures separately the somatic and cognitive arousal associated with pre-sleep time. Treatment included lectures on sleep hygiene, dysfunctional beliefs and attitudes about sleep, microanalitic and cognitive models of insomnia and the role of worries in maintaining insomnia. Reading group was asked to read during 15 min before sleep a boring, or difficult or calming book. Imagery group received a 14 min CD with imagery instructions related to get rid of worries that disturbed sleep to be listened before sleep. The Federal University of São Paulo Ethics Committee approved the protocol, and all candidates signed the study consent form (#01677/04). Results: The comparison shows that there is no difference between reading (p = 0,977) and somatic (p = 0,877) groups at baseline (B), post treatment (PT) and follow-up (FU) for the cognitive and somatic components. Compared to baseline, cognitive component at post treatment and follow-up decreased significantly (p < 0.001). There was no change in cognitive component from post treatment to follow-up. Somatic component compared to baseline had no statistical difference in post treatment (p = 0,233) and decreased at follow-up (p = 0,001).When compared to post treatment, somatic component showed significant decrease at follow-up (p = 0,003). Conclusion: Reading and guided imagery added to insomnia treatment are useful tools in reducing pre-sleep arousal. However, both had a quicker effect on cognitive components, while effects on somatic components appeared just at follow-up. As thoughts and worry are very important in maintaining insomnia, reading and guided imagery added to the treatment may help to cope with cognitive arousal. Acknowledgements: I acknowledge Dr. Charles Morin for his generous help. http://dx.doi.org/10.1016/j.sleep.2013.11.504
Treatment patterns among those who experience middle-of-thenight awakening (MOTN) M. Moline 1, D. Brown 2, M. Dibonaventura 2, R. Lorenzo 2, D. Shah 1, R. Ben-Joseph 1 1 Purdue Pharma LP 2 Kantar Health
Introduction: Middle-of-the-night awakening (MOTN) is a common insomnia symptom, but it is unclear how patients treat their condition in the real world. A cross-sectional patient survey was used to assess treatment patterns. Materials and methods: 300 respondents from the 2011 US National Health and Wellness Survey who reported experiencing MOTN and were taking a prescription medication for their sleep condition were recontacted in December 2012 with a follow-up Internet survey. Data on demographics, sleep characteristics, treatment usage (both prescription and over-the-counter), and attitudes were assessed. While there is a currently approved treatment specifically
e211
for MOTN insomnia, this product (buffered zolpidem sublingual tablets) had been marketed for <1 year at the time of this survey. Results: 63.3% of respondents were female, with mean age 54.7 years (SD = 12.7). Respondents reported experiencing MOTN 19.7 days in the past month (SD = 8.8) and 4.9 (SD = 2.1) days in the past week. 6.7% (n = 20) reported MOTN as their sole sleep symptom (MOTN only). 73.0% of all respondents reported using zolpidem IR and 19.0% reported using zolpidem CR. 13.7% of all respondents and 25.0% of MOTN only respondents reported that their physician instructed them to either dose their prescribed medication in the MOTN or before and during the MOTN; 16.0% (and 35% of MOTN only respondents) reported using their medication in one of those two ways. Among respondents whose physicians instructed MOTN dosing, 21.4% and 28.6% (n = 6 and 8) advised patients to split a 5 mg or 10 mg zolpidem IR tablet, respectively. 66.0% used something other than a prescription sleep medication when going to bed (27.33% used prescription depression/anxiety medication, 23.67% used an over-the-counter [OTC] sleep drugs). However, only 40% used something other than a prescription sleep medication when experiencing MOTN (12.33% used an OTC sleep medication; 10.33% used soft music). Respondents reported an inadequacy of current treatment dosages (e.g., 21.7% need more medication over time; 10.3% take more medication than prescribed). Conclusion: Those who experience MOTN and who are using a prescription medication still experience MOTN frequently (>65% of all nights). Respondents primarily use their medication before bed, though will also use medication against prescribing guidelines (occasionally splitting pills or using more than prescribed) to return to sleep if they experience middle-of-the- night awakening. Acknowledgements: Funding was provided byPurdue Pharma LP. http://dx.doi.org/10.1016/j.sleep.2013.11.505
Sleep architecture following treatment of patients with middleof-the-night insomnia with buffered sublingual zolpidem compared to placebo T. Roth 1, N. Singh 2, F. Steinberg 2, A. Waldron 3, M. Moline 3 1 Henry Ford Hospital, United States 2 Transcept Pharmaceuticals, Inc., United States 3 Purdue Pharma LP
Introduction: Aside from inducing and maintaining sleep, hypnotic medications also impact sleep stages. Historically, the barbiturates were REM suppressants, while the benzodiazepines were Stage 3–4 (SWS) suppressants. The newer benzodiazepine receptor agonists like zolpidem increase stage 2 and latency to REM. Previous research, however, was conducted utilizing bedtime dosing. Across the night, there are dramatic changes in sleep stages, with the first half being primarily enriched with SWS, and the last half with REM sleep. A buffered zolpidem sublingual formulation (ZST) is approved to be taken in the middle of the night (MOTN) by patients with MOTN insomnia (and at least 4 h of bedtime remaining). The question then arises regarding possible sleep stage effects following MOTN ZST dosing taking pharmacologic and circadian influences into consideration. Materials and methods: A double-blind, placebo-controlled 3- way cross-over sleep laboratory polysomnography study conducted with 1.75 and 3.5 mg buffered zolpidem tartrate sublingual tablets (ZST) demonstrated efficacy, compared to placebo, on latency to persistent sleep (LPS) when administered to patients with primary insomnia whose chief complaint was MOTN awakenings with difficulty returning to sleep. 58 Female and 24 male patients were randomized. Patients were dosed with 3.5 mg, 1.75 mg or placebo 4 h after
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Abstracts / Sleep Medicine 14S (2013) e165–e238
lights out, kept awake for 30 min, then returned to bed for 4 h. Sleep stages were scored centrally by standardized criteria in 30 s epochs for 4 h predose and 4 h postdose. The mean of each sleep parameter was calculated from the postdose periods of the 2 treatment nights. Subjective ratings of sleep quality and morning alertness were also obtained. Results: LPS, total sleep time, and sleep efficiency all improved significantly postdose with both ZST doses compared to placebo. Postdose, there was a dose-dependent change in NREM sleep. The percent of light stage 1 decreased, while the % and minutes of deeper stages 2 and 3–4 increased. While REM sleep minutes were stable, % REM declined with a minor dose- dependent increase in REM latency. The overall improvements in sleep quality and daytime alertness reported by patients on mornings post ZST dosing may be related to the differential effects in NREM sleep stages. Conclusion: In summary, sleep after MOTN dosing with ZST included all sleep stages, including SWS typically not observed in the latter half of the night. These findings may relate to the improved ratings of sleep quality and alertness. Acknowledgements: Funding was provided by Transcept Pharmaceuticals, Inc. and Purdue Pharma LP.
52%, and impaired alertness in 64% of our participants. Clinical insomnia based on ISS was found in 96% of workers. A significant association was found between outcome of interest (FSS total score) and the number of work-related injuries occurring in the past 5 years (r = 0.48, p = 0.016), PHQ-9 total score (r = 0.49, p = 0.012), anxiety total score (r = 0.48, p = 0.015) and alertness total score (r = 0.78, p < 0.0001). Weak correlation was found between fatigue total score and insomnia (r = 0.36, p = 0.078). No association was found between outcome of interest and daytime sleepiness total score (r = 0.29, p = 0.15). Conclusion: Fatigue was strongly associated with depression and weakly with insomnia. A moderate positive association found between fatigue and the number of previous work-related injuries and the strong negative association between fatigue and alertness may indicate workers’ inability to perform tasks that require sustained attention. Future research in the area of sleep timing and medications effect as a determinant of fatigue, alertness and performance is warranted. Acknowledgements: Shirin Mollayeva was funded through the Ontario Work Study Program, University of Toronto. http://dx.doi.org/10.1016/j.sleep.2013.11.507
http://dx.doi.org/10.1016/j.sleep.2013.11.506
Fatigue in Ontario workers with head trauma: frequencies and correlations S. Mollayeva 1, C. Shapiro 2, T. Mollayeva 3, A. Colantonio 1 1 University of Toronto, Acquired Brain Injury Research Lab, Toronto Rehabilitation Institute, Canada 2 University of Toronto, Toronto Western Hospital, The Youthdale Child and Adolescent Sleep Centre, Canada 3 University of Toronto, Graduate Department of Rehabilitation Science, Collaborative Program in Neuroscience, Canada
Introduction: Fatigue is one of the most disabling symptoms in patients with Traumatic Brain Injury (TBI) and it is difficult to clarify the nature of this symptom and manage it. In the context of workplace disability, fatigue is defined subjectively by self-report and objectively as degraded performance and inability to perform occupational duties. While workers have little difficulty recognizing physical tiredness, they have less insight in detecting the more subtle signs of mental fatigue, and may fail to indicate and appreciate its impact on their performance. As fatigue after head trauma may be the end result of a common pathway integrating multiple factors, the aim of this study is to evaluate the frequency and correlations of fatigue in a sample of Ontario workers with trauma to the head. Materials and methods: A cross-sectional study of a population with mild to moderate TBI with persistent symptoms, who were seen for assessment at the Toronto Rehabilitation Institute’s Worker’s Safety and Insurance Board outpatient clinic May–September 2012. Twenty-five Ontario workers (60% males, 40% females) were asked to complete the Fatigue Severity Scale (FSS), Patient’s Health Questionnaire (PHQ-9), Hospital Anxiety Scale (HADS-A), Insomnia Severity Index (ISI), Epworth Sleepiness Scale (ESS) and Toronto Hospital Alertness Test (THAT) questionnaires. Frequency distribution and Pearson correlation were used for data analysis. Workers also reported on the number of work-related injuries occurring in the past 5 years. Results: Twenty-eight percent of workers named fatigue as one of their three most disabling symptoms. Fifty-two percent of our sample performed shift work at the time of their injury. Fatigue requiring further evaluation based on self-report (FSS total) was found in 88%, depression in 96%, anxiety in 64%, excessive daytime sleepiness in
Self-report instruments for assessing sleep dysfunction in an adult traumatic brain injury population: a systematic review T. Mollayeva 1, T. Kendzerska 2, A. Colantonio 3 1 University of Toronto, Graduate Department of Rehabilitation Science/ Collaborative Program in Neuroscience, Canada 2 University of Toronto, Faculty of Health Policy, Management, and Evaluation, Canada 3 University of Toronto, Canada
Introduction: Studies on sleep and TBI have shown that patients represent different sleep and wakefulness symptoms from an acute or chronic inability to sleep adequately at night (insomnia), chronic fatigue, sleepiness, disturbances of circadian rhythm to behavioral manifestations associated with sleep itself. The recognition of the importance of systematically assessing sleep difficulties in TBI population has been influencing clinical practice and research in the field of TBI recently. This reflects clinicians’ concern for better evaluation and treatment of persons with TBI who report significant disturbances of sleep/wake cycles post-injury. Self-reported questionnaires are often the instrument of first choice to assess sleep, given its cost effectiveness, ability to collect patient’s unique experience and the added privacy which can enhance the validity of the responses. Objectives of the study were: (1) to comprehensively assess a variety of the existing self-report sleep measures that have been applied to the evaluation of TBI adults’ impaired sleep and wakefulness; (2) to examine these instruments in terms of their fit in patients’ population; (3) to discuss the strengths and weaknesses of the self-report sleep measures when applied to TBI population. Materials and methods: Comprehensive peer-reviewed literature search of Medline, Embase, PsychInfo, Cinahl and bibliographies of identified articles. All studies on TBI adult population that used a standardized patient-report sleep measure were considered for this review. Results: Identified 16 self-report measures used in TBI research and clinical practice. Five were of generic nature, five were symptom-related and six were condition-specific measures. The Pittsburgh Sleep Quality Index and Epworth Sleepiness Scale have been partially validated in post-acute TBI. Conclusion: Although no instrument has been specifically developed for TBI patients, there are scientific benefits to using existing.
insomnia that target diminishing pre-sleep cognitive arousal or worry. Although reading is a popular method of getting to sleep, it is recommended in stimulus control not to read in bed. Guided imagery is considered a way of dealing with cognitive pre sleep arousal. Our aim is to compare the effect on pre-sleep worry from reading and guided imagery added to insomnia treatment. Materials and methods: Eighty volunteer participants were divided in reading (n = 42; 30 females; mean age = 52.1 years) and imagery (n = 38; 27 females; mean age = 53.3 years) groups after two baseline weeks. Treatment lasted 3 weeks and after 4 weeks follow-up was made during one week. Pre-sleep arousal scale (PSAS) was measured at baseline, post treatment and follow-up. PSAS is a 16-item scale that measures separately the somatic and cognitive arousal associated with pre-sleep time. Treatment included lectures on sleep hygiene, dysfunctional beliefs and attitudes about sleep, microanalitic and cognitive models of insomnia and the role of worries in maintaining insomnia. Reading group was asked to read during 15 min before sleep a boring, or difficult or calming book. Imagery group received a 14 min CD with imagery instructions related to get rid of worries that disturbed sleep to be listened before sleep. The Federal University of São Paulo Ethics Committee approved the protocol, and all candidates signed the study consent form (#01677/04). Results: The comparison shows that there is no difference between reading (p = 0,977) and somatic (p = 0,877) groups at baseline (B), post treatment (PT) and follow-up (FU) for the cognitive and somatic components. Compared to baseline, cognitive component at post treatment and follow-up decreased significantly (p < 0.001). There was no change in cognitive component from post treatment to follow-up. Somatic component compared to baseline had no statistical difference in post treatment (p = 0,233) and decreased at follow-up (p = 0,001).When compared to post treatment, somatic component showed significant decrease at follow-up (p = 0,003). Conclusion: Reading and guided imagery added to insomnia treatment are useful tools in reducing pre-sleep arousal. However, both had a quicker effect on cognitive components, while effects on somatic components appeared just at follow-up. As thoughts and worry are very important in maintaining insomnia, reading and guided imagery added to the treatment may help to cope with cognitive arousal. Acknowledgements: I acknowledge Dr. Charles Morin for his generous help. http://dx.doi.org/10.1016/j.sleep.2013.11.504
Treatment patterns among those who experience middle-of-thenight awakening (MOTN) M. Moline 1, D. Brown 2, M. Dibonaventura 2, R. Lorenzo 2, D. Shah 1, R. Ben-Joseph 1 1 Purdue Pharma LP 2 Kantar Health
Introduction: Middle-of-the-night awakening (MOTN) is a common insomnia symptom, but it is unclear how patients treat their condition in the real world. A cross-sectional patient survey was used to assess treatment patterns. Materials and methods: 300 respondents from the 2011 US National Health and Wellness Survey who reported experiencing MOTN and were taking a prescription medication for their sleep condition were recontacted in December 2012 with a follow-up Internet survey. Data on demographics, sleep characteristics, treatment usage (both prescription and over-the-counter), and attitudes were assessed. While there is a currently approved treatment specifically
e211
for MOTN insomnia, this product (buffered zolpidem sublingual tablets) had been marketed for <1 year at the time of this survey. Results: 63.3% of respondents were female, with mean age 54.7 years (SD = 12.7). Respondents reported experiencing MOTN 19.7 days in the past month (SD = 8.8) and 4.9 (SD = 2.1) days in the past week. 6.7% (n = 20) reported MOTN as their sole sleep symptom (MOTN only). 73.0% of all respondents reported using zolpidem IR and 19.0% reported using zolpidem CR. 13.7% of all respondents and 25.0% of MOTN only respondents reported that their physician instructed them to either dose their prescribed medication in the MOTN or before and during the MOTN; 16.0% (and 35% of MOTN only respondents) reported using their medication in one of those two ways. Among respondents whose physicians instructed MOTN dosing, 21.4% and 28.6% (n = 6 and 8) advised patients to split a 5 mg or 10 mg zolpidem IR tablet, respectively. 66.0% used something other than a prescription sleep medication when going to bed (27.33% used prescription depression/anxiety medication, 23.67% used an over-the-counter [OTC] sleep drugs). However, only 40% used something other than a prescription sleep medication when experiencing MOTN (12.33% used an OTC sleep medication; 10.33% used soft music). Respondents reported an inadequacy of current treatment dosages (e.g., 21.7% need more medication over time; 10.3% take more medication than prescribed). Conclusion: Those who experience MOTN and who are using a prescription medication still experience MOTN frequently (>65% of all nights). Respondents primarily use their medication before bed, though will also use medication against prescribing guidelines (occasionally splitting pills or using more than prescribed) to return to sleep if they experience middle-of-the- night awakening. Acknowledgements: Funding was provided byPurdue Pharma LP. http://dx.doi.org/10.1016/j.sleep.2013.11.505
Sleep architecture following treatment of patients with middleof-the-night insomnia with buffered sublingual zolpidem compared to placebo T. Roth 1, N. Singh 2, F. Steinberg 2, A. Waldron 3, M. Moline 3 1 Henry Ford Hospital, United States 2 Transcept Pharmaceuticals, Inc., United States 3 Purdue Pharma LP
Introduction: Aside from inducing and maintaining sleep, hypnotic medications also impact sleep stages. Historically, the barbiturates were REM suppressants, while the benzodiazepines were Stage 3–4 (SWS) suppressants. The newer benzodiazepine receptor agonists like zolpidem increase stage 2 and latency to REM. Previous research, however, was conducted utilizing bedtime dosing. Across the night, there are dramatic changes in sleep stages, with the first half being primarily enriched with SWS, and the last half with REM sleep. A buffered zolpidem sublingual formulation (ZST) is approved to be taken in the middle of the night (MOTN) by patients with MOTN insomnia (and at least 4 h of bedtime remaining). The question then arises regarding possible sleep stage effects following MOTN ZST dosing taking pharmacologic and circadian influences into consideration. Materials and methods: A double-blind, placebo-controlled 3- way cross-over sleep laboratory polysomnography study conducted with 1.75 and 3.5 mg buffered zolpidem tartrate sublingual tablets (ZST) demonstrated efficacy, compared to placebo, on latency to persistent sleep (LPS) when administered to patients with primary insomnia whose chief complaint was MOTN awakenings with difficulty returning to sleep. 58 Female and 24 male patients were randomized. Patients were dosed with 3.5 mg, 1.75 mg or placebo 4 h after
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Abstracts / Sleep Medicine 14S (2013) e165–e238
lights out, kept awake for 30 min, then returned to bed for 4 h. Sleep stages were scored centrally by standardized criteria in 30 s epochs for 4 h predose and 4 h postdose. The mean of each sleep parameter was calculated from the postdose periods of the 2 treatment nights. Subjective ratings of sleep quality and morning alertness were also obtained. Results: LPS, total sleep time, and sleep efficiency all improved significantly postdose with both ZST doses compared to placebo. Postdose, there was a dose-dependent change in NREM sleep. The percent of light stage 1 decreased, while the % and minutes of deeper stages 2 and 3–4 increased. While REM sleep minutes were stable, % REM declined with a minor dose- dependent increase in REM latency. The overall improvements in sleep quality and daytime alertness reported by patients on mornings post ZST dosing may be related to the differential effects in NREM sleep stages. Conclusion: In summary, sleep after MOTN dosing with ZST included all sleep stages, including SWS typically not observed in the latter half of the night. These findings may relate to the improved ratings of sleep quality and alertness. Acknowledgements: Funding was provided by Transcept Pharmaceuticals, Inc. and Purdue Pharma LP.
52%, and impaired alertness in 64% of our participants. Clinical insomnia based on ISS was found in 96% of workers. A significant association was found between outcome of interest (FSS total score) and the number of work-related injuries occurring in the past 5 years (r = 0.48, p = 0.016), PHQ-9 total score (r = 0.49, p = 0.012), anxiety total score (r = 0.48, p = 0.015) and alertness total score (r = 0.78, p < 0.0001). Weak correlation was found between fatigue total score and insomnia (r = 0.36, p = 0.078). No association was found between outcome of interest and daytime sleepiness total score (r = 0.29, p = 0.15). Conclusion: Fatigue was strongly associated with depression and weakly with insomnia. A moderate positive association found between fatigue and the number of previous work-related injuries and the strong negative association between fatigue and alertness may indicate workers’ inability to perform tasks that require sustained attention. Future research in the area of sleep timing and medications effect as a determinant of fatigue, alertness and performance is warranted. Acknowledgements: Shirin Mollayeva was funded through the Ontario Work Study Program, University of Toronto. http://dx.doi.org/10.1016/j.sleep.2013.11.507
http://dx.doi.org/10.1016/j.sleep.2013.11.506
Fatigue in Ontario workers with head trauma: frequencies and correlations S. Mollayeva 1, C. Shapiro 2, T. Mollayeva 3, A. Colantonio 1 1 University of Toronto, Acquired Brain Injury Research Lab, Toronto Rehabilitation Institute, Canada 2 University of Toronto, Toronto Western Hospital, The Youthdale Child and Adolescent Sleep Centre, Canada 3 University of Toronto, Graduate Department of Rehabilitation Science, Collaborative Program in Neuroscience, Canada
Introduction: Fatigue is one of the most disabling symptoms in patients with Traumatic Brain Injury (TBI) and it is difficult to clarify the nature of this symptom and manage it. In the context of workplace disability, fatigue is defined subjectively by self-report and objectively as degraded performance and inability to perform occupational duties. While workers have little difficulty recognizing physical tiredness, they have less insight in detecting the more subtle signs of mental fatigue, and may fail to indicate and appreciate its impact on their performance. As fatigue after head trauma may be the end result of a common pathway integrating multiple factors, the aim of this study is to evaluate the frequency and correlations of fatigue in a sample of Ontario workers with trauma to the head. Materials and methods: A cross-sectional study of a population with mild to moderate TBI with persistent symptoms, who were seen for assessment at the Toronto Rehabilitation Institute’s Worker’s Safety and Insurance Board outpatient clinic May–September 2012. Twenty-five Ontario workers (60% males, 40% females) were asked to complete the Fatigue Severity Scale (FSS), Patient’s Health Questionnaire (PHQ-9), Hospital Anxiety Scale (HADS-A), Insomnia Severity Index (ISI), Epworth Sleepiness Scale (ESS) and Toronto Hospital Alertness Test (THAT) questionnaires. Frequency distribution and Pearson correlation were used for data analysis. Workers also reported on the number of work-related injuries occurring in the past 5 years. Results: Twenty-eight percent of workers named fatigue as one of their three most disabling symptoms. Fifty-two percent of our sample performed shift work at the time of their injury. Fatigue requiring further evaluation based on self-report (FSS total) was found in 88%, depression in 96%, anxiety in 64%, excessive daytime sleepiness in
Self-report instruments for assessing sleep dysfunction in an adult traumatic brain injury population: a systematic review T. Mollayeva 1, T. Kendzerska 2, A. Colantonio 3 1 University of Toronto, Graduate Department of Rehabilitation Science/ Collaborative Program in Neuroscience, Canada 2 University of Toronto, Faculty of Health Policy, Management, and Evaluation, Canada 3 University of Toronto, Canada
Introduction: Studies on sleep and TBI have shown that patients represent different sleep and wakefulness symptoms from an acute or chronic inability to sleep adequately at night (insomnia), chronic fatigue, sleepiness, disturbances of circadian rhythm to behavioral manifestations associated with sleep itself. The recognition of the importance of systematically assessing sleep difficulties in TBI population has been influencing clinical practice and research in the field of TBI recently. This reflects clinicians’ concern for better evaluation and treatment of persons with TBI who report significant disturbances of sleep/wake cycles post-injury. Self-reported questionnaires are often the instrument of first choice to assess sleep, given its cost effectiveness, ability to collect patient’s unique experience and the added privacy which can enhance the validity of the responses. Objectives of the study were: (1) to comprehensively assess a variety of the existing self-report sleep measures that have been applied to the evaluation of TBI adults’ impaired sleep and wakefulness; (2) to examine these instruments in terms of their fit in patients’ population; (3) to discuss the strengths and weaknesses of the self-report sleep measures when applied to TBI population. Materials and methods: Comprehensive peer-reviewed literature search of Medline, Embase, PsychInfo, Cinahl and bibliographies of identified articles. All studies on TBI adult population that used a standardized patient-report sleep measure were considered for this review. Results: Identified 16 self-report measures used in TBI research and clinical practice. Five were of generic nature, five were symptom-related and six were condition-specific measures. The Pittsburgh Sleep Quality Index and Epworth Sleepiness Scale have been partially validated in post-acute TBI. Conclusion: Although no instrument has been specifically developed for TBI patients, there are scientific benefits to using existing.