939 Impact of Sleep Disorders on Neurological Outcomes in Burn Survivors

TL;DR

This study shows that sleep disorders after burn injuries significantly increase the risk of long-term neurological problems in survivors.

Contribution

The study identifies sleep disorders as a novel risk factor for poor neurological outcomes in burn survivors.

Findings

Patients with post-burn sleep disorders had a more than twofold increase in new neurological diagnoses.

Neurodegenerative disorders were 2.29 times more likely in patients with post-burn sleep disorders.

Most neurological disorders occurred more than 12 months after the onset of sleep disorders.

Abstract

Burn injuries are traumatic events that severely impact patients socially, psychologically, and physically. Some burn survivors tend to have more arduous recoveries with lasting impacts long after the primary injury. Altered neurologic outcomes after burn have been reported in some studies; however, it is not clear what factors predispose certain burn patients to poor neurologic outcomes. We investigated the impact of primary sleep disorder after a burn injury on neurologic outcomes.

Using the TriNetX database, a large, federated research network of de-identified patient data, we identified patients with burns and compared those who developed a first-time sleep disorder after a burn to those who did not. Cohorts were propensity-matched by age, gender, race, ethnicity, and percent Total Body Surface Area (TBSA) burn. Excluding patients with pre-existing neurologic disorders, we evaluated new incidences of neurologic disorders including dementia, delirium, demyelinating disorders, seizures and epilepsy, migraines, mono- and polyneuropathies, and neurodegenerative disorders.

Of the 657,108 burn patients identified in TriNetX, 62,667 patients developed a sleep disorder post-burn. The age of patients developing a sleep disorder post-burn were significantly older than those who did not (43.8 ± 21.4 vs. 30.2 ± 22.3, p < 0.001). Neurodegenerative disorders were 2.29, 95% CI [2.21, 2.49] times more likely to occur if patients with burn injury developed a sleep disorder. Patients who developed a first-time sleep disorder after a burn showed a more than twofold increase in new neurologic diagnoses such as delirium, demyelinating disorder, migraines, neuropathies, and vascular dementia. Additionally, patients who developed a first-time sleep disorder were two times more likely to develop seizures and epilepsy 95% CI [1.83, 2.17] as well as unspecified dementia all with p=0.05. Most primary neurologic disorders occur later than 12 months after the onset of primary sleep disorder after a burn.

The development of a sleep disorder after primary burn injury significantly increases the risk of subsequent poor neurologic outcomes. The post-burn period is integral for adequate neurologic recovery, and we demonstrate the importance of sleep in that process. This study aims to emphasize the importance of adequate sleep in improving neurologic outcomes after a burn.

The majority of these disorders occurred more than 12 months after the onset of a primary sleep disorder after burn. This study underscores the long-term impact of burns and the integral role that sleep plays in neurologic recovery during the post-burn phase. We emphasize the importance of identifying and treating sleep disorders in burn survivors to mitigate poor neurologic outcomes.

Database funding by National Center for Advancing Translational Sciences