586 Sleep Disturbances After Whiplash Injury: Objective and Subjective Findings Ilana Schlesinger, MD; Rachel Hering-Hanit, MD; Yaron Dagan, PhD Objective.—A controlled objective and subjective evaluation of sleep in a consecutive series of persons who had had a whiplash injury, shortly following the injury and 3 to 5 months later. Methods.—In whiplash-injured subjects and healthy controls, sleep characteristics were monitored objec- tively throughout the night by means of an actigraph. The following morning, participants in both groups filled out a prestructured “sleep log” that conveyed their subjective impressions as to how they had slept. The correlation between objectively measured sleep characteristics and the symptoms and physical findings, respectively, resulting from whiplash injury were also examined. Results.—Actigraphic monitoring did not reveal a significant group difference between whiplash-injured sub- jects and controls with respect to any of the sleep characteristics recorded. In self-maintained “sleep logs,” how- ever, the whiplash-injured subjects reported a significantly prolonged sleep latency and significantly impaired sleep quality compared with controls (P.001 and P.04, respectively). In whiplash-injured subjects, the number of arousals was positively correlated with the number of symptoms and with the number of physical signs of whip- lash injury (P.01 and P.001, respectively). Sleep efficiency was inversely correlated with the number of injury- related findings on physical examination (P.009). Conclusion.—Sleep, as monitored by actigraph in whiplash-injured subjects, was not adversely affected by whiplash injury. The subjective impressions of the subjects, as recorded in “sleep logs,” suggest the opposite con- clusion. A significant correlation exists between certain symptoms and signs of whiplash injury and abnormalities in given sleep characteristics as detected by actigraph. Key words: sleep, whiplash, actigraph (Headache 2001;41:586-589) Whiplash injury is characterized by sudden hy- perextension, hyperflexion, or lateral movement of the neck without external head injury. 1 The injury is caused by the abrupt acceleration and deceleration of the neck. Road accidents are the most common cause of whiplash injury. The incidence of the latter is in- creased by the use of seat belts. 2 Persons who have had a whiplash injury tend to have multiple complaints. The most common are neck pain, headache, fatigue, sleep disturbances, vertigo, nau- sea, anxiety, memory impairment, and impaired concen- tration. Sleep disturbances are reported in 39% to 87% of the cases, 3,4 mostly during the first few days after the injury. The prevalence of this complaint falls signifi- cantly thereafter. 4 Several studies have found that sleep complaints correlate positively with the severity of injury and that their early appearance is an adverse prognostic sign 3 ; yet the causation of sleep distur- bances by whiplash injury has never been verified in a controlled and objective fashion. The primary pur- pose of the present study was to make up for this defi- ciency. Its secondary aims were to compare objectively derived sleep records with the subjective impressions of the subjects as to how they had slept and with the From the Department of Neurology, Meir General Hospital, Sa- pir Medical Center, Kfar-Saba (Drs. Schlesinger and Hering- Hanit) and the Department for the Treatment of Sleep Disor- ders, Sheba Medical Center, Tel-Hashomer (Dr. Dagan), Israel. Address all correspondence to Dr. Ilana Schlesinger, Depart- ment of Neurology, Meir General Hospital, Sapir Medical Center, Kfar-Saba 44281, Israel. Accepted for publication February 2, 2001.