Sleep disturbances following traumatic brain injury are associated with poor neurobehavioral outcomes in US military service members and veterans

Cassandra L Pattinson; Tracey A Brickell; Jason Bailie; Lars Hungerford; Sara M Lippa; Louis M French; Rael T Lange

doi:10.5664/jcsm.9454

Sleep disturbances following traumatic brain injury are associated with poor neurobehavioral outcomes in US military service members and veterans

J Clin Sleep Med. 2021 Dec 1;17(12):2425-2438. doi: 10.5664/jcsm.9454.

Authors

Cassandra L Pattinson¹, Tracey A Brickell^{2

3

4

5

6

7}, Jason Bailie^{2

6

8}, Lars Hungerford^{2

6

9}, Sara M Lippa^{3

4}, Louis M French^{2

3

4

5}, Rael T Lange^{2

3

4

6

7

10}

Affiliations

¹ University of Queensland, Institute for Social Science Research, Brisbane, Queensland, Australia.
² Defense and Veterans Brain Injury Center, Silver Spring, Maryland.
³ Walter Reed National Military Medical Center, Bethesda, Maryland.
⁴ National Intrepid Center of Excellence, Bethesda, Maryland.
⁵ Uniformed Services University of the Health Sciences, Bethesda, Maryland.
⁶ General Dynamics Information Technology, Falls Church, Virginia.
⁷ Centre of Excellence on Post-Traumatic Stress Disorder, Ottawa, Ontario, Canada.
⁸ Naval Hospital Camp Pendleton, Oceanside, California.
⁹ Naval Medical Center, San Diego, California.
¹⁰ University of British Columbia, Vancouver, Canada.

Abstract

Study objectives: This study examined whether sleep disturbances were associated with neurobehavioral outcome following a traumatic brain injury (TBI) in a well characterized group of service members and veterans.

Methods: Six hundred and six participants were enrolled into the Defense and Veterans Brain Injury Center, 15-Year Longitudinal TBI study. All participants completed a battery of tests measuring self-reported sleep disturbances, neurobehavioral symptoms, and posttraumatic stress disorder symptoms. Data were analyzed using analysis of variance with post hoc comparisons. Four groups were analyzed separately: uncomplicated mild TBI; complicated mild, moderate, severe, or penetrating combined TBI; injured controls (ie, orthopedic or soft-tissue injury without TBI); and noninjured controls.

Results: A higher proportion of the mild TBI group reported moderate-severe sleep disturbances (66.5%) compared to the injured control group (54.9%), combined TBI (47.5%), and noninjured control groups (34.3%). Participants classified as having Poor Sleep had significantly worse scores on the majority of TBI-Quality of Life scales compared to those classified as having Good Sleep, regardless of TBI severity or the presence of TBI. There was a significant interaction between sleep disturbances and posttraumatic stress disorder. While sleep disturbances and posttraumatic stress disorder by themselves were significant factors associated with worse outcome, both factors combined resulted in worse outcome than either singularly.

Conclusions: Regardless of group (injured or noninjured control), sleep disturbances were common and were associated with significantly worse neurobehavioral functioning. When experienced concurrently with posttraumatic stress disorder, sleep disturbances pose significant burden to service members and veterans.

Citation: Pattinson CL, Brickell TA, Bailie J, et al. Sleep disturbances following traumatic brain injury are associated with poor neurobehavioral outcomes in US military service members and veterans. J Clin Sleep Med. 2021;17(12):2425-2438.

Keywords: PTSD; TBI; military; posttraumatic stress disorder; sleep disturbances; veterans.

Publication types

Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

Brain Injuries, Traumatic* / complications
Humans
Military Personnel*
Quality of Life
Sleep
Stress Disorders, Post-Traumatic* / complications
Stress Disorders, Post-Traumatic* / epidemiology
Veterans*