Research Reports - Sleep Disturbances Among Soldiers with Combat Related Traumatic Brain Injury

Jacob Collen, Nicholas Orr, Christopher J. Lettieri, Kevin Carter, and Aaron B. Holley

Chest, April 2012, 141 (4)

Background: Sleep complaints are common among patients with traumatic brain injuries. Evaluation of this population is confounded by polypharmacy and comorbid disease, with few studies addressing combat-related injuries. Our aim is to assess the prevalence of sleep disorders among Soldiers sustaining combat-related traumatic brain injury.

Methods: Retrospective review of Soldiers returning from combat with mild-moderate traumatic brain injury. All underwent comprehensive sleep evaluations. We determined the prevalence of sleep complaints and disorders in this population. We assessed demographics, mechanism of injury, medication use, comorbid psychiatric disease, and polysomnographic findings to identify variables that correlated with the development of specific sleep disorders.

Results: 116 consecutive patients; 96.6% were men, mean age 31.1±9.8 years, and mean BMI was 27.8±4.1 Kg/m2. 29.5% sustained blunt and 70.5% sustained blast injuries. Nearly all (97.4%) reported sleep complaints. Hypersomnia and sleep fragmentation were reported in 85.2% and 54.3%, respectively. Obstructive sleep apnea syndrome (OSAS) was diagnosed in 34.5% and 55.2% had insomnia. Patients with blast injuries developed more anxiety (50.6% vs. 20.0% p=0.002), and insomnia (63% vs. 40%, p=0.02), while patients with blunt trauma had significantly more OSAS (54.3% vs. 25.9%, p=0.003). In multivariate analysis blunt trauma was a significant predictor of OSAS (OR 3.09, 95% CI 1.02-9.38, p=0.047).

Conclusions: Sleep disruption is common following traumatic brain injuries and the majority developed a chronic sleep disorder. It appears that sleep disturbances may be influenced by mechanism of injury in those with combat-related traumatic brain injury, with blunt injury potentially predicting the development of OSAS.

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