Neurological

Traumatic brain injury associated with an increased risk of insomnia

Traumatic brain injuries (TBI) can increase the risk of sleep disorders, including sleep apnea and insomnia, a study in Neurology suggests.

The study included a cohort of 98,709 veterans from the Veterans Health Administration system who were diagnosed with TBI from 2001 to 2015. An additional 98,709 age-matched veterans without TBI were included as a control population. The researchers looked at the development of insomnia in the two groups.

Sleep disorders covered in this study included newly diagnosed sleep apnea, hypersomnia, insomnia, or sleep-related movement disorders that developed after the initial diagnosis of TBI or at random in veterans without TBI. All participants in this study had at least 1 year of follow-up data available for analysis.

At the start of the study, the mean age of all participants was 49 years (standard deviation ± 20). Approximately 11.7% of the total cohort were women, and approximately half (49.6%) of the TBIs were mild. After a mean follow-up period of 5 years, 19.6% (n = 23,127) veterans with TBI developed insomnia.

In an analysis adjusted for age, gender, race, education, and income, it was found that people with TBI were 50% more likely to develop a sleep disorder compared to veterans without a TBI (hazard ratio) [HR]1.50; 95% CI, 1.47-1.53). Additional adjustments for medical and psychiatric disorders indicated that patients with TBI (hazard ratio) were 41% more likely to develop sleep disorders [HR]1.41; 95% CI, 1.37-1.44).

Particularly in patients with TBI, the likelihood of sleep apnea (HR 1.28; 95% CI 1.24-1.32), insomnia (HR 1.50; 95% CI 1.45-1.55), and hypersomnia (HR 1.50; 95%) significantly higher CI, 1.39-1.61) and sleep-related movement disorders (HR, 1.33; 95% CI, 1.16-1.52).

The association between TBI and incident-related sleep disorders in an adjusted analysis was mild TBI (HR 1.49; 95% CI 1.45-1.53) versus moderate to severe TBI (HR 1.33; 95% CI 1.30- 1.37) strongest for demographics and medical and psychiatric disorders.

Limitations of this study were the inclusion of veterans only, which questions whether the results can be generalized to civilians, and the reliance on ICD-9 codes to define TBI and sleep disorders.

The study’s researchers concluded that “Strategies for the early detection and prevention of post-TBI sleep disorders need to be developed and are critical to improving the quality of life and other long-term outcomes in patients with TBI”.

reference

Leng Y, Byers AL, Barnes DE, Peltz CB, Li Y, Yaffe K. Traumatic brain injury and incidence risk for sleep disorders in nearly 200,000 US veterans. Neurology. Published online March 3, 2021. doi: 10.1212 / WNL.0000000000011656

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