Treatment of Sleep Disturbance in Patients with Traumatic Brain Injury

Aims:Traumatic brain injury (TBI) affects nearly 1.5 million individuals in the United States each year. During peacetime, over 7,000 Americans with a diagnosis of TBI are admitted to military and veterans hospitals every year; this number increases significantly during combat, during which TBI may comprise up to 20% of survivor casualties. Pain and discomfort relating to injuries are frequent causes of sleep disturbance in TBI patients. Sleep disturbances can manifest as difficulty falling or staying asleep, early morning wakening and non-restorative sleep, and affects up to 30% of individuals with TBI. Because there are few studies on pharmacotherapy for sleep disturbances in TBI, many physicians base their intervention on experience with the general population. in this poster, we will consider the unique features of the patient with TBI and make recommendations for psychoactive medications that are appropriate to treat insomnia in this population.Methodology:A literature review was performed and recommendations for treatment of sleep disturbances in patients with TBI are summarized here based on published findings.Conclusion:Non-pharmacological means should be the first-line treatment for sleep disturbances in patients with TBI. These include sleep hygiene and cognitive behavioral therapy. Physicians and other clinicians should pay attention to the specific sleep complaint, adverse effect profile of the medication as well as the anticipated duration of treatment before deciding upon a sleep agent for patients with TBI.

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Treatments for sleep disturbances in individuals with acquired brain injury: A systematic review

Clinical Rehabilitation ◽

10.1177/02692155211014827 ◽

2021 ◽

pp. 026921552110148

Author(s):

Louise Pilon ◽

Nikita Frankenmolen ◽

Dirk Bertens

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Cognitive Behavioral Therapy ◽

Sleep Disturbances ◽

Behavioral Therapy ◽

Experimental Studies ◽

Acquired Brain Injury ◽

Cognitive Behavioral ◽

Study Quality ◽

Severe Acquired Brain Injury

Objective: To systematically review the evidence on the treatments of sleep disturbances in individuals with acquired brain injury. Data sources: PubMed, Embase, Web of Science, and PsycINFO were searched from inception to January 2021. Review method: Eligibility criteria were (1) participants with mild to severe acquired brain injury from traumatic brain injury and stroke (⩾three months post-injury), (2) individuals aged 16 years and older, (3) participants with self-reported sleep disturbances, (4) controlled group studies and single case (experimental) studies, and (5) interventions aimed at treatment of sleep disturbances. Two researchers independently identified relevant studies and assessed their study quality using the revised Cochrane assessment of bias tool (RoB 2.0) and the risk-of-bias in N-of-1 trials (RoBiNT) scale. Results: The search yielded 655 records; 11 studies met the inclusion criteria and were included, with a total of 227 participants (207 individuals with traumatic brain injury, 20 stroke patients). Two studies included pharmacological therapy, six studies examined the effects of cognitive behavioral therapy and three studies investigated alternative interventions such as acupuncture. Conclusion: Although there was heterogeneity in the study quality of the included studies, their outcomes suggest that cognitive behavioral therapy is recommended as treatment of choice for improving sleep in individuals with acquired brain injury, especially for patients with mild to severe traumatic brain injury. Future research should examine the effects of cognitive behavioral therapy in more high-quality randomized controlled designs.

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A-144 Mild Traumatic Brain Injury and Sleep Disturbances in Military Service Members as Predictors of Days Missed from Duty

Archives of Clinical Neuropsychology ◽

10.1093/arclin/acaa068.144 ◽

2020 ◽

Vol 35 (6) ◽

pp. 938-938

Author(s):

Higa J ◽

Lu L ◽

Reid M ◽

Khokhar B ◽

Seegmiller R ◽

...

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Sleep Disturbance ◽

Mild Traumatic Brain Injury ◽

Military Service ◽

Sleep Disturbances ◽

Acute Stress ◽

Service Members ◽

Military Readiness ◽

Military Service Members

Abstract Objective Duty-limiting pain impacts military readiness. Conditions such as mild traumatic brain injury (mTBI), stress-related disorders (Acute Stress Disorder (ASD)/PTSD), depression, anxiety and sleep disturbance occur frequently among military service members and can be associated with pain-related time off from duty. The purpose of this study was to explore which of these conditions best predict time off duty. Method Time off duty was categorized into low (0–3 days), medium (3–30 days) and high (more than 30 days). After excluding participants undergoing a Medical Evaluation Board (MEB) or with potentially invalid symptom reporting, 364 military service members were included. An ordinal regression analysis was conducted with presence or absence of mTBI, ASD/PTSD, depression/anxiety and sleep disturbance as predictors. Results The regression model was significant (χ2 = 21.93, p < .001), with mTBI status and sleep disturbance emerging as significant predictors of pain-related time off duty. Those with a history of mTBI were five times more likely to miss duty days than those without mTBI (Odds Ratio (OR) = 5.09 [p = .04]). Presence of ongoing sleep disturbance conveyed two times the risk of more missed duty (OR = 2.09 [p = .04]). Conclusion This suggests that treating mTBI and sleep disturbances in military service members can reduce pain-related absenteeism and consequently improve military readiness.

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Traumatic Brain Injury: A Trauma Surgeon's Perspective

Perspectives on Neurophysiology and Neurogenic Speech and Language Disorders ◽

10.1044/nnsld22.3.82 ◽

2012 ◽

Vol 22 (3) ◽

pp. 82-89

Author(s):

Oscar D. Guillamondegui

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Multidisciplinary Approach ◽

Trauma Team ◽

The United States ◽

Long Term Outcomes ◽

Term Care ◽

Injured Brain ◽

The Moment

Traumatic brain injury (TBI) is a serious epidemic in the United States. It affects patients of all ages, race, and socioeconomic status (SES). The current care of these patients typically manifests after sequelae have been identified after discharge from the hospital, long after the inciting event. The purpose of this article is to introduce the concept of identification and management of the TBI patient from the moment of injury through long-term care as a multidisciplinary approach. By promoting an awareness of the issues that develop around the acutely injured brain and linking them to long-term outcomes, the trauma team can initiate care early to alter the effect on the patient, family, and community. Hopefully, by describing the care afforded at a trauma center and by a multidisciplinary team, we can bring a better understanding to the armamentarium of methods utilized to treat the difficult population of TBI patients.

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Divergence in the epidemiological estimates of traumatic brain injury in the United States: comparison of two national databases

Journal of Neurosurgery ◽

10.3171/2020.7.jns201896 ◽

2020 ◽

pp. 1-10

Author(s):

Brittany M. Stopa ◽

Maya Harary ◽

Ray Jhun ◽

Arun Job ◽

Saef Izzy ◽

...

Keyword(s):

Traumatic Brain Injury ◽

Emergency Department ◽

Brain Injury ◽

Data Bank ◽

The United States ◽

National Sample ◽

Population Based ◽

Weighted Estimates ◽

True Incidence ◽

Ed Visits

OBJECTIVETraumatic brain injury (TBI) is a leading cause of morbidity and mortality in the US, but the true incidence of TBI is unknown.METHODSThe National Trauma Data Bank National Sample Program (NTDB NSP) was queried for 2007 and 2013, and population-based weighted estimates of TBI-related emergency department (ED) visits, hospitalizations, and deaths were calculated. These data were compared to the 2017 Centers for Disease Control and Prevention (CDC) report on TBI, which used the Healthcare Cost and Utilization Project’s National (“Nationwide” before 2012) Inpatient Sample and National Emergency Department Sample.RESULTSIn the NTDB NSP the incidence of TBI-related ED visits was 59/100,000 in 2007 and 62/100,000 in 2013. However, in the CDC report there were 534/100,000 in 2007 and 787/100,000 in 2013. The CDC estimate for ED visits was 805% higher in 2007 and 1169% higher in 2013. In the NTDB NSP, the incidence of TBI-related deaths was 5/100,000 in 2007 and 4/100,000 in 2013. In the CDC report, the incidence was 18/100,000 in both years. The CDC estimate for deaths was 260% higher in 2007 and 325% higher in 2013.CONCLUSIONSThe databases disagreed widely in their weighted estimates of TBI incidence: CDC estimates were consistently higher than NTDB NSP estimates, by an average of 448%. Although such a discrepancy may be intuitive, this is the first study to quantify the magnitude of disagreement between these databases. Given that research, funding, and policy decisions are made based on these estimates, there is a need for a more accurate estimate of the true national incidence of TBI.

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Faculty Opinions recommendation of Sleep disturbances among soldiers with combat-related traumatic brain injury.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.14267269.15779453 ◽

2012 ◽

Author(s):

Donald Marion

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Sleep Disturbances

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Can Cognitive Behavioral Therapy for Insomnia also treat fatigue, pain, and mood symptoms in individuals with traumatic brain injury? – A multiple case report

Neurorehabilitation ◽

10.3233/nre-151296 ◽

2016 ◽

Vol 38 (1) ◽

pp. 59-69 ◽

Cited By ~ 18

Author(s):

William Lu ◽

Jason W. Krellman ◽

Marcel P. Dijkers

Keyword(s):

Traumatic Brain Injury ◽

Case Report ◽

Brain Injury ◽

Cognitive Behavioral Therapy ◽

Behavioral Therapy ◽

Cognitive Behavioral ◽

Mood Symptoms ◽

Multiple Case

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Neuropsychological Performance and Sleep Disturbance Following Traumatic Brain Injury

Journal of Head Trauma Rehabilitation ◽

10.1097/00001199-200409000-00003 ◽

2004 ◽

Vol 19 (5) ◽

pp. 378-390 ◽

Cited By ~ 110

Author(s):

Omar Mahmood ◽

Lisa J. Rapport ◽

Robin A. Hanks ◽

Norman L. Fichtenberg

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Sleep Disturbance ◽

Neuropsychological Performance

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Adult sports-related traumatic brain injury in United States trauma centers

Neurosurgical FOCUS ◽

10.3171/2016.1.focus15613 ◽

2016 ◽

Vol 40 (4) ◽

pp. E4 ◽

Cited By ~ 25

Author(s):

Ethan A. Winkler ◽

John K. Yue ◽

John F. Burke ◽

Andrew K. Chan ◽

Sanjay S. Dhall ◽

...

Keyword(s):

United States ◽

Traumatic Brain Injury ◽

Brain Injury ◽

The United States ◽

Mortality Rates ◽

Hospital Length Of Stay ◽

Health Concern ◽

Medical Complications ◽

Equestrian Sports ◽

Prolonged Hospital

OBJECTIVE Sports-related traumatic brain injury (TBI) is an important public health concern estimated to affect 300,000 to 3.8 million people annually in the United States. Although injuries to professional athletes dominate the media, this group represents only a small proportion of the overall population. Here, the authors characterize the demographics of sports-related TBI in adults from a community-based trauma population and identify predictors of prolonged hospitalization and increased morbidity and mortality rates. METHODS Utilizing the National Sample Program of the National Trauma Data Bank (NTDB), the authors retrospectively analyzed sports-related TBI data from adults (age ≥ 18 years) across 5 sporting categories—fall or interpersonal contact (FIC), roller sports, skiing/snowboarding, equestrian sports, and aquatic sports. Multivariable regression analysis was used to identify predictors of prolonged hospital length of stay (LOS), medical complications, inpatient mortality rates, and hospital discharge disposition. Statistical significance was assessed at α < 0.05, and the Bonferroni correction for multiple comparisons was applied for each outcome analysis. RESULTS From 2003 to 2012, in total, 4788 adult sports-related TBIs were documented in the NTDB, which represented 18,310 incidents nationally. Equestrian sports were the greatest contributors to sports-related TBI (45.2%). Mild TBI represented nearly 86% of injuries overall. Mean (± SEM) LOSs in the hospital or intensive care unit (ICU) were 4.25 ± 0.09 days and 1.60 ± 0.06 days, respectively. The mortality rate was 3.0% across all patients, but was statistically higher in TBI from roller sports (4.1%) and aquatic sports (7.7%). Age, hypotension on admission to the emergency department (ED), and the severity of head and extracranial injuries were statistically significant predictors of prolonged hospital and ICU LOSs, medical complications, failure to discharge to home, and death. Traumatic brain injury during aquatic sports was similarly associated with prolonged ICU and hospital LOSs, medical complications, and failure to be discharged to home. CONCLUSIONS Age, hypotension on ED admission, severity of head and extracranial injuries, and sports mechanism of injury are important prognostic variables in adult sports-related TBI. Increasing TBI awareness and helmet use—particularly in equestrian and roller sports—are critical elements for decreasing sports-related TBI events in adults.

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