United States Military Service Members Demonstrate Substantial and Heterogeneous Long-Term Neuropsychological Dysfunction after Moderate, Severe, and Penetrating Traumatic Brain Injury

Abstract Study Objectives Epidemiologic studies of obstructive sleep apnea (OSA) and insomnia in the U.S. military are limited. The primary aim of this study was to report and compare OSA and insomnia diagnoses in active duty the United States military service members. Method Data and service branch densities used to derive the expected rates of diagnoses on insomnia and OSA were drawn from the Defense Medical Epidemiology Database. Single sample chi-square goodness of fit tests and independent samples t-tests were conducted to address the aims of the study. Results Between 2005 and 2019, incidence rates of OSA and insomnia increased from 11 to 333 and 6 to 272 (per 10,000), respectively. Service members in the Air Force, Navy, and Marines were diagnosed with insomnia and OSA below expected rates, while those in the Army had higher than expected rates (p < .001). Female service members were underdiagnosed in both disorders (p < .001). Comparison of diagnoses following the transition from ICD 9 to 10 codes revealed significant differences in the amounts of OSA diagnoses only (p < .05). Conclusion Since 2005, incidence rates of OSA and insomnia have markedly increased across all branches of the U.S. military. Despite similar requirements for overall physical and mental health and resilience, service members in the Army had higher rates of insomnia and OSA. This unexpected finding may relate to inherent differences in the branches of the military or the role of the Army in combat operations. Future studies utilizing military-specific data and directed interventions are required to reverse this negative trend.

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A-116 Predicting Chronic Neurobehavioral Symptoms based on Acute Injury Characteristics and Symptoms in U.S. Military Service Members with and without history of TBI

Archives of Clinical Neuropsychology ◽

10.1093/arclin/acaa068.116 ◽

2020 ◽

Vol 35 (6) ◽

pp. 909-909

Author(s):

Lippa S ◽

Bailie J ◽

Brickell T ◽

French L ◽

Hungerford L ◽

...

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Military Service ◽

Service Members ◽

Injury Characteristics ◽

Military Service Members ◽

History Of ◽

Neurobehavioral Symptoms ◽

Severe Tbi

Abstract Objective Recovery following traumatic brain injury (TBI) is complex. Often following mild TBI, recovery occurs within days or weeks, though this is not always the case. Following more severe TBI, some recover quickly, while many never fully recover. This study examines acute predictors of chronic neurobehavioral symptoms in U.S. military service members (Age: M = 33.9 years, SD = 10.2) without injury (n = 86), or with history of uncomplicated mild traumatic brain injury (TBI; n = 56), complicated mild, moderate, or severe TBI (mod-sev TBI; n = 43), or bodily injury (n = 25). Method Participants completed the Neurobehavioral Symptom Inventory (NSI), Posttraumatic Stress Disorder Checklist, Alcohol Use Disorder Checklist, Combat Exposure Scale, and TBI Quality of Life and passed symptom validity tests at 0–8 months and ≥ 2 years post-injury. Forward stepwise logistic regression included 26 potential predictors (demographics, injury characteristics, military characteristics, and self-report measures at baseline) of International Statistical Classification of Diseases and Related Health Problems-10 Postconcussional Syndrome (PCSy) at follow-up. Results Cognitive Concerns (Exp(B) = .896, p = .001), Sleep (Exp(B) = 1.874, p < .001), Somatosensory Symptoms (Exp(B) = 1.194, p = .012), and mod-sev TBI (Exp(B) = 2.959, p = .045) significantly predicted follow-up PCSy. When baseline NSI symptoms were removed from the model, Cognitive Concerns (Exp(B) = .902, p < .001), Post-traumatic stress (Exp(B) = 1.173, p = .001), and Resilience (Exp(B) = .950, p < .031) significantly predicted PCSy. For all included measures in both models, higher symptoms at baseline predicted increased likelihood of follow-up PCSy. Both models correctly classified 81.3% of participants. Conclusion Findings suggest patients reporting psychological distress and cognitive concerns acutely should be targeted for treatment to mitigate prolonged neurobehavioral symptoms.

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