A-117 Sleep Disruption has a Stronger Influence on Self-reported Neurobehavioral Status than Traumatic Brain Injury in U.S. Military Service Members and Veterans

Objective To examine the relation between sleep disruption and neurobehavioral outcome following mild, moderate, and severe traumatic brain injury (TBI). Methods Participants were 509 U.S. military service members/veterans divided into four groups: uncomplicated mild TBI (n = 183; MTBI); complicated mild TBI and moderate–severe TBI (n = 96; STBI); injured controls (n = 138; IC); and non-injured controls (n = 92; NIC). Participants completed a 2-hour neurobehavioral test battery 12 or more months post-injury that included the PTSD Checklist and 13 scales from the TBI-Quality of Life (TBI-QOL). Using the TBI-QOL Sleep Disturbance scale, participants were classified into two ‘Sleep’ subgroups: Poor Sleep (55 T or higher) or Good Sleep (50 T or lower). Results A higher proportion of the MTBI group was classified as having Poor Sleep (79.2%) compared to the IC (64.5%) and STBI (58.3%) groups; and all were higher than the NIC group (40.2%). In each group separately, participants with Poor Sleep had significantly worse scores on all TBI-QOL scales compared to those with Good Sleep (all p’s < .001, d = .68 to d = 1.98). Participants with Poor Sleep consistently had worse TBI-QOL scores regardless of TBI severity or the presence/absence of TBI (all p’s < .05). Additionally, there was a significant interaction between Sleep and PTSD. Both factors combined resulted in worse outcome than either factor alone (p’s < .05). Conclusions Poor Sleep had a very strong influence on self-reported neurobehavioral outcome, and a greater influence on outcome than TBI severity or the presence/absence of TBI. Poor Sleep may be a useful ‘risk factor’ that can be used clinically to identify individuals in need of early intervention.