Sleep problems contribute to post-concussive symptoms in service members with a history of mild traumatic brain injury without posttraumatic stress disorder or major depressive disorder

Abstract

BACKGROUND: Many with a history of mild traumatic brain injury (TBI) experience sleep problems, which are also common symptoms of stress-related and mood disorders. OBJECTIVE: To determine if sleep problems contributed unique variance to post-concussive symptoms above and beyond symptoms of posttraumatic stress disorder/major depressive disorder (PTSD/MDD) after mild TBI. METHODS: 313 active duty service members with a history of mild TBI completed sleep, PTSD, and mood symptom questionnaires, which were used to determine contributions to the Neurobehavioral Symptom Inventory. RESULTS: 59% of the variance in post-concussive symptoms were due to PTSD symptom severity while depressive symptoms and sleep problems contributed an additional 1% each. This pattern differed between those with and without clinical diagnosis of PTSD/MDD. For those with PTSD/MDD, PTSD and depression symptoms but not sleep contributed to post-concussive symptoms. For those without PTSD/MDD, PTSD symptoms and sleep contributed specifically to somatosensory post-concussive symptoms. Daytime dysfunction and sleep disturbances were associated with post-concussive symptoms after PTSD and depression symptoms were controlled. CONCLUSIONS: PTSD symptom severity explained the most variance for post-concussive symptoms among service members with a history of mild TBI, while depression symptoms, daytime dysfunction, and sleep disturbances independently contributed small amounts of variance.

Prevalence of insomnia and insomnia symptoms following mild-traumatic brain injury: A systematic review and meta-analysis

“…Insomnia symptoms prevalence was assessed by a number of questionnaire measures and, in one instance, according to medical records. Nine studies solely reported overall prevalence of poor sleep quality, sleep disturbance or other insomnia symptoms at one time point post-mTBI [52][53][54][55][56][57][58][59][60], with only two studies reporting prevalence of insomnia symptoms at different time points post-injury [61,62]. Prevalence of insomnia symptoms varied considerably from 10.0% to 96.0%.…”

From Provider to Advocate: The Complexities of Mild Traumatic Brain Injury Prompt the Evolution of Provider Engagement

“…Weight loss could be associated with insufficient calories or nutrients required to effect recovery and could signal other concerns, such as depression or financial problems. Weight gain can be associated with lack of motivation to exercise [34], fatigue [35][36][37][38], insomnia [35,[39][40][41],…”

Post-concussive symptoms mediate the relationship between sleep problems and participation restrictions among veterans with mild traumatic brain injury

“…Likewise, sleep disruption may undermine these same neurophysiological processes and impede post-concussive recovery ( 18 , 20 ). Indeed, poor sleep quality is linked to more severe post-concussive symptoms across vestibular, sensory, behavioral, and cognitive domains ( 24 , 25 ). In turn, such post-concussive symptoms are a robust risk factor for participation restrictions among post-9/11 Veterans with TBI ( 8 , 9 ).…”

“…The purpose of this study was to examine whether post-concussive symptoms mediate the relationship between sleep problems and participation restrictions among post-9/11 Veterans with mTBI. There is theoretical and empirical support for relationships between: (1) sleep problems and post-concussive symptoms ( 24 , 25 ); and, (2) post-concussive symptoms and participation restrictions ( 8 , 9 ). Thus, we hypothesized that the relationship between sleep problems and participation restrictions would be mediated by post-concussive symptoms.…”