Sleep-Wake Disturbances After Traumatic Brain Injury: Synthesis of Human and Animal Studies

Sandsmark, Danielle K.; Elliott, Jonathan E.; Lim, Miranda M.

doi:10.1093/sleep/zsx044

Cited by 124 publications

(149 citation statements)

References 238 publications

(302 reference statements)

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“…Sleep disturbances have long been recognized as a prominent symptom of PTSD; however, disturbed sleep has also been posited as a potential risk factor for PTSD (Gehrman et al, 2013;Mellman et al, 2014). These reciprocal associations are also mirrored in mTBI in that sleep disturbances have been correlated with an increased risk of sustaining injuries such as TBI and, conversely, sleep disturbances are a known consequence following TBI of all severities (Sandsmark, Elliott, & Lim, 2017). Sleep disturbances have also been linked to increased symptom reporting and have been shown to hinder recovery following TBI (White et al, 2016).…”

Section: Discussionmentioning

confidence: 99%

Concurrent Mild Traumatic Brain Injury and Posttraumatic Stress Disorder Is Associated With Elevated Tau Concentrations in Peripheral Blood Plasma

Pattinson

Gill

Lippa

et al. 2019

Journal of Traumatic Stress

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Concurrent mild traumatic brain injury (mTBI) and posttraumatic stress disorder (PTSD) are common in U.S. military service members and veterans. Tau and amyloid‐beta‐42 (Aβ42) are proteins that have been linked to cognitive impairment, neurological hallmarks of Alzheimer's disease, and may also relate to recovery from mTBI. However, the role of these proteins in the maintenance or resolution of chronic symptoms has not yet been determined. Participants in the current study were 102 service members and veterans who had sustained an mTBI (n = 84) or injured controls (IC) without TBI (n = 18). They were categorized into three groups based on the presence or absence of mTBI and PTSD: IC/PTSD‐Absent (n = 18), mTBI/PTSD‐Absent (n = 63), and mTBI/PTSD‐Present (n = 21). Concentrations of tau and Aβ42 in peripheral blood plasma were measured using SimoaTM, an ultrasensitive technology, and compared across groups. Tau concentrations were highest in the mTBI/PTSD‐Present group, F(2, 99) = 4.33, p = .016, compared to the other two groups. Linear multiple regression was conducted to determine the independent effects of PTSD and mTBI on tau concentrations, controlling for gender and sleep medication. PTSD was a significant and independent predictor of tau concentrations, β = .25, p = .009, ηp2 = .26. Aβ42 concentrations did not differ between the groups. The results indicated that PTSD was associated with an elevation of tau in peripheral blood and suggest that there may be increased biological effects of PTSD in this young cohort of service members and veterans following mTBI.

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Section: Discussionmentioning

confidence: 99%

Concurrent Mild Traumatic Brain Injury and Posttraumatic Stress Disorder Is Associated With Elevated Tau Concentrations in Peripheral Blood Plasma

Pattinson

Gill

Lippa

et al. 2019

Journal of Traumatic Stress

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“…Sleep disturbances can also impede the TBI rehabilitation process (Bell et al, 2018;Sandsmark, Elliott, & Lim, 2017) and are risk factors for the development of anxiety and mood disorders following stress exposure (Babson & Feldner, 2010;Bryant, Creamer, O'Donnell, Silove, & McFarlane, 2010;Gehrman et al, 2013). Realizing the impact TBI has on functional outcomes and quality of life, as well as the role of disturbed sleep as a risk factor for the development and maintenance of death, disease, and disability, the comorbidity between TBI and chronic sleep disturbance may increase the risk for poor health outcomes among SMs and veterans relative to the general population (Barr et al, 2015).…”

Section: Sleep Disturbances In Combat-related Tbimentioning

confidence: 99%

“…This review uniquely contributes to the existing science due to the overall scarcity of prior summaries of sleep disturbances and TBI, as well as existing reviews focusing primarily on the general population (see Barshikar & Bell, 2017;Bogdanov, Naismith, & Lah, 2017;Orff, Ayalon, & Drummond, 2009;Ponsford et al, 2012 for reviews), on sleep disturbances occurring post-TBI (Bogdanov et al, 2017;Ponsford et al, 2012), or that isolate only one sleep disturbance (i.e. insomnia; Sandsmark, Elliott, & Lim, 2017). First, we discuss the nature and prevalence of sleep disturbances based on varying TBI assessment meth-ods.…”

Section: Sleep Disturbances In Combat-related Tbimentioning

confidence: 99%

Traumatic brain injury and sleep disturbances in combat-exposed service members and veterans: Where to go next?

McKeon

Stocker

Germain

2019

NRE

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OBJECTIVE: To synthesize the current evidence on sleep disturbances in military service members (SMs) and veterans with traumatic brain injury (TBI). METHODS: An electronic literature search first identified abstracts published from 2008-2018 inclusively referencing sleep, TBI, and military personnel from Operation Enduring Freedom, Operation Iraqi Freedom, Operation New Dawn, and Persian Gulf veterans. Selection criteria eliminated studies on non-combat TBI, open or penetrating injuries, and articles where the relationship between sleep and TBI was not directly examined. Articles on all military branches and components, those currently serving and veterans-ranging from medical chart reviews to clinical trials, were included. Forty-one articles were selected for full text-review. RESULTS: Twenty-four papers estimated the prevalence of sleep disturbances in TBI. Eight studies demonstrated the contribution of common co-occurring conditions, most notably posttraumatic stress disorder, to the relationship between disrupted sleep and TBI. Ten studies differentiated sleep profiles between military SMs and veterans with and without acute TBI and detected significant differences in sleep disturbances across the course of injury. Longitudinal studies were scarce but helped to establish the temporal relationship between sleep disturbances and TBI and isolate sleep-related mechanisms influencing TBI prognosis. Only three studies reported on interventions for improving sleep quality and TBI symptoms. Systematic research testing assessments and interventions that target sleep disturbances for improving sleep, TBI symptoms, and long-term functional outcomes were identified as critical knowledge gaps. CONCLUSION: Findings unequivocally establish that sleep disturbances are highly prevalent in SMs and veterans with TBI. However, studies testing the effectiveness of treatments for improving sleep in military groups with TBI have been limited and their results inconsistent. This review highlights a critical opportunity for advancing military medicine through future research aimed at identifying and testing sleep-focused treatments in SMs and veterans with combat-related TBI.

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“…Thus, the total score ranges from 0 to 80. The survey questions are subdivided into four subscales, or clusters: cluster B (intrusion; 1-5), cluster C (avoidance; 6-7), cluster D (mood and cognition; [8][9][10][11][12][13][14], and cluster E (arousal activity; [15][16][17][18][19][20]. Cluster A, which was not administered in this study, is a structured clinical interview (eg, Clinician-Administered PTSD Scale) and is required for administering an official diagnosis of PTSD.…”

Section: Ptsd Status and Symptom Severitymentioning

confidence: 99%

Increased Sleep Disturbances and Pain in Veterans With Comorbid Traumatic Brain Injury and Posttraumatic Stress Disorder

Balba

Elliott

Weymann

et al. 2018

Journal of Clinical Sleep Medicine

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Study Objectives: Veterans are at an increased risk for traumatic brain injury (TBI) and posttraumatic stress disorder (PTSD), both of which are associated with sleep disturbances and increased pain. Furthermore, sleep disturbances and pain are reciprocally related such that each can exacerbate the other. Although both TBI and PTSD are independently linked to sleep disturbances and pain, it remains unclear whether Veterans with comorbid TBI+PTSD show worse sleep disturbances and pain compared to those with only TBI or PTSD. We hypothesized that sleep and pain would be worse in Veterans with comorbid TBI+PTSD compared to Veterans with only TBI or PTSD. Methods: Veterans (n = 639) from the VA Portland Health Care System completed overnight polysomnography and self-report questionnaires. Primary outcome variables were self-reported sleep disturbances and current pain intensity. Participants were categorized into four trauma-exposure groups: (1) neither: without TBI or PTSD (n = 383); (2) TBI: only TBI (n = 67); (3) PTSD: only PTSD (n = 126); and (4) TBI+PTSD: TBI and PTSD (n = 63). Results: The PTSD and TBI+PTSD groups reported worse sleep compared to the TBI and neither groups. The TBI+PTSD group reported the greatest pain intensity compared to the other groups. Conclusions: These data suggest sleep and pain are worst in Veterans with TBI and PTSD, and that sleep is similarly impaired in Veterans with PTSD despite not having as much pain. Thus, although this is a complex relationship, these data suggest PTSD may be driving sleep disturbances, and the added effect of TBI in the comorbid group may be driving pain in this population. stress disorder (PTSD). Among the most prevalent, persistent, and debilitating sequelae in both TBI and PTSD are sleep disturbances and increased pain. Importantly, sleep disturbances and pain also share a reciprocal relationship such that increases in either can independently exacerbate the other. [4][5][6][7] It has been estimated that > 50% of people with TBI experience sleep disturbances, 8-10 including insomnia, 11 hypersomnia, 8 obstructive sleep apnea (OSA), 9 and circadian rhythm sleep disorders. 9,12 Furthermore, current evidence suggests these sleep disturbances can persist for several years postinjury. 13 Sleep disturbances are also a hallmark feature of PTSD BRIEF SUMMARY Current Knowledge/Study Rationale: Traumatic brain injury (TBI) and posttraumatic stress disorder (PTSD) are common in Veterans and are independently associated with sleep disturbances and pain, both of which can exacerbate the other and impede rehabilitation. Understanding the relationship between TBI, PTSD, sleep, and pain will help improve treatment and rehabilitation in this vulnerable population. Study Impact: This study demonstrates that Veterans with PTSD and with both PTSD and TBI experience more sleep disturbances, but those with TBI and PTSD report significantly greater current pain intensity. These data help in the limited understanding of how Veterans with comorbid TBI and PTSD differ from Veteran...

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Sleep-Wake Disturbances After Traumatic Brain Injury: Synthesis of Human and Animal Studies

Cited by 124 publications

References 238 publications

Concurrent Mild Traumatic Brain Injury and Posttraumatic Stress Disorder Is Associated With Elevated Tau Concentrations in Peripheral Blood Plasma

Concurrent Mild Traumatic Brain Injury and Posttraumatic Stress Disorder Is Associated With Elevated Tau Concentrations in Peripheral Blood Plasma

Traumatic brain injury and sleep disturbances in combat-exposed service members and veterans: Where to go next?

Increased Sleep Disturbances and Pain in Veterans With Comorbid Traumatic Brain Injury and Posttraumatic Stress Disorder

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