title: Impact of the "polytrauma clinical triad" on sleep disturbance in a department of veterans affairs outpatient rehabilitation setting.
abstract: OBJECTIVE
  There is a high prevalence of Operation Enduring Freedom/Operation Iraqi Freedom veterans returning with the "polytrauma clinical triad" of pain, posttraumatic stress disorder, and traumatic brain injury. This study examined the effect of the polytrauma clinical triad on sleep disturbance, defined as difficulty falling or staying asleep, a common problem in Operation Enduring Freedom/Operation Iraqi Freedom veterans.
  
  
  METHODS
  A chart review was conducted for 200 Operation Enduring Freedom/Operation Iraqi Freedom veterans evaluated at a polytrauma outpatient clinic. Data that were abstracted included a sleep disturbance severity index, diagnoses of posttraumatic stress disorder and traumatic brain injury, and reported problems of pain.
  
  
  RESULTS
  Sleep disturbance was highly prevalent (93.5%) in this sample, in which the majority of traumatic brain injury diagnoses were mild. In the multiple regression analysis, posttraumatic stress disorder, pain, the interaction of traumatic brain injury and posttraumatic stress disorder, and the interaction of posttraumatic stress disorder and pain significantly accounted for sleep disturbance. As a separate independent variable, traumatic brain injury was not associated with sleep disturbance.
  
  
  CONCLUSIONS
  Our preliminary results showed that posttraumatic stress disorder and pain significantly contributed to sleep disturbance. When traumatic brain injury or pain coexisted with posttraumatic stress disorder, sleep problems worsened. In this clinical population, where the majority of traumatic brain injury diagnoses tend to be in the mild category, traumatic brain injury alone did not predict sleep disturbance. Through increased awareness of pain, posttraumatic stress disorder, and traumatic brain injury, clinicians can work collaboratively to maximize rehabilitation outcomes.
authors.affiliation: Defense and Veterans Brain Injury Center, Richmond, Virginia 23219, USA.
authors.forename: Henry L
authors.initials: HL
authors.lastname: Lew
authors.forename: Terri K
authors.initials: TK
authors.lastname: Pogoda
authors.forename: Pei-Te
authors.initials: PT
authors.lastname: Hsu
authors.forename: Sara
authors.initials: S
authors.lastname: Cohen
authors.forename: Melissa M
authors.initials: MM
authors.lastname: Amick
authors.forename: Errol
authors.initials: E
authors.lastname: Baker
authors.forename: Mark
authors.initials: M
authors.lastname: Meterko
authors.forename: Rodney D
authors.initials: RD
authors.lastname: Vanderploeg
mesh_terms: D000328:Adult; D055826:Afghan Campaign 2001-; D000553:Ambulatory Care; D015331:Cohort Studies; D003130:Combat Disorders / Q000150:complications* / Q000175:diagnosis / Q000534:rehabilitation; D004185:Disability Evaluation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D009104:Multiple Trauma / Q000150:complications; D010146:Pain / Q000150:complications* / Q000175:diagnosis / Q000534:rehabilitation; D015995:Prevalence; D012189:Retrospective Studies; D012720:Severity of Illness Index; D012893:Sleep Wake Disorders / Q000453:epidemiology* / Q000209:etiology* / Q000534:rehabilitation; D013313:Stress Disorders, Post-Traumatic / Q000150:complications* / Q000175:diagnosis / Q000534:rehabilitation; D014481:United States; D014493:United States Department of Veterans Affairs; D014728:Veterans / Q000706:statistics & numerical data; D014857:Warfare