title: Insomnia characteristics and clinical correlates in Operation Enduring Freedom/Operation Iraqi Freedom veterans with post-traumatic stress disorder and mild traumatic brain injury: an exploratory study.
abstract: BACKGROUND
  There is limited data on chronic insomnia in Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) veterans, in whom post-traumatic stress disorder (PTSD) and mild traumatic brain injury (mTBI) often co-exist. Our aim was to compare sleep characteristics of three groups of OEF/OIF veterans: (1) healthy sleepers (HS), (2) those with insomnia associated with PTSD and mTBI (PTSD-mTBI), and (3) those with insomnia associated with PTSD alone.
  
  
  METHODS
  Consecutive veterans with insomnia complaints (> 6 months) were recruited over 6 months from the Miami VA Post Deployment clinic. Participants completed a sleep disorders clinical interview, medical history, and questionnaires about insomnia, sleepiness, pain, fatigue, depression, PTSD, and health-related quality of life. They underwent polysomnography (PSG) with 2 weeks of actigraphy (ACT) and sleep diaries.
  
  
  RESULTS
  There were no differences in demographics or most questionnaire responses between PTSD and PTSD-mTBI groups. Subjective daytime sleepiness was significantly greater in PTSD-mTBI subjects compared with HS and PTSD participants. Significant co-morbid sleep disorders were noted in insomnia patients. PSG and ACT wake after sleep onset was significantly shorter in PTSD-mTBI subjects as compared with PTSD participants.
  
  
  CONCLUSIONS
  Insomnia patients with PTSD-mTBI were subjectively sleepier despite spending less time awake during the night than PTSD subjects, possibly as a consequence of head trauma.
authors.affiliation: Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, USA. dwallace@med.miami.edu
authors.forename: D M
authors.initials: DM
authors.lastname: Wallace
authors.forename: S
authors.initials: S
authors.lastname: Shafazand
authors.forename: A R
authors.initials: AR
authors.lastname: Ramos
authors.forename: D Z
authors.initials: DZ
authors.lastname: Carvalho
authors.forename: H
authors.initials: H
authors.lastname: Gardener
authors.forename: D
authors.initials: D
authors.lastname: Lorenzo
authors.forename: W K
authors.initials: WK
authors.lastname: Wohlgemuth
mesh_terms: D056044:Actigraphy; D000293:Adolescent; D000328:Adult; D001930:Brain Injuries / Q000453:epidemiology*; D015897:Comorbidity; D003863:Depression / Q000453:epidemiology; D005221:Fatigue / Q000453:epidemiology; D006304:Health Status; D006801:Humans; D054542:Iraq War, 2003-2011; D008297:Male; D010146:Pain / Q000453:epidemiology; D012720:Severity of Illness Index; D007319:Sleep Initiation and Maintenance Disorders / Q000175:diagnosis* / Q000453:epidemiology*; D013313:Stress Disorders, Post-Traumatic / Q000453:epidemiology*; D011795:Surveys and Questionnaires; D014728:Veterans / Q000706:statistics & numerical data*; D055815:Young Adult