title: Sleep disturbances among soldiers with combat-related traumatic brain injury.
abstract: BACKGROUND
  Sleep complaints are common among patients with traumatic brain injury. Evaluation of this population is confounded by polypharmacy and comorbid disease, with few studies addressing combat-related injuries. The aim of this study was to assess the prevalence of sleep disorders among soldiers who sustained combat-related traumatic brain injury.
  
  
  METHODS
  The study design was a retrospective review of soldiers returning from combat with mild to moderate traumatic brain injury. All underwent comprehensive sleep evaluations. We determined the prevalence of sleep complaints and disorders in this population and assessed demographics, mechanism of injury, medication use, comorbid psychiatric disease, and polysomnographic findings to identify variables that correlated with the development of specific sleep disorders.
  
  
  RESULTS
  Of 116 consecutive patients, 96.6% were men (mean age, 31.1 ± 9.8 years; mean BMI, 27.8 ± 4.1 kg/m²), and 29.5% and 70.5% sustained blunt and blast injuries, respectively. Nearly all (97.4%) reported sleep complaints. Hypersomnia and sleep fragmentation were reported in 85.2% and 54.3%, respectively. Obstructive sleep apnea syndrome (OSAS) was found in 34.5%, and 55.2% had insomnia. Patients with blast injuries developed more anxiety (50.6% vs 20.0%, P = .002) and insomnia (63% vs 40%, P = .02), whereas patients with blunt trauma had significantly more OSAS (54.3% vs 25.9%, P = .003). In multivariate analysis, blunt trauma was a significant predictor of OSAS (OR, 3.09; 95% CI, 1.02-9.38; P = .047).
  
  
  CONCLUSIONS
  Sleep disruption is common following traumatic brain injury, and the majority of patients develop a chronic sleep disorder. It appears that sleep disturbances may be influenced by the mechanism of injury in those with combat-related traumatic brain injury, with blunt injury potentially predicting the development of OSAS.
authors.affiliation: Department of Pulmonary, Critical Care, and Sleep Medicine, Walter Reed National Military Medical Center, Bethesda, MD. Electronic address: jacob.collen@us.army.mil.
authors.forename: Jacob
authors.initials: J
authors.lastname: Collen
authors.affiliation: Department of Medicine, Walter Reed National Military Medical Center, Bethesda, MD.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Orr
authors.affiliation: Department of Pulmonary, Critical Care, and Sleep Medicine, Walter Reed National Military Medical Center, Bethesda, MD; Department of Medicine, Uniformed Services University, Bethesda, MD.
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Lettieri
authors.affiliation: Department of Pulmonary, Critical Care, and Sleep Medicine, Walter Reed National Military Medical Center, Bethesda, MD.
authors.forename: Kevin
authors.initials: K
authors.lastname: Carter
authors.affiliation: Department of Pulmonary, Critical Care, and Sleep Medicine, Walter Reed National Military Medical Center, Bethesda, MD; Department of Medicine, Uniformed Services University, Bethesda, MD.
authors.forename: Aaron B
authors.initials: AB
authors.lastname: Holley
mesh_terms: D000328:Adult; D001930:Brain Injuries / Q000150:complications*; D015897:Comorbidity; D006970:Disorders of Excessive Somnolence / Q000175:diagnosis / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology; D008889:Military Personnel; D015999:Multivariate Analysis; D017286:Polysomnography; D015995:Prevalence; D012189:Retrospective Studies; D020181:Sleep Apnea, Obstructive / Q000175:diagnosis / Q000453:epidemiology; D012892:Sleep Deprivation / Q000175:diagnosis / Q000453:epidemiology; D012893:Sleep Wake Disorders / Q000175:diagnosis* / Q000453:epidemiology*; D014857:Warfare