title: Insomnia, fatigue, and sleepiness in the first 2 years after traumatic brain injury: an NIDRR TBI model system module study.
abstract: OBJECTIVE
  To determine the prevalence of insomnia and posttraumatic brain injury (TBI) fatigue (PTBIF) in individuals with moderate to severe TBI, to explore the relationship between PTBIF and insomnia and their association with outcomes.
  
  
  METHODS
  Cross-sectional study.
  
  
  METHODS
  Five National Institute of Disability and Rehabilitation Research TBI Model Systems.
  
  
  METHODS
  Three hundred thirty-four individuals with TBI who completed 1-year (n = 213) or 2-year (n = 121) follow-up interviews between 2008 and 2012.
  
  
  RESULTS
  Insomnia occurred in 11% to 24% and PTBIF in 33% to 44% of the individuals. Insomnia and fatigue were both related to sleep disturbance, sleep hygiene, satisfaction with life, anxiety, and depression. PTBIF was associated with greater disability and sleepiness. Insomnia without fatigue was rare (2%-3%) but PTBIF without insomnia occurred in 21% to 23% of the individuals. Comorbidity occurred in 9% to 22% of the individuals.
  
  
  CONCLUSIONS
  Although PTBIF and insomnia are closely related and both associated with poorer quality of life, they are affected independently by a variety of factors, especially psychopathology and sleep quality. A majority of individuals with PTBIF do not have insomnia; and PTBIF appears to be related to disability severity and daytime sleepiness, where insomnia is not. Demographic and injury variables are not strong predictors of insomnia or PTBIF.
authors.affiliation: Mount Sinai School of Medicine, New York, NY, USA. joshua.cantor@mountsinai.org
authors.forename: Joshua B
authors.initials: JB
authors.lastname: Cantor
authors.forename: Tamara
authors.initials: T
authors.lastname: Bushnik
authors.forename: Keith
authors.initials: K
authors.lastname: Cicerone
authors.forename: Marcel P
authors.initials: MP
authors.lastname: Dijkers
authors.forename: Wayne
authors.initials: W
authors.lastname: Gordon
authors.forename: Flora M
authors.initials: FM
authors.lastname: Hammond
authors.forename: Stephanie A
authors.initials: SA
authors.lastname: Kolakowsky-Hayner
authors.forename: Anthony
authors.initials: A
authors.lastname: Lequerica
authors.forename: Michael
authors.initials: M
authors.lastname: Nguyen
authors.forename: Lisa A
authors.initials: LA
authors.lastname: Spielman
mesh_terms: D000328:Adult; D001930:Brain Injuries / Q000150:complications*; D003430:Cross-Sectional Studies; D006970:Disorders of Excessive Somnolence / Q000453:epidemiology*; D005221:Fatigue / Q000209:etiology*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011788:Quality of Life; D007319:Sleep Initiation and Maintenance Disorders / Q000209:etiology*; D055815:Young Adult