title: Insomnia in workers with delayed recovery from mild traumatic brain injury.
abstract: Insomnia has not been explored as it relates to recovery after mild traumatic brain injury (mTBI). We aimed to evaluate the prevalence of insomnia among Ontario workers with delayed recovery from mTBI, and its relationship with sociodemographic, TBI- and claim-related, behavioral, and clinical factors.
  
  
  
  This was a cross-sectional study carried out over a period of 24 months in a large rehabilitation hospital in Ontario. To assess the prevalence of insomnia, we used the Insomnia Severity Index (ISI). Data were collected from standardized questionnaires, insurer records, and clinical assessment at the time of recruitment. Bivariate associations were calculated using the Spearman's correlation coefficient or analysis of variance. We established stepwise multivariate linear regression models of factors associated with insomnia. Additional analyses, including the assessment of the internal consistency of the ISI, were performed.
  
  
  
  Of the 94 participants diagnosed with mTBI, clinical insomnia was reported by 69.2%. The mean age was 45.20 ± 9.94 years; 61.2% were men. No sex-related differences were observed in insomnia prevalence or severity. Insomnia was significantly associated with certain sociodemographic, claim-related, behavioral, and clinical variables. In the multivariable regression analysis, several determinants explained 53% of the insomnia variance. The internal consistency of the ISI, as measured by Cronbach's α, was 0.86.
  
  
  
  Insomnia is common in persons with delayed recovery from mTBI, and is significantly associated with potentially modifiable clinical and nonclinical variables. Care of persons with brain injury requires greater attention with regard to the diagnosis and management of insomnia and associated disorders.
authors.affiliation: Graduate Department of Rehabilitation Science, Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Collaborative Program in Neuroscience, University of Toronto, Toronto, ON, Canada; Toronto Rehab-University Health Network, Toronto, ON, Canada. Electronic address: tatyana.mollayeva@utoronto.ca.
authors.forename: Tatyana
authors.initials: T
authors.lastname: Mollayeva
authors.affiliation: Faculty of Arts and Science, University of Toronto, Toronto, ON, Canada; Aquired Brain Injury Research Lab, University of Toronto, Toronto, ON, Canada; Youthdale Child and Adolescent Sleep Clinic, Toronto, ON, Canada.
authors.forename: Shirin
authors.initials: S
authors.lastname: Mollayeva
authors.affiliation: Faculty of Arts and Science, University of Toronto, Toronto, ON, Canada; Youthdale Child and Adolescent Sleep Clinic, Toronto, ON, Canada; Toronto Western Hospital, University Health Network, Toronto, ON, Canada.
authors.forename: Colin M
authors.initials: CM
authors.lastname: Shapiro
authors.affiliation: Faculty of Health, Department of Sport Sciences and Clinical Biomechanics, University of Southern Denmark, Odense M, Denmark; Division of Health Care and Outcomes Research, University Health Network, Toronto, ON, Canada; Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
authors.forename: J David
authors.initials: JD
authors.lastname: Cassidy
authors.affiliation: Graduate Department of Rehabilitation Science, Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Aquired Brain Injury Research Lab, University of Toronto, Toronto, ON, Canada; Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, ON, Canada.
authors.forename: Angela
authors.initials: A
authors.lastname: Colantonio
mesh_terms: D001924:Brain Concussion / Q000150:complications* / Q000534:rehabilitation*; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009864:Ontario / Q000453:epidemiology; D015995:Prevalence; D012307:Risk Factors; D012720:Severity of Illness Index; D007319:Sleep Initiation and Maintenance Disorders / Q000453:epidemiology* / Q000209:etiology; D011795:Surveys and Questionnaires
keywords: Concussion; Delayed recovery; Diagnostic modeling; Insomnia; Rehabilitation; Traumatic brain injury