title: Telephone Problem-Solving Treatment Improves Sleep Quality in Service Members With Combat-Related Mild Traumatic Brain Injury: Results From a Randomized Clinical Trial.
abstract: OBJECTIVE
  Evaluate sleep quality, its correlates, and the effect of telephone-based problem-solving treatment (PST) in active duty postdeployment service members with mild traumatic brain injury (mTBI) SETTING:: Randomized clinical trial.
  
  
  METHODS
  Active duty service members with combat-related mTBI.
  
  
  METHODS
  Education-only (EO) and PST groups (N = 178 each) received printed study materials and 12 educational brochures. The PST group additionally received up to 12 PST telephone calls addressing participant-selected issues. Outcomes were evaluated postintervention (6 months) and at 12 months.
  
  
  METHODS
  Pittsburgh Sleep Quality Index.
  
  
  RESULTS
  Sleep quality was manifestly poor in both groups at baseline (Pittsburgh Sleep Quality Index = 12.5 ± 4). Overall sleep quality was significantly different between the PST and EO groups at 6 months (P = .003) but not at 12 months. Longitudinally, PST significantly improved sleep quality at 6 months (P = .001) but not over the follow-up. Low sleep quality was associated with concussion symptoms, pain, depression, and posttraumatic stress disorder at all time points (P < .0001).
  
  
  CONCLUSIONS
  Sleep disorders, common in postdeployment service members with mTBI, are strongly associated with the presence of pain, posttraumatic stress disorder, and depression. Telephone-based PST may be an effective therapeutic approach for reducing sleep disorders in this population. Research should focus on maintenance of treatment gains.
authors.affiliation: National Center for Telehealth and Technology (T2), Tacoma, Washington (Drs Vuletic, Bush, Stanfill, and Gahm); Departments of Rehabilitation Medicine (Drs Bell, Temkin, Dikmen, and Brockway), Neurological Surgery (Drs Temkin and Dikmen), Biostatistics (Drs Temkin and Fann), and Psychiatry and Behavioral Sciences (Dr Fann), University of Washington, Seattle; Department of Physical Medicine and Rehabilitation, University of Texas Southwestern, Dallas (Dr Bell); Departments of Family Medicine and Public Health (Drs Jain, Raman, and Stein and Messrs He and Ernstrom) and Psychiatry (Dr Stein), University of California San Diego, La Jolla; Department of Neurosurgery, Stanford University School of Medicine, Stanford, California (Dr Grant); and Defense Centers of Excellence (DCoE), Olympia, Washington (Dr Gahm).
authors.forename: S
authors.initials: S
authors.lastname: Vuletic
authors.forename: K R
authors.initials: KR
authors.lastname: Bell
authors.forename: S
authors.initials: S
authors.lastname: Jain
authors.forename: N
authors.initials: N
authors.lastname: Bush
authors.forename: N
authors.initials: N
authors.lastname: Temkin
authors.forename: J R
authors.initials: JR
authors.lastname: Fann
authors.forename: K E
authors.initials: KE
authors.lastname: Stanfill
authors.forename: S
authors.initials: S
authors.lastname: Dikmen
authors.forename: J A
authors.initials: JA
authors.lastname: Brockway
authors.forename: F
authors.initials: F
authors.lastname: He
authors.forename: K
authors.initials: K
authors.lastname: Ernstrom
authors.forename: R
authors.initials: R
authors.lastname: Raman
authors.forename: G
authors.initials: G
authors.lastname: Grant
authors.forename: M B
authors.initials: MB
authors.lastname: Stein
authors.forename: G A
authors.initials: GA
authors.lastname: Gahm
mesh_terms: D000328:Adult; D001924:Brain Concussion / Q000150:complications / Q000523:psychology* / Q000534:rehabilitation*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008889:Military Personnel; D011340:Problem Solving; D012893:Sleep Wake Disorders / Q000209:etiology / Q000628:therapy*; D013313:Stress Disorders, Post-Traumatic / Q000209:etiology / Q000628:therapy; D017216:Telemedicine; D013689:Telephone; D055815:Young Adult