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Original Research |

Sleep Disturbances Among Soldiers With Combat-Related Traumatic Brain InjurySleep Disorders in Combat Traumatic Brain Injury

Jacob Collen, MD; Nicholas Orr, MD; Christopher J. Lettieri, MD, FCCP; Kevin Carter, DO; Aaron B. Holley, MD
Author and Funding Information

From the Department of Pulmonary, Critical Care, and Sleep Medicine (Drs Collen, Lettieri, Carter, and Holley) and Department of Medicine (Dr Orr), Walter Reed National Military Medical Center; and Department of Medicine (Drs Lettieri and Holley), Uniformed Services University, Bethesda, MD.

Correspondence to: Jacob Collen, MD, Department of Pulmonary, Critical Care, and Sleep Medicine, Walter Reed National Military Medical Center, 8901 Rockville Pike, Bethesda, MD 20889; e-mail: jacob.collen@us.army.mil


Funding/Support: The authors have reported to CHEST that no funding was received for this study.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2012;142(3):622-630. doi:10.1378/chest.11-1603
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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.


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