PURPOSE: Sleep complaints are frequent and poorly understood in recently deployed Soldiers. The purpose of this study was to determine the prevalence of sleep disorders in combat-related TBI and PTSD.
METHODS: Retrospective review of consecutive Soldiers with TBI or PTSD. We reviewed demographic data, mechanism of injury, comorbid disease, medication use, polysomnography (PSG), and type of sleep disorder. Clinical variables were assessed for correlation with an increased rate of sleep disorders.
RESULTS: 261 patients were included (90.4% men, mean age 35.5±10, mean BMI 29.28±4.7). 135 patients had PTSD, 116 had TBI, and 66 had both. Sleep complaints were universal (97.4%; mean Epworth Sleepiness Scale score was 10.8±5; 51.5% had an ESS≥10). Sleep fragmentation was present in 71.3% and hypersomnia was present in 87.4%. Diagnostic polysomnogaphy was performed for 81.2% of patients. 56.3% were diagnosed with OSA and 48.7% were diagnosed with insomnia. Sleep disorders following TBI were affected by mechanism of injury. Those with blunt trauma had more OSA (54.3% v 25.9%, p=0.003) and those with blast injuries experienced more insomnia (63.0% v 40.0%, p=0.022). Similarly, sleep disorders differed between traumatic versus atraumatic PTSD. Among those with PTSD and OSA, there were significantly fewer patients with battle injuries (37.0% v 71.0%, p<0.001), compared to those without sleep apnea. Among those with TBI, there were fewer patients with OSA (28.8% v 78.3%, p<0.001), compared to those without head injury. Rates of insomnia were equal among traumatic and atraumatic PTSD patients.
CONCLUSIONS: Soldiers with combat related TBI and PTSD have high rates of disordered sleep. Sleep disorders in TBI were divided by mechanism of injury, with higher rates of OSA in blunt trauma, and more insomnia in blast injury. Among those with PTSD, higher rates of OSA in noninjured patients raises the possibility that preexisting sleep apnea predisposes soldiers to PTSD.
CLINICAL IMPLICATIONS: An increased awareness of the high prevalence of sleep disorders in combat veterans is critical given the chronicity of these disorders, and extension beyond the military healthcare system.
DISCLOSURE: The following authors have nothing to disclose: Jacob Collen, Nicholas Orr, Kevin Carter, Aaron Holley, Christopher Lettieri
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