Increased Sleep Disturbances and Pain in Veterans With Comorbid Traumatic Brain Injury and Posttraumatic Stress Disorder

Abstract

Study Objectives: Veterans are at an increased risk for traumatic brain injury (TBI) and posttraumatic stress disorder (PTSD), both of which are associated with sleep disturbances and increased pain. Furthermore, sleep disturbances and pain are reciprocally related such that each can exacerbate the other. Although both TBI and PTSD are independently linked to sleep disturbances and pain, it remains unclear whether Veterans with comorbid TBI+PTSD show worse sleep disturbances and pain compared to those with only TBI or PTSD. We hypothesized that sleep and pain would be worse in Veterans with comorbid TBI+PTSD compared to Veterans with only TBI or PTSD. Methods: Veterans (n = 639) from the VA Portland Health Care System completed overnight polysomnography and self-report questionnaires. Primary outcome variables were self-reported sleep disturbances and current pain intensity. Participants were categorized into four trauma-exposure groups: (1) neither: without TBI or PTSD (n = 383); (2) TBI: only TBI (n = 67); (3) PTSD: only PTSD (n = 126); and (4) TBI+PTSD: TBI and PTSD (n = 63). Results: The PTSD and TBI+PTSD groups reported worse sleep compared to the TBI and neither groups. The TBI+PTSD group reported the greatest pain intensity compared to the other groups. Conclusions: These data suggest sleep and pain are worst in Veterans with TBI and PTSD, and that sleep is similarly impaired in Veterans with PTSD despite not having as much pain. Thus, although this is a complex relationship, these data suggest PTSD may be driving sleep disturbances, and the added effect of TBI in the comorbid group may be driving pain in this population. stress disorder (PTSD). Among the most prevalent, persistent, and debilitating sequelae in both TBI and PTSD are sleep disturbances and increased pain. Importantly, sleep disturbances and pain also share a reciprocal relationship such that increases in either can independently exacerbate the other. [4][5][6][7] It has been estimated that > 50% of people with TBI experience sleep disturbances, 8-10 including insomnia, 11 hypersomnia, 8 obstructive sleep apnea (OSA), 9 and circadian rhythm sleep disorders. 9,12 Furthermore, current evidence suggests these sleep disturbances can persist for several years postinjury. 13 Sleep disturbances are also a hallmark feature of PTSD BRIEF SUMMARY Current Knowledge/Study Rationale: Traumatic brain injury (TBI) and posttraumatic stress disorder (PTSD) are common in Veterans and are independently associated with sleep disturbances and pain, both of which can exacerbate the other and impede rehabilitation. Understanding the relationship between TBI, PTSD, sleep, and pain will help improve treatment and rehabilitation in this vulnerable population. Study Impact: This study demonstrates that Veterans with PTSD and with both PTSD and TBI experience more sleep disturbances, but those with TBI and PTSD report significantly greater current pain intensity. These data help in the limited understanding of how Veterans with comorbid TBI and PTSD differ from Veteran...

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