Insomnia prevalence among U.S. Army soldiers with history of TBI.

Abstract

To determine the rate of insomnia among active-duty soldiers with and without a history of traumatic brain injury (TBI). Research Method and Design: Data were extracted from the All Army Study (AAS), a cross-sectional, self-report survey completed by a representative sample of 21,499 U.S. Army soldiers from 2011 to 2013 as part of the Army Study to Assess Risk and Resilience in Servicemembers. History and severity of TBI were determined by participants' responses to questions regarding postinjury symptomology (i.e., loss of consciousness [LOC], amnesia, etc.). Insomnia symptoms were defined using DSM-5 criteria as measured by the Brief Insomnia Questionnaire. Results: Approximately 63% of respondents reported lifetime history of mild TBI (mTBI), with ϳ7% endorsing a history of moderate to severe TBI. Insomnia symptom prevalence rate increased with brain injury severity and number of TBIs with LOC, with ϳ51% of those with mTBI and ϳ55% of those with moderate to severe TBI demonstrating clinically elevated insomnia symptoms, compared to ϳ37% insomnia prevalence rate among servicemembers without TBI. Conclusion/Implications: Results suggest high (Ͼ 50%) prevalence rates of insomnia symptoms among servicemembers with a lifetime history of brain injury, underscoring the need for behavioral sleep medicine interventions among active-duty personnel. Impact and ImplicationsIncreased prevalence of sleep disturbance among individuals with history of traumatic brain injury (TBI) has been well documented. The current study extends this line of research by investigating the rate and severity of insomnia symptoms in individuals with and without history of TBI among a large, representative sample of active-duty U.S. soldiers as part of the Army Study to Assess Risk and Resilience in Servicemembers (STARRS). Rates of clinically elevated insomnia and lifetime-acquired TBI among active-duty servicemembers are considerably higher than the general population, and individuals with a positive history of brain injury endorsed higher rates of clinically elevated insomnia symptoms compared to peers with no history of TBI. While behavioral sleep interventions (i.e., cognitive-behavioral therapy for insomnia) are frequently employed throughout the Veterans Affairs system, application among active-duty personnel remains somewhat limited, although initial outcomes are promising. Current findings underscore the need for widespread implementation of behavioral sleep interventions among active-duty servicemembers, particularly given the known cognitive, physical, emotional, functional, and financial repercussions of untreated insomnia symptoms.

Prevalence of insomnia and insomnia symptoms following mild-traumatic brain injury: A systematic review and meta-analysis

“…Meares et al, [48] diagnosis codes from inpatient and outpatient obtained data. Mosti et al, [51] measured insomnia using the Brief Insomnia Questionnaire (BIQ) and utilised its psychometric properties to diagnose insomnia based on the DSM-V criteria. However, Mosti et al, [51] did not report their unweighted mTBI sample size.…”

“…Mosti et al, [51] measured insomnia using the Brief Insomnia Questionnaire (BIQ) and utilised its psychometric properties to diagnose insomnia based on the DSM-V criteria. However, Mosti et al, [51] did not report their unweighted mTBI sample size. The mTBI sample sizes of the three other studies examining insomnia prevalence combined was 93,134 [48][49][50].…”

“…Farrell-Carnahan et al, [54] determined TBI severity from the duration of PTA, Mosti et al, [51] classified mTBI according to reported LOC for 30 minutes or less and PTA lasting less than 24 hours, and Albicini et al, [53] defined mTBI when LOC lasting under 30 minutes was reported, or any PTA or feeling dazed was described following an injury. Lu et al, [58] classified mTBI using electronic medical record review and patient self-report based off semi-structured interviews conducted by health professionals.…”

“…Based on the 14 outstanding studies [48,50,51,[53][54][55][56]58,60,[63][64][65][66][67], on average 75.3% of the mTBI sample were male (unadjusted for study size). Only three studies [51,56,67] had mTBI samples of which less than half were male. Nine studies [49, 51,52,56,57,59,[61][62][63] failed to report the mean age for their mTBI sample.…”

“…Only three studies [51,56,67] had mTBI samples of which less than half were male. Nine studies [49, 51,52,56,57,59,[61][62][63] failed to report the mean age for their mTBI sample. The average age across the remaining 11 studies [48,50,[53][54][55]58,60,[64][65][66][67] was 32.8 years (unadjusted for study size).…”