Traumatic brain injury and sleep disturbances in combat-exposed service members and veterans: Where to go next?

Abstract

OBJECTIVE: To synthesize the current evidence on sleep disturbances in military service members (SMs) and veterans with traumatic brain injury (TBI). METHODS: An electronic literature search first identified abstracts published from 2008-2018 inclusively referencing sleep, TBI, and military personnel from Operation Enduring Freedom, Operation Iraqi Freedom, Operation New Dawn, and Persian Gulf veterans. Selection criteria eliminated studies on non-combat TBI, open or penetrating injuries, and articles where the relationship between sleep and TBI was not directly examined. Articles on all military branches and components, those currently serving and veterans-ranging from medical chart reviews to clinical trials, were included. Forty-one articles were selected for full text-review. RESULTS: Twenty-four papers estimated the prevalence of sleep disturbances in TBI. Eight studies demonstrated the contribution of common co-occurring conditions, most notably posttraumatic stress disorder, to the relationship between disrupted sleep and TBI. Ten studies differentiated sleep profiles between military SMs and veterans with and without acute TBI and detected significant differences in sleep disturbances across the course of injury. Longitudinal studies were scarce but helped to establish the temporal relationship between sleep disturbances and TBI and isolate sleep-related mechanisms influencing TBI prognosis. Only three studies reported on interventions for improving sleep quality and TBI symptoms. Systematic research testing assessments and interventions that target sleep disturbances for improving sleep, TBI symptoms, and long-term functional outcomes were identified as critical knowledge gaps. CONCLUSION: Findings unequivocally establish that sleep disturbances are highly prevalent in SMs and veterans with TBI. However, studies testing the effectiveness of treatments for improving sleep in military groups with TBI have been limited and their results inconsistent. This review highlights a critical opportunity for advancing military medicine through future research aimed at identifying and testing sleep-focused treatments in SMs and veterans with combat-related TBI.

Common Symptoms of Mild Traumatic Brain Injury and Work Functioning of Active-Duty Service Members with a History of Deployment

“…Because ADSMs are always screened for mTBI as well as these symptoms before and after any deployment, we are confident that the symptoms are a sequalae of mTBI and not pre-existing conditions. Further, these findings are consistent with other studies that have investigated the association between TBI and other employment-related outcomes [14,29,33,[39][40][41][42][43][44][45][46][47].…”

Exploring the relationship between sleep apnea and vestibular symptoms following traumatic brain injury

“…[30][31][32][33][34][35][36] The incidence and prevalence of sleep disturbances, particularly obstructive sleep apnea (OSA), are disproportionally higher in veterans and service members (V/SM) than in the general population, 37 and have been largely attributed to deployment status, TBI, and comorbid mental health diagnoses such as posttraumatic stress disorder (PTSD). [38][39][40][41] Indeed, OSA has been identified as one of the most commonly reported comorbid conditions associated with blast-related TBI 42 and may be an important mediator of vestibular symptoms. 43 Although data are limited, there is evidence supporting a correlation between OSA and vestibular dysfunction in the general population.…”

Multi-Scale Permutation Entropy: A Potential Measure for the Impact of Sleep Medication on Brain Dynamics of Patients with Insomnia

“…Insomnia is a common sleep disorder that mainly manifests as difficulty falling asleep, difficulty maintaining sleep and frequent and early awakenings [ 1 ]. Insomnia negatively affects health and quality of life, and is strongly associated with the incidence and deterioration of diabetes [ 2 , 3 , 4 ], cardiovascular disease [ 5 , 6 , 7 ], cancer [ 8 , 9 , 10 ], cognitive impairment [ 11 , 12 , 13 ], brain damage [ 14 , 15 ] and depression [ 16 , 17 ]. In addition, blood circulation, endocrine dyscrasia, loss of immunological competence and thermoregulation are also affected by insomnia [ 18 ].…”