Sleep problems contribute to post-concussive symptoms in service members with a history of mild traumatic brain injury without posttraumatic stress disorder or major depressive disorder.
Lisa H Lu, Matthew W Reid, Douglas B Cooper and 1 others
PMID 31256090WHAT IT FOUND
In service members with remote mild TBI, sleep problems were linked to post-concussive symptoms mainly when PTSD or depression was absent.
Daytime dysfunction and nighttime disruptions were associated with somatosensory symptoms, not cognitive or balance symptoms.
Key findings
01Sleep problems contributed an additional 1% to post-concussive symptoms after PTSD and depression symptoms were accounted for in the full sample.
02That independent sleep contribution was driven by service members without documented PTSD or MDD; it was not found in those with either diagnosis.
03In those without PTSD or MDD, daytime dysfunction and sleep disturbances contributed an additional 4% to post-concussive symptoms, and sleep problems were linked to somatosensory symptoms but not cognitive or vestibular symptoms.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTsWhat it means for SLPs
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What it does not show
This study used questionnaires at one evaluation and did not test treatment, so it cannot show that sleep problems caused symptoms or that treating sleep would improve them. Sleep was measured by self-report, not objective sleep testing, and subjective sleep reports may differ from actual sleep architecture or sleep disorder diagnoses. The sample was mostly active duty military men, so findings may not generalize to women or civilian patients. The final sample was 279 after excluding 34 of 313 mild TBI cases for possible symptom exaggeration, and exclusions may affect generalizability. PTSD and MDD status came from medical records and was not independently verified against DSM criteria. The unique contribution of sleep was 1% in the full sample and 2% in the no PTSD/MDD group, and clinically meaningful change was undetermined. Time since injury ranged from 0 to 340 months with a median of 52 months, so this was a chronic remote mild TBI sample.
Declared interests
No conflicts were declared. Funding came from the Defense and Veterans Brain Injury Center.
The easy way to misread this
Do not conclude that treating sleep problems will reduce post-concussive symptoms. The study did not test treatment, and the sleep contribution was 1% in the full sample and 2% in those without documented PTSD or MDD.