Persistent insomnia symptoms common in first year following TBI

Many adults with a traumatic brain injury had a persistent form of insomnia for up to 12 months, according to a prospective cohort study published in JAMA Network Open.

“Insomnia can develop during the acute (0 to 7 days), subacute (8 to 90 days), or chronic (>90 days) phase after TBI,” Emerson W. Wickwire, PhD, of the Sleep Disorders Center and division of pulmonary and critical care medicine in the department of medicine at the University of Maryland School of Medicine in Baltimore, and colleagues wrote. “Not only can TBI disturb sleep, but there is evidence that poor sleep is associated with neurodegeneration, independently contributing to morbidity and long-term sequelae of TBI,”

Wickwire and colleagues set out to identify any various tracks of insomnia in the 12 months following incidence of TBI.

Participants were screened through the Federal Interagency Traumatic Brain Injury Repository (FITBIR), a data cache for federally funded research projects in the U.S., which yielded 2,022 suitable candidates, including those aged 17 years and older already taking part in the Transforming Research and Clinical Knowledge in Traumatic Brain Injury (TRACK-TBI) study.

Participants were placed at one of 18 participating level one trauma centers and admitted to the study within 24 hours of TBI. The researchers made serial assessments through the Insomnia Severity Index (ISI) at the 2-week mark, then at 3, 6 and 12 months, which logged clinical, neuroimaging and blood biomarkers for enhancement of TBI classification and outcome assessments.

Data revealed elevated rates of insomnia at all four evaluation times. Rates of insomnia were at their highest point after 2 weeks (43.3%) before dipping to 27.8% by the 12-month evaluation, compared with only 10% in the general adult population.

Results revealed five distinct classes of insomnia trajectories, with 1,245 participants (61.6%) reporting persistent mild insomnia symptoms, 627 (31.0%) who initially reported mild insomnia symptoms that eventually resolved, 91 (4.5%) who reported persistent severe insomnia symptoms, 44 (2.2%) who reported severe insomnia symptoms at the initial evaluation time which resolved by final evaluation and 15 (0.7%) who had no symptoms of insomnia but progressed to severe symptoms after 12 months.

Multinomial logistic regression analysis revealed factors linked to insomnia trajectory class membership, which included female sex, Black race, psychiatric illness history and findings consistent with intracranial injury on computed tomography.

“Our results also provide novel insight into the natural history of insomnia after TBI,” Wickwire and colleagues wrote. “Others have considered the natural history of insomnia in the general population, among military service members, or during the transition from acute to chronic insomnia. By contrast, using data-driven analytic approaches, we identified five latent class trajectory groups of insomnia after TBI.”