Sleep disturbances among combatants with mild traumatic brain injury

Yaroslav  Saminin; Larysa  Sokolova

doi:10.32345/USMYJ.4(150).2024.129-138

Yaroslav Saminin Bogomolets National Medical University, Kyiv, Ukraine https://orcid.org/0009-0006-0669-6098
Larysa Sokolova Bogomolets National Medical University, Kyiv, Ukraine https://orcid.org/0000-0002-1478-047X

DOI: https://doi.org/10.32345/USMYJ.4(150).2024.129-138

Keywords: Brain Injuries, Traumatic; Disorders of Excessive Somnolence, Anxiety, Depression.

Abstract

to evaluate the level of sleep disorders in combatants with mild traumatic brain injury (TBI), to provide a comprehensive characterization of sleep disorders using the assessment of complaints, anamnesis data, neurological status, and ESS and PSQI questionnaires with the involvement of comparison groups of patients.bMethods and subjects. The study involved 117 patients who were divided into three groups: combatant patients with mild TBI (n=30) (study group № 1), combatant patients without TBI (n=30) (study group № 2), and group relative to healthy civilian respondents (n=57) (control group). A cross-sectional research design was used. Patients were evaluated using the Pittsburgh Sleep Quality Index (PSQI) and the Epworth Sleepiness Scale (ESS), as well as the frequency of complaints (inability to fall asleep, night awakenings, early awakenings, and nightmares), anamnesis (age, time since injury) and neurological status data. The method of statistical hypothesis testing for multiple comparisons with appropriate post-hoc calculations was used to compare the obtained results. Results. In study group №1, complaints about the inability to fall asleep were observed in 73.3% of cases, complaints about night awakenings — 46.7%, complaints about early awakenings — 23.3%, and complaints about nightmares — 20.0%. The age was 31 (24 — 40) years, and the time since the injury — 14 (8 — 28) days. A difference from the average values in other groups was found according to the χ² criterion with correction for continuity (p<0.05). In the process of post hoc analysis using the Bonferroni correction, a statistically significant increased frequency of complaints of inability to fall asleep, early awakenings, and nightmares were found in study group №1 compared to other groups (p<0.05). The frequency of major deviations in neurological status among combatant patients was evaluated. The score on the ESS scale in the study group №1 — 8.1±3.6 points; in the study group №2 — 6 (4 — 8) points; in the control group — 4 (3 — 6) points. The difference in medians is statistically significant according to the Kruskal-Wallis test (p<0.001). Post-hoc comparisons using the Steel-Dwass test indicate that the values of this scale differ when comparing study group №1 and the control group (p<0.001) and study group №2 and the control group (p=0.008). PSQI score in study group №1 — 11.2±4.5 points; in the study group №2 — 7.5 (5 — 11) points; in the control group — 5 (4 — 8) points. The difference in medians is statistically significant according to the Kruskal-Wallis test (p<0.001). Post-hoc comparisons using the Steel-Dwass test indicate that the values of this scale differ when comparing study group №1 and study group №2 (p=0.02) and study group №1 and the control group (p<0.001). Conclusions. Comparisons of the frequency of complaints revealed a statistically significant increase in the frequency of complaints of inability to fall asleep, early awakenings, and nightmares in combatants with TBI. A statistically significant increased level of daytime dysfunction was found in this group of patients according to the ESS scale. A statistically significant decrease in sleep quality also was found in this group of patients according to the PSQI scale. The obtained data can be interpreted as a reflection of the increased prevalence of sleep disorders in patients with traumatic brain injury.

References

Гур’янов В. Г., Лях Ю. Є., Парій В. Д., Короткий О. В., & Чалий О. В. (2018) Аналіз результатів медичних досліджень у пакеті EZR (R-statistics): для магістрів, інтернів, клінічних ординаторів та аспірантів галузі знань «Охорона здоров’я». К.: Вістка, 206.

Лях, Ю. Е., Гурьянов, В. Г., Хоменко, В. Н., & Панченко, О. А. (2006). Основы компьютерной биостатистики: анализ информации в биологии, медицине и фармации статистическим пакетом MedStat. Д.: Папакица ЕК, 214.

Самінін, Я. Г., & Соколова, Л. І. (2023). Когнітивні та емоційно-афективні розлади в учасників бойових дій із черепно-мозковою травмою (огляд літератури).

Buysse, D. J., Reynolds, C. F., 3rd, Monk, T. H., Berman, S. R., & Kupfer, D. J. (1989). The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry research, 28(2), 193–213. https://doi.org/10.1016/0165-1781(89)90047-4

Centers for Disease Control and Prevention [CDC]. Traumatic brain injury & concussion (2017).

Ellis, J. G., Perlis, M. L., Neale, L. F., Espie, C. A., & Bastien, C. H. (2012). The natural history of insomnia: focus on prevalence and incidence of acute insomnia. Journal of psychiatric research, 46(10), 1278–1285. https://doi.org/10.1016/j.jpsychires.2012.07.001

Hong, C. T., Wong, C. S., Ma, H. P., Wu, D., Huang, Y. H., Wu, C. C., Lin, C. M., Su, Y. K., Liao, K. H., Ou, J. C., & Hu, C. J. (2015). PERIOD3 polymorphism is associated with sleep quality recovery after a mild traumatic brain injury. Journal of the neurological sciences, 358(1-2), 385–389. https://doi.org/10.1016/j.jns.2015.09.376

Ibáñez, V., Silva, J., & Cauli, O. (2018). A survey on sleep questionnaires and diaries. Sleep medicine, 42, 90–96. https://doi.org/10.1016/j.sleep.2017.08.026

Joshi, A., Kale, S., Chandel, S. and Pal, D. (2015) Likert Scale: Explored and Explained. British Journal of Applied Science & Technology, 7, 396-403.

https://doi.org/10.9734/BJAST/2015/14975

Kim, J. (2020). ezr: Easy Use of R via Shiny App for Basic Analyses of Experimental Data. R package version 0.1.4.

Mac Donald, C. L., Johnson, A. M., Wierzechowski, L., Kassner, E., Stewart, T., Nelson, E. C., Werner, N. J., Zonies, D., Oh, J., Fang, R., & Brody, D. L. (2014). Prospectively assessed clinical outcomes in concussive blast vs nonblast traumatic brain injury among evacuated US military personnel. JAMA neurology, 71(8), 994–1002. https://doi.org/10.1001/jamaneurol.2014.1114

National Academies of Sciences, Engineering, and Medicine; Health and Medicine Division; Board on Health Care Services; Committee on the Review of the Department of Veterans Affairs Examinations for Traumatic Brain Injury. (2019). Evaluation of the Disability Determination Process for Traumatic Brain Injury in Veterans. National Academies Press (US).

Ohayon M. M. (2002). Epidemiology of insomnia: what we know and what we still need to learn. Sleep medicine reviews, 6(2), 97–111. https://doi.org/10.1053/smrv.2002.0186

Sateia M. J. (2014). International classification of sleep disorders-third edition: highlights and modifications. Chest, 146(5), 1387–1394. https://doi.org/10.1378/chest.14-0970

Shekleton, J. A., Parcell, D. L., Redman, J. R., Phipps-Nelson, J., Ponsford, J. L., & Rajaratnam, S. M. (2010). Sleep disturbance and melatonin levels following traumatic brain injury. Neurology, 74(21), 1732–1738. https://doi.org/10.1212/WNL.0b013e3181e0438b

Taylor, D. J., Pruiksma, K. E., Hale, W. J., Kelly, K., Maurer, D., Peterson, A. L., Mintz, J., Litz, B. T., Williamson, D. E., & STRONG STAR Consortium (2016). Prevalence, Correlates, and Predictors of Insomnia in the US Army prior to Deployment. Sleep, 39(10), 1795–1806. https://doi.org/10.5665/sleep.6156

Viola-Saltzman, M., & Watson, N. F. (2012). Traumatic brain injury and sleep disorders. Neurologic clinics, 30(4), 1299–1312. https://doi.org/10.1016/j.ncl.2012.08.008