Severe insomnia after traumatic brain injury (TBI) is more prevalent among Black individuals, women, individuals with prior TBI, and those with pre-TBI psychiatric history, according to a prospective cohort study published in JAMA Network Open.
Following TBI, insomnia can develop during the acute (0-7 days), subacute (8-90 days), or chronic (after 90 days) phase. TBI can interfere with sleep and previous research suggests poor sleep is associated with neurodegeneration, independently contributing to morbidity and long-term sequelae of TBI, the researchers explained. The objective of the current study was to identify the trajectories of insomnia in the 12 months following incidence of TBI.
The study included 2022 participants (mean age 40.1±17.2 years; 68.1% [n=1377] men; 16.4% [n=330] Black; 20.5% [n=413] Hispanic; 77.6% [n=1561] White), all of whom were enrolled at one of 18 trauma centers within 24 hours of TBI. Data were taken from the Transforming Research and Clinical Knowledge in TBI (TRACK-TBI) study and were collected between February 2014 and August 2018.
The participants were assessed for insomnia using the Insomnia Severity Index at week 2 and months 3, 6, and 12 after TBI. Insomnia Severity Index trajectories were modeled. Insomnia rates were elevated during all 4 visits with the highest insomnia rates after 2 weeks (43%) and then dropping to (27.8%) by the 12-month visit compared with the general adult population (10%).
Participants were also stratified into latent trajectory classes using unconditional latent class mixed models (LCMMs), with the Akaike information criterion (AIC) used to fit models with 1 to 7 classes to determine the best fit. The best fit for data were 5-class (AIC, 12,636.76) and 4-class (AIC, 12,634.91) LCMMs.
With regard to insomnia among the participants, 61.6% (n=1245) experienced mild symptoms (class 1), 31.0% (n=627) experienced initially mild symptoms that resolved with time (class 2), 4.5% (n=91) experienced severe symptoms (class 3), 2.2% (n=44) experienced initially severe symptoms that resolved by 1 year (class 4), and 0.7% (n=15) experienced no insomnia initially but reported severe symptoms by 1 year (class 5).
Multinomial logistic regression revealed several significant factors associated with being in class 3 vs class 1: being a woman (odds ratio [OR] 1.65; 95% CI, 1.02-2.66), Black (OR 2.36; 95% CI, 1.39-4.01), pre-TBI psychiatric illness (OR 2.21; 95% CI, 1.35-3.60), and prior TBI (OR 0.36; 95% CI, 0.20-0.65).
Study limitations included a potential lack of generalizability, a lack of objective sleep measures, and the need for more sensitive measurements of health behaviors like alcohol use and sleep. In addition, potential clinically relevant trajectory groups were overlooked, there was an inability to examine the mechanisms behind the association with insomnia outcomes and Black race, and the inability to determine causality.
The study researchers concluded, “The prevalence of insomnia [after TBI] was notably high, particularly for moderate and severe insomnia.” Moreover, “black race, female sex, pre-TBI psychiatric history, and prior TBI were associated with persistent severe insomnia.”
They also noted that “more work is needed to identify mechanisms underlying these associations, to understand the impact of insomnia trajectory group status on TBI outcomes, and to identify optimal subgroup-specific treatment approaches.”
Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.
Wickwire EM, Albrecht JS, Capaldi VF, et al. Trajectories of insomnia in adults after traumatic brain injury. JAMA Netw Open. Published online January 26, 2022. doi:10.1001/jamanetworkopen.2021.45310