Traumatic Brain Injury Associated With Increased Risk of Sleep Disorders

close up of asian young man is worrying about something on bed at night
According to a study conducted among veterans, traumatic brain injury may influence the risk of sleep disorders.

Traumatic brain injury (TBI) may increase the risk of sleep disorders, including sleep apnea and insomnia, a study in Neurology suggests.

The study included a cohort of 98,709 veterans from the Veterans Health Administration system who were diagnosed with a TBI from 2001 to 2015. Another 98,709 age-matched veterans without TBI were included as a control population. Study researchers examined the development of sleep disorders among the 2 groups.

Sleep disorders addressed in this study included newly diagnosed sleep apnea, hypersomnia, insomnia, or sleep-related movement disorders which developed after the first TBI diagnosis or at a random date in veterans without TBI. All participants in this study had at least 1 year of follow-up data available for analysis.

At baseline, the mean age of all participants was 49 (standard deviation, ±20) years. Approximately 11.7% of the entire cohort consisted of women, and roughly half (49.6%) of TBIs were mild. After a mean follow-up period of 5 years, 19.6% (n=23,127) veterans with TBI developed sleep disorders.

In an analysis adjusted for age, sex, race, education, and income, it was found that individuals with TBI were 50% more likely to develop any sleep disorder compared with veterans without TBI (hazard ratio [HR], 1.50; 95% CI, 1.47-1.53). Additional adjustment for medical and psychiatric disorders suggested that the likelihood of developing any sleep disorders was 41% higher in those with TBI (hazard ratio [HR], 1.41; 95% CI, 1.37-1.44).

Specifically, those with TBI were significantly more likely to develop sleep apnea (HR, 1.28; 95% CI, 1.24-1.32), insomnia (HR, 1.50; 95% CI, 1.45-1.55), hypersomnia (HR, 1.50; 95% CI, 1.39-1.61), and sleep-related movement disorders (HR, 1.33; 95% CI, 1.16-1.52).

The association between TBI and incident sleep disorders was strongest for mild TBI (HR, 1.49; 95% CI, 1.45-1.53) vs moderate-to-severe TBI (HR, 1.33; 95% CI, 1.30-1.37) in an analysis adjusted for demographic characteristics, as well as medical and psychiatric disorders.

Limitations of this study were its inclusion of only veterans, which draws into question whether the findings could be generalized across civilians, and the reliance on ICD-9 codes to define TBI and sleep disorders.

The study researchers concluded that “early identification and prevention strategies for sleep disorders after TBI need to be developed and would be critical for improving quality of life and other long-term outcomes in” patients with TBI.


Leng Y, Byers AL, Barnes DE, Peltz CB, Li Y, Yaffe K. Traumatic brain injury and incidence risk of sleep disorders in nearly 200,000 US veterans. Neurology. Published online March 3, 2021. doi:10.1212/WNL.0000000000011656