Insomnia Associated with Traumatic Brain Injury in Adult Patients

Emerson M. Wickwire, PhD

A new investigation observed several courses of insomnia in adults who had experienced traumatic brain injury (TBI), with moderate and severe cases of insomnia being particularly prevalent.

Roughly 2.5 million adults seek medical care for traumatic brain injuries in the United States every year, with insomnia considered to be one of the most common complaints among patients.

Over the years, studies of insomnia in TBR have often been hampered by heterogeneous TBI samples, inconsistent operational definitions of insomnia, and highly variable follow-up durations.

Investigators led by Emerson M. Wickwire, PhD, University of Maryland School of Medicine, used advanced, data-driven analytic approaches to identify unique trajectories of insomnia 12 months after TBI based on a serial assessment using standardized measures.

The Methods

Participants for the study were identified through the Federal Interagency Traumatic Brain Injury Repository (FITBIR). Participants were only identified by a global unique identifier, and common data elements were collected from February 26, 2014 to August 8, 2018.

The study included participants aged 17 years or older from TRACK-TBI, a longitudinal, multi-site observational study. Participants were enrolled at 1 of 18 participating level I trauma centers and enrolled within 24 hours of TBI injury.

Race and ethnicity data, which have been associated with TBI outcomes, were obtained via self-report during clinical interviews, and participants completed serial assessments at 2, 3, and 6 weeks, and 12 months thereafter. The assessments captured clinical, neuroimaging, and blood biomarkers to improve TBI classification and outcome assessments.

The data were analyzed from July 1, 2020 to November 15, 2021.

The Findings

The final sample included a total of 2022 participants (1377 [68.1%] men; mean [SD] age, 40.1 [17.2] years) from the FITBIR database and the TRACK-TBI study.

The data were best fit by a 5-class latent class mixed model (LCMM).

Of the total number of participants, investigators observed that 1245 (61.6%) reported persistent mild insomnia symptoms (class 1) while 627 (31.0%) initially reported mild insomnia symptoms that resolved over time (class 2) and 91 (4.5%) reported persistent severe insomnia symptoms (class 3).

Additionally, 44 (2.2%) initially reported severe insomnia symptoms that resolved by 12 months (class 4) and 15 (0.7%) had initially reported no insomnia symptoms, though they did experience severe symptoms by 12 months (class 5).

In a multinomial logistic regression model, investigators identified several factors significantly associated with insomnia trajectory class membership. These factors included female sex (odds ratio [OR], 1.65 [95% CI, 1.02-2.66]), Black race (OR, 2.36 [95% CI, 1.39-4.01]), history of psychiatric illness (OR, 2.21 [95% CI, 1.35-3.60]), and findings consistent with intracranial injury on computed tomography (OR, 0.36 [95% CI, 0.20-0.65]) when comparing class 3 with class 1.

To the team’s knowledge, the cohort study represented the largest analysis of insomnia after TBI to date. Though they collected significant data on the associations of insomnia regarding Black race, female sex, pre-TBI psychiatric history, and prior TBI, additional research was warranted.

“However, 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,” the team wrote.