Sleep assessment in a randomized trial of hyperbaric oxygen in U.S. service members with post concussive mild traumatic brain injury compared to normal controls.

Publication Type
Journal Article
Year of Publication
2018
Authors
Walker, James M; Mulatya, Caroline; Hebert, Donald; Wilson, Steffanie H; Lindblad, Anne S; Weaver, Lindell K
Secondary
Sleep Med
Volume
51
Start Page
66
Pagination
66-79
Date Published
11/2018
Keywords
Actigraphy; Hyperbaric; PSQI; Self-report; Sleep; TBI
Abstract

STUDY OBJECTIVE: In this exploratory, double-blind, longitudinal sham-controlled trial of hyperbaric oxygen (HBO) for military personnel with post concussive mild traumatic brain injury (mTBI), self-reports and objective measures of sleep-wake disturbances were assessed and compared to normals.

METHODS: Self-reports consisting of Pittsburg Sleep Quality Index (PSQI), sleep diary, screening for obstructive sleep apnea (OSA) risk, restless legs syndrome (RLS), cataplexy, and objective actigraphic measures of sleep-wake were obtained on 71 military personnel with mTBI [baseline, 13 weeks and six months post-randomization (post-intervention)], of which 35 met post-traumatic stress disorder (PTSD) criteria, and 75 healthy volunteers (baseline). Baseline between-group and follow-up changes from baseline overall and within subgroups were evaluated. Mild TBI was defined as consisting of head injury associated loss of consciousness (<24 h), post-traumatic amnesia, and neurological deficits.

RESULTS: Sleep quality by self-reports was markedly degraded in the mTBI group at baseline compared to a normative cohort; insomnia 87.3 versus 2.8%, OSA risk 70% versus 1.3%, RLS 32.4% versus and 2.7%. (all p-values <0.001), but actigraphy measures did not differentiate between groups. HBO compared to sham treatment improved self-reports of PSQI sleep measures, reports (five out of eight at 13-weeks and two out of eight at six-months). However, other sleep-wake measures were not different.

CONCLUSIONS: Perceived sleep quality was markedly disrupted in mTBI military personnel and sleep-wake disturbances were prevalent compared to a normative cohort. HBO relative to sham improved some measures of sleep quality on the PSQI, but other measures of sleep were not significantly different.