SLEEP DISTURBANCE IN VETERANS WITH A HISTORY OF MODERATE/SEVERE TAUMATIC BRAIN INJURY

Purpose/Aims: 1) To determine the feasibility and acceptability of collecting actigraphy and sleep diary data for one week from male Veterans with a history of moderate to severe traumatic brain injury (m/sTBI), 2) to characterize sleep-wake disturbances, and 3) to explore relationships among sleep disturbance and daytime functioning and mood.  

Rationale/Background:TBI can result in long-term physical, cognitive and neurobehavioural impairments. Complaints of disturbed sleep, excessive daytime sleepiness and disorders of arousal are among the most pervasive, enduring and common sequelae of TBI. TBI is a common occurrence for military personnel returning from deployment, Veterans in general, and across all levels of TBI severity and the continuum of recovery, often evolving over time. Understanding the nature of sleep-wake disturbances is critical from the perspective of recovery from TBI because adequate sleep is essential for overall health and functioning even in the general public.

Methods:In this prospective, descriptive study, we evaluated detailed data about sleep habits and daytime consequences of impaired sleep. Veterans wore an actigraphy watch and completed a sleep diary for one week. An extensive clinical sleep interview was conducted and Veterans completed the Insomnia Severity Index, Epworth Sleepiness Scale, Functional Outcomes of Sleep Questionnaire and a qualitative interview about sleep during two study visits.

Results:The mean age of the 20 male Veteran participants was 50.6 (SD = 8.4), 60% were Caucasian; 50% reported an annual income between $15,000-34,999, 60% served in the army, and 65% were unemployed. Enrollment, attendance, and data collection was feasible and acceptable to Veterans. Moderate to severe insomnia was reported by 68% of the Veterans, and 55% experienced excessive daytime sleepiness depending on the situation. Usual bedtime was 10 PM and wake up time was 7 AM, however there was a wide range of sleep patterns, and great variability from night to night. Nearly 70% napped 1-2 times per day, 60% used sleep aids in the past month, and only half exercised at least once per week. Additional symptoms and relationships with other outcomes will be presented.

Implications: Knowledge of factors that contribute to sleep-wake disturbance in Veterans will help nurses address this significant public health issue. Based on the specific sleep problems, Veterans may benefit from nonpharmacological interventions and education.