Trajectories of Insomnia in Adults After Traumatic Brain Injury.

Autor:	Wickwire EM; Department of Psychiatry, University of Maryland School of Medicine, Baltimore.; Sleep Disorders Center, Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Maryland School of Medicine, Baltimore., Albrecht JS; Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore., Capaldi VF 2nd; Center for Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research, Silver Spring, Maryland.; Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland., Jain SO; Biostatistics Research Center, Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego., Gardner RC; Department of Neurology, University of California, San Francisco., Werner JK; Department of Neurology, Uniformed Services University of the Health Sciences, Bethesda, Maryland.; Department of Neurology, The Johns Hopkins University, Baltimore, Maryland., Mukherjee P; Department of Radiology, School of Medicine, University of California, San Francisco., McKeon AB; Center for Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research, Silver Spring, Maryland., Smith MT; Division of Behavioral Medicine, Department of Psychiatry, Johns Hopkins University School of Medicine, Baltimore, Maryland., Giacino JT; Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts.; Spaulding Rehabilitation Hospital, Charlestown, Massachusetts., Nelson LD; Department of Neurosurgery, Medical College of Wisconsin, Milwaukee.; Department of Neurology, Medical College of Wisconsin, Milwaukee., Williams SG; Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland.; Department of Medicine, Fort Belvoir Community Hospital, Fort Belvoir, Virginia.; Department of Psychiatry, Uniformed Services University of the Health Sciences, Bethesda, Maryland., Collen J; Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland.; Sleep Disorders Center, Department of Medicine, Walter Reed National Military Medical Center, Bethesda, Maryland., Sun X; Biostatistics Research Center, Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego., Schnyer DM; Department of Psychology, University of Texas at Austin., Markowitz AJ; Department of Epidemiology and Biostatistics, School of Medicine, University of California, San Francisco., Manley GT; Brain and Spinal Injury Center, University of California, San Francisco.; Department of Neurosurgery, University of California, San Francisco., Krystal AD; Department of Psychiatry and Behavioral Sciences, University of California, San Francisco.; Weill Institute for Neurosciences, University of California, San Francisco.
Jazyk:	angličtina
Zdroj:	JAMA network open [JAMA Netw Open] 2022 Jan 04; Vol. 5 (1), pp. e2145310. Date of Electronic Publication: 2022 Jan 04.
DOI:	10.1001/jamanetworkopen.2021.45310
Abstrakt:	Importance: Insomnia is common after traumatic brain injury (TBI) and contributes to morbidity and long-term sequelae. Objective: To identify unique trajectories of insomnia in the 12 months after TBI. Design, Setting, and Participants: In this prospective cohort study, latent class mixed models (LCMMs) were used to model insomnia trajectories over time and to classify participants into distinct profile groups. Data from the Transforming Research and Clinical Knowledge in Traumatic Brain Injury (TRACK-TBI) study, a longitudinal, multisite, observational study, were uploaded to the Federal Interagency Traumatic Brain Injury Repository (FITBIR) database. Participants were enrolled at 1 of 18 participating level I trauma centers and enrolled within 24 hours of TBI injury. Additional data were obtained directly from the TRACK-TBI investigators that will be uploaded to FITBIR in the future. Data were collected from February 26, 2014, to August 8, 2018, and analyzed from July 1, 2020, to November 15, 2021. Exposures: Traumatic brain injury. Main Outcomes and Measures: Insomnia Severity Index assessed serially at 2 weeks and 3, 6, and 12 months thereafter. Results: The final sample included 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 LCMM. Of these participants, 1245 (61.6%) reported persistent mild insomnia symptoms (class 1); 627 (31.0%) initially reported mild insomnia symptoms that resolved over time (class 2); 91 (4.5%) reported persistent severe insomnia symptoms (class 3); 44 (2.2%) initially reported severe insomnia symptoms that resolved by 12 months (class 4); and 15 (0.7%) initially reported no insomnia symptoms but had severe symptoms by 12 months (class 5). In a multinomial logistic regression model, several factors significantly associated with insomnia trajectory class membership were identified, including 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. Conclusions and Relevance: These results suggest important heterogeneity in the course of insomnia after TBI in adults. More work is needed to identify outcomes associated with these insomnia trajectory class subgroups and to identify optimal subgroup-specific treatment approaches.
Databáze:	MEDLINE
Externí odkaz:	Zobrazit plný text záznamu