Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Observational Study
. 2022 Jan 4;5(1):e2145310.
doi: 10.1001/jamanetworkopen.2021.45310.

Trajectories of Insomnia in Adults After Traumatic Brain Injury

Emerson M Wickwire  1   2 , Jennifer S Albrecht  3 , Vincent F Capaldi 2nd  4   5 , Sonia O Jain  6 , Raquel C Gardner  7 , J Kent Werner  8   9 , Pratik Mukherjee  10 , Ashlee B McKeon  4 , Michael T Smith  11 , Joseph T Giacino  12   13 , Lindsay D Nelson  14   15 , Scott G Williams  5   16   17 , Jacob Collen  5   18 , Xiaoying Sun  6 , David M Schnyer  19 , Amy J Markowitz  20 , Geoffrey T Manley  21   22 , Andrew D Krystal  23   24 ; Transforming Research and Clinical Knowledge in Traumatic Brain Injury (TRACK-TBI) Investigators
Collaborators, Affiliations
Observational Study

Trajectories of Insomnia in Adults After Traumatic Brain Injury

Emerson M Wickwire et al. JAMA Netw Open. .

Abstract

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.

PubMed Disclaimer

Conflict of interest statement

Conflict of Interest Disclosures: Dr Wickwire reported consulting for Dayzz, Eisai Inc, Purdue, and Merck & Co Inc and receiving institutional grants from Merck & Co Inc, and ResMed outside the submitted work. Dr Albrecht reported receiving grants from the US Department of Defense Psychological Health and Traumatic Brain Injury Research Program during the conduct of the study and grants from the Agency for Health Care Research and Quality and the AASM Foundation outside the submitted work. Dr Gardner reported receiving grants from the Weill Institute for Neurosciences during the conduct of the study and grants from the National Institutes of Health (NIH) and US Department of Defense outside the submitted work. Dr Mukherjee reported holding a patent for 15/782,005 pending UC Regents. Dr Giacino reported grants from the National Institutes of Neurological Disorders and Stroke (NINDS), NIH, and National Football League (NFL) during the conduct of the study. Dr Nelson reported receiving salary support from the NINDS during the conduct of the study and grants from the US Department of Defense, Centers for Disease Control and Prevention, Medical College of Wisconsin Advancing a Healthier Wisconsin Endowment, Medical Technology Enterprise Consortium, and NFL Foundation for unrelated research outside the submitted work. Dr Schnyer reported receiving grants from the NIH during the conduct of the study. Dr Markowitz reported receiving grants from the US Department of Defense TBI Endpoints Development Initiative and salary support from the US Department of Defense/MTEC TRACK-TBI NETWORK and US Department of Energy during the conduct of the study. Dr Manley reported receiving grants from the US Department of Defense TBI Endpoints Development Initiative, US Department of Defense TRACK-TBI Precision Medicine, and NIH-NINDS TRACK-TBI; research support from the US Department of Defense/MTEC TRACK-TBI NETWORK; support from the US Department of Energy for a precision medicine collaboration; funding for TRACK-TBI patient stipends and support to clinical sites from One Mind; and support for TRACK-TBI data curation efforts from Neurotruama Sciences LLC during the conduct of the study. Dr Krystal reported receiving grants from Janssen Pharmaceuticals, Axsome Therapeutics Inc, and Reveal Pharmaceuticals; serving on the advisory board for Adare Pharmaceuticals, Axsome Therapeutics Inc, Evecxia Therapeutics, Harmony Biosciences, Millenium Pharmaceuticals Inc, Angelini, Merck & Co Inc, Sage Therapeutics, Takeda Pharmaceutical Company Limited, and Otsuka Pharmaceutical Co, Ltd; consulting paid with stock options from BigHealth; consulting and serving on the advisory board for Eisai Co, Ltd, Janssen Pharmaceuticals, Jazz Pharmaceuticals plc, H Lundbeck A/S, and NeuraWell Therapeutics; consulting and serving on the advisory and data safety monitoring boards for Idorsia; and serving on the advisory and data safely monitoring boards for Neurocrine Biosciences Inc, outside the submitted work. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Insomnia Severity Categories by Time Since Injury
Includes 2022 participants 17 years or older from the Transforming Research and Clinical Knowledge in Traumatic Brain Injury (TBI) study. ISI indicates Insomnia Severity Index, with higher scores indicating greater severity.
Figure 2.
Figure 2.. Five-Class Model of Trajectories of Insomnia After Traumatic Brain Injury (TBI)
Includes 2022 participants 17 years or older from the Transforming Research and Clinical Knowledge in Traumatic Brain Injury study. Five classes of insomnia trajectory were identified: mild insomnia symptoms that did not change over time (class 1); mild insomnia symptoms that resolved over time (class 2); consistently severe insomnia symptoms (class 3); initially severe insomnia symptoms that resolved by 12 months (class 4); and no initial reports of insomnia symptoms followed by severe symptoms at 12 months (class 5). ISI indicates Insomnia Severity Index.
See this image and copyright information in PMC

References

    1. Taylor CA, Bell JM, Breiding MJ, Xu L. Traumatic brain injury–related emergency department visits, hospitalizations, and deaths—United States, 2007 and 2013. MMWR Surveill Summ. 2017;66(9):1-16. doi:10.15585/mmwr.ss6609a1 - DOI - PMC - PubMed
    1. Cifu DX, Taylor BC, Carne WF, et al. . Traumatic brain injury, posttraumatic stress disorder, and pain diagnoses in OIF/OEF/OND veterans. J Rehabil Res Dev. 2013;50(9):1169-1176. doi:10.1682/JRRD.2013.01.0006 - DOI - PubMed
    1. Taylor BC, Hagel EM, Carlson KF, et al. . Prevalence and costs of co-occurring traumatic brain injury with and without psychiatric disturbance and pain among Afghanistan and Iraq War veteran VA users. Med Care. 2012;50(4):342-346. doi:10.1097/MLR.0b013e318245a558 - DOI - PubMed
    1. Vasterling JJ, Proctor SP, Amoroso P, Kane R, Heeren T, White RF. Neuropsychological outcomes of army personnel following deployment to the Iraq War. JAMA. 2006;296(5):519-529. doi:10.1001/jama.296.5.519 - DOI - PubMed
    1. Hoge CW, McGurk D, Thomas JL, Cox AL, Engel CC, Castro CA. Mild traumatic brain injury in US Soldiers returning from Iraq. N Engl J Med. 2008;358(5):453-463. doi:10.1056/NEJMoa072972 - DOI - PubMed

Publication types