Sleep and pain complaints in symptomatic traumatic brain injury and neurologic populations

Abstract

Objective: To compare the incidence of sleep and pain complaints in symptomatic traumatic brain injury (TBI) (mild vs moderate/severe) and neurologic populations.

Design: Case-control study.

Setting: Outpatient neuropsychology service at a university-affiliated tertiary care center.

Patients: A consecutive sample of mild (n = 127) and moderate to severe (n = 75) patients with TBI and a general neurologic (non-TBI) group (n = 123) referred for neuropsychological assessment.

Main outcome measures: Patient report of sleep and/or pain problems.

Results: TBI subjects had significantly more insomnia (56.4% vs 30.9%) and pain complaints (58.9% vs 22%) than non-TBI subjects (p < .0001). For both subject groups, the presence of pain increased insomnia approximately twofold. Poor sleep maintainance was the most common sleep problem. In those subjects without pain, TBI patients reported more sleep complaints that non-TBI patients (p = .05). Mild TBI patients reported significantly (p < .0001) more pain than patients with a moderate to severe injury (70% vs 40%). In TBI subjects without pain, there were significantly more insomnia complaints in mild than in moderate to severe injuries (p < .01).

Conclusions: TBI patients with persistent cognitive complaints have more sleep and pain concerns than general neurologic patients. Pain is strongly associated with sleep problems. Aggressive evaluation and treatment of pain and sleep problems in the TBI, especially mild TBI, population appears warranted and may contribute to increased disability. The etiology of greater sleep and pain problems in the mild than in the more severe TBI patients requires further study.