0632 Early sleep-disordered breathing in moderate-to-severe traumatic brain injury (TBI) is linked with chronic pain status at long-term follow-up: A TBI Model Systems study

Abstract

Abstract Introduction Sleep disorders and chronic pain (pain of >3 months duration) are common after traumatic brain injury (TBI). A recently completed multi-center trial found that two-thirds of adults with moderate-to-severe TBI had sleep apnea diagnosed during polysomnography (PSG) completed during inpatient rehabilitation. Although a bidirectional relationship between sleep and pain exists, attention to sleep apnea as a specific diagnosis and its possible role in chronic pain following TBI has not been explored. We hypothesized that PSG-derived respiratory indices shortly following TBI would be worse among those reporting chronic pain at 1- to 2-year follow-up compared to those without chronic pain. Methods Sample (N=66) derived from overlapping cohorts across two separate multicenter studies. Participants with moderate to severe TBI underwent PSG during inpatient rehabilitation and completed a telephone follow-up interview to assess chronic pain status using standardized measures at 1-2 years post-TBI (610-day average). Pairwise comparisons across participants with and without chronic pain were made to determine the magnitude of clinically significant differences on respiratory indices including oxygen desaturation, central and obstructive apneas, and total apnea-hypopnea index (AHI). Results Presence of chronic pain at follow-up was associated with elevated central apnea events (2.6) and oxygen desaturation (19.6) relative to those without chronic pain (0.8 and 7.9, respectively). Important differences were also seen between obstructive and total apnea hypopnea index (AHI) using Centers for Medicaid and Medicare Services scoring criteria, with those in the chronic pain cohort being 6.5 and 8.7 points higher than their non-pain counterparts, respectively. Group differences on obstructive and total AHI were considered minor when using the American Academy of Sleep Medicine scoring criteria, although those with current pain experienced categorically worse sleep apnea (total AHI = 19 versus 12.4). Conclusion This is the first study to find an association between PSG-derived respiratory indices and long-term chronic pain status following moderate-to-severe TBI. Sleep apnea represents an important modifiable factor following injury that may contribute to long-term pain-related outcomes. Given the prominence of chronic pain several years post injury, future studies should investigate the role of sleep apnea and early intervention among those following moderate-to-severe TBI to determine impact on long-term rehabilitation and pain outcomes. Support (If Any) PCORI; CER-1511-33005); VA TBI Model Systems Program of Research; GDIT; NIDILRR 90DPTB0008. Clinicaltrial.gov Registration Number: NCT03033901.