Association between Insomnia and Mental Health and Neurocognitive Outcomes Following Traumatic Brain Injury.

Abstract

To describe the association between five previously identified trajectories of insomnia (each defined by a distinct pattern of insomnia severity over 12 months following TBI) and trajectories of mental health and neurocognitive outcomes during the 12 months after TBI. N=2,022 adults from the Federal Inter-agency Traumatic Brain Injury Repository (FITBIR) database and Transforming Research and Clinical Knowledge in Traumatic Brain Injury (TRACK-TBI) study. The following outcome measures were assessed serially at 2 weeks, and 3, 6, and 12 months post-injury: Insomnia Severity Index, Patient Health Questionnaire, PTSD Checklist for DSM-5, PROMIS-PAIN, and Quality of Life After Brain Injury-Overall Scale. Neurocognitive performance was assessed at 2 weeks, 6 and 12 months using the Wechsler Adult Intelligence Scales Processing Speed Index and the Trails Making Test Parts A and B. Greater insomnia severity was associated with greater abnormality in mental health, quality of life, and neuropsychological testing outcomes. The pattern of insomnia over time tracked the temporal pattern of all these outcomes for all but a very small number of participants. Notably, severe insomnia at 3 or 6 months post-TBI was a risk factor for poor recovery at 12 months post-injury. In this well-characterized sample of individuals with TBI, insomnia severity generally tracked severity of depression, pain, PTSD, quality of life, and neurocognitive outcomes over 12 months post-injury. More intensive sleep assessment is needed to elucidate the nature of these relationships and to help inform best strategies for intervention.