Sleep assessment in a randomized trial of hyperbaric oxygen in U.S. service members with post concussive mild traumatic brain injury compared to normal controls

Sleep Med. 2018 Nov;51:66-79. doi: 10.1016/j.sleep.2018.06.006. Epub 2018 Jun 30.


Study objective: In this exploratory, double-blind, longitudinal sham-controlled trial of hyperbaric oxygen (HBO2) for military personnel with post concussive mild traumatic brain injury (mTBI), self-reports and objective measures of sleep-wake disturbances were assessed and compared to normals.

Methods: Self-reports consisting of Pittsburg Sleep Quality Index (PSQI), sleep diary, screening for obstructive sleep apnea (OSA) risk, restless legs syndrome (RLS), cataplexy, and objective actigraphic measures of sleep-wake were obtained on 71 military personnel with mTBI [baseline, 13 weeks and six months post-randomization (post-intervention)], of which 35 met post-traumatic stress disorder (PTSD) criteria, and 75 healthy volunteers (baseline). Baseline between-group and follow-up changes from baseline overall and within subgroups were evaluated. Mild TBI was defined as consisting of head injury associated loss of consciousness (<24 h), post-traumatic amnesia, and neurological deficits.

Results: Sleep quality by self-reports was markedly degraded in the mTBI group at baseline compared to a normative cohort; insomnia 87.3 versus 2.8%, OSA risk 70% versus 1.3%, RLS 32.4% versus and 2.7%. (all p-values <0.001), but actigraphy measures did not differentiate between groups. HBO2 compared to sham treatment improved self-reports of PSQI sleep measures, reports (five out of eight at 13-weeks and two out of eight at six-months). However, other sleep-wake measures were not different.

Conclusions: Perceived sleep quality was markedly disrupted in mTBI military personnel and sleep-wake disturbances were prevalent compared to a normative cohort. HBO2 relative to sham improved some measures of sleep quality on the PSQI, but other measures of sleep were not significantly different.

Trial registration: NCT01611194 NCT01925963.

Keywords: Actigraphy; Hyperbaric; PSQI; Self-report; Sleep; TBI.

Publication types

  • Randomized Controlled Trial
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Adult
  • Brain Injuries, Traumatic / complications*
  • Cataplexy / diagnosis
  • Cohort Studies
  • Female
  • Humans
  • Hyperbaric Oxygenation / methods*
  • Longitudinal Studies
  • Male
  • Military Personnel / statistics & numerical data*
  • Post-Concussion Syndrome / etiology*
  • Restless Legs Syndrome / diagnosis
  • Self Report
  • Sleep Apnea, Obstructive / diagnosis
  • Sleep Initiation and Maintenance Disorders / diagnosis
  • Sleep Wake Disorders / etiology*
  • Stress Disorders, Post-Traumatic / diagnosis
  • Stress Disorders, Post-Traumatic / etiology

Associated data