Sleep disturbances among older adults following traumatic brain injury

Int Rev Psychiatry. 2020 Feb;32(1):31-38. doi: 10.1080/09540261.2019.1656176. Epub 2019 Sep 23.


Sleep disturbances are common sequelae of traumatic brain injury (TBI) that are associated with poorer recovery. This is important among older adults, who fare worse following TBI relative to younger adults and have a higher prevalence of sleep disorders. The objective of this study was to assess the risk of newly-diagnosed sleep disorders following TBI among adults ≥65 years. Using a large commercial insurance database, older adults diagnosed with TBI between 2008-2014 (n = 78,044) and non-TBI controls (n = 76,107) were identified. The first dates of diagnosis of four common sleep disorders (hypersomnia, insomnia, obstructive sleep apnea, and restless legs syndrome) and a composite of any sleep disorder were identified. To compare groups, this study used a difference-in-differences (DID) approach, accounting for pre-index differences between cohorts and the trends in sleep diagnoses over time. Individuals with TBI were more likely to have any newly-diagnosed sleep disorder before (14.1% vs 9.4%, p < 0.001) and after (22.7% vs 14.1%, p < 0.001) the index date. In fully adjusted DID models, TBI was associated with an increased risk of insomnia (rate ratio (RR) = 1.17; 95% confidence interval (CI) = 1.08-1.26) and any sleep disorder (RR = 1.13; 95% CI = 1.08-1.19). Following TBI among older adults, screening and education on sleep disorders should be considered.

Keywords: Traumatic brain injury; administrative claims; insomnia; older adults; sleep disturbances.

Publication types

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

MeSH terms

  • Aged
  • Aged, 80 and over
  • Aging*
  • Brain Injuries, Traumatic / complications*
  • Brain Injuries, Traumatic / epidemiology
  • Disorders of Excessive Somnolence / epidemiology
  • Disorders of Excessive Somnolence / etiology
  • Female
  • Humans
  • Male
  • Restless Legs Syndrome / epidemiology
  • Restless Legs Syndrome / etiology
  • Retrospective Studies
  • Risk
  • Sleep Apnea, Obstructive / epidemiology
  • Sleep Apnea, Obstructive / etiology
  • Sleep Initiation and Maintenance Disorders / epidemiology
  • Sleep Initiation and Maintenance Disorders / etiology*
  • Sleep Wake Disorders / epidemiology
  • Sleep Wake Disorders / etiology*