Association Between Insomnia and Mental Health and Neurocognitive Outcomes Following Traumatic Brain Injury

Emerson M Wickwire; Jennifer S Albrecht; Vincent F Capaldi 2nd; Sonia Jain; Raquel C Gardner; Michael T Smith; Scott G Williams; Jacob Collen; David M Schnyer; Joseph T Giacino; Lindsay D Nelson; Pratik Mukherjee; Xiaoying Sun; J Kent Werner; Caterina B Mosti; Amy J Markowitz; Geoffrey T Manley; Andrew D Krystal

doi:10.1089/neu.2023.0009

Association Between Insomnia and Mental Health and Neurocognitive Outcomes Following Traumatic Brain Injury

J Neurotrauma. 2023 Oct 11. doi: 10.1089/neu.2023.0009. Online ahead of print.

Authors

Emerson M Wickwire^{1

2}, Jennifer S Albrecht³, Vincent F Capaldi 2nd^{4

5}, Sonia Jain⁶, Raquel C Gardner⁷, Michael T Smith⁸, Scott G Williams^{5

9

10}, Jacob Collen^{5

11}, David M Schnyer¹², Joseph T Giacino^{13

14}, Lindsay D Nelson¹⁵, Pratik Mukherjee¹⁶, Xiaoying Sun⁶, J Kent Werner^{17

18}, Caterina B Mosti¹⁹, Amy J Markowitz²⁰, Geoffrey T Manley^{21

22}, Andrew D Krystal^{23

24}

Affiliations

¹ Sleep Disorders Center, Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA.
² Department of Psychiatry, University of Maryland School of Medicine, Baltimore, Maryland, USA.
³ Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland, USA.
⁴ Center for Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research, Silver Spring, Maryland, USA.
⁵ Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA.
⁶ Biostatistics Research Center, Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, San Diego, California, USA.
⁷ Department of Neurology, University of California, San Francisco, San Francisco, California, USA.
⁸ Department of Psychiatry, Division of Behavioral Medicine, Johns Hopkins University, Baltimore, Maryland, USA.
⁹ Department of Medicine, Fort Belvoir Community Hospital, Fort Belvoir, Virginia, USA.
¹⁰ Department of Psychiatry, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA.
¹¹ Sleep Disorders Center, Department of Medicine, Walter Reed National Military Medical Center, Bethesda, Maryland, USA.
¹² Department of Psychology, University of Texas Austin, Austin, Texas, USA.
¹³ Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts, USA.
¹⁴ Spaulding Rehabilitation Hospital, Charlestown, Massachusetts, USA.
¹⁵ Departments of Neurosurgery and Neurology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.
¹⁶ Department of Radiology, University of California, San Francisco, San Francisco, California, USA.
¹⁷ Department of Neurology, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA.
¹⁸ Department of Neurology, Division of Behavioral Medicine, Johns Hopkins University, Baltimore, Maryland, USA.
¹⁹ Department of Psychiatry, University of California, San Francisco, San Francisco, California, USA.
²⁰ Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, USA.
²¹ Brain and Spinal Injury Center, University of California, San Francisco, San Francisco, California, USA.
²² Department of Neurosurgery, University of California, San Francisco, San Francisco, California, USA.
²³ Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, California, USA.
²⁴ Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, California, USA.

PMID: 37463057
DOI: 10.1089/neu.2023.0009

Abstract

We previously described five trajectories of insomnia (each defined by a distinct pattern of insomnia severity over 12 months following traumatic brain injury [TBI]). Our objective in the present study was to estimate the association between insomnia trajectory status and trajectories of mental health and neurocognitive outcomes during the 12 months after TBI. In this study, participants included N = 2022 adults from the Federal Inter-agency Traumatic Brain Injury Repository database and Transforming Research and Clinical Knowledge in TBI (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, Post-Traumatic Stress Disorder (PTSD) Checklist for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), Patient Reported Outcomes Measurement Information System-Pain, and Quality of Life After Brain Injury-Overall Scale. Neurocognitive performance was assessed at 2 weeks, and 6 and 12 months using the Wechsler Adult Intelligence Scales Processing Speed Index and the Trails Making Test Parts A and B. Results indicated that 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 conclusion, 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.

Keywords: concussion; depression; insomnia; neurocognition; pain; quality of life; trauma; traumatic brain injury.