Department of Pulmonary, Critical Care, and Sleep Medicine, Walter Reed National Military Medical Center, Bethesda, MD.
Department of Medicine, Walter Reed National Military Medical Center, Bethesda, MD.
Chest. 2012 Sep;142(3):622-630. doi: 10.1378/chest.11-1603.
Sleep complaints are common among patients with traumatic brain injury. Evaluation of this population is confounded by polypharmacy and comorbid disease, with few studies addressing combat-related injuries. The aim of this study was to assess the prevalence of sleep disorders among soldiers who sustained combat-related traumatic brain injury.
The study design was a retrospective review of soldiers returning from combat with mild to moderate traumatic brain injury. All underwent comprehensive sleep evaluations. We determined the prevalence of sleep complaints and disorders in this population and assessed demographics, mechanism of injury, medication use, comorbid psychiatric disease, and polysomnographic findings to identify variables that correlated with the development of specific sleep disorders.
Of 116 consecutive patients, 96.6% were men (mean age, 31.1 ± 9.8 years; mean BMI, 27.8 ± 4.1 kg/m²), and 29.5% and 70.5% sustained blunt and blast injuries, respectively. Nearly all (97.4%) reported sleep complaints. Hypersomnia and sleep fragmentation were reported in 85.2% and 54.3%, respectively. Obstructive sleep apnea syndrome (OSAS) was found in 34.5%, and 55.2% had insomnia. Patients with blast injuries developed more anxiety (50.6% vs 20.0%, P = .002) and insomnia (63% vs 40%, P = .02), whereas patients with blunt trauma had significantly more OSAS (54.3% vs 25.9%, P = .003). In multivariate analysis, blunt trauma was a significant predictor of OSAS (OR, 3.09; 95% CI, 1.02-9.38; P = .047).
Sleep disruption is common following traumatic brain injury, and the majority of patients develop a chronic sleep disorder. It appears that sleep disturbances may be influenced by the mechanism of injury in those with combat-related traumatic brain injury, with blunt injury potentially predicting the development of OSAS.
睡眠问题在创伤性脑损伤患者中很常见。由于合并用药和合并疾病，对该人群的评估受到干扰，很少有研究涉及与战斗相关的损伤。本研究旨在评估与战斗相关的创伤性脑损伤后士兵睡眠障碍的发生率。
研究设计为对从战斗中返回的轻度至中度创伤性脑损伤士兵进行的回顾性研究。所有患者均接受了全面的睡眠评估。我们确定了该人群中睡眠主诉和障碍的发生率，并评估了人口统计学、损伤机制、用药情况、合并精神疾病和多导睡眠图发现，以确定与特定睡眠障碍发展相关的变量。
在 116 例连续患者中，96.6%为男性（平均年龄 31.1±9.8 岁；平均 BMI 27.8±4.1kg/m²），分别有 29.5%和 70.5%患者发生钝器伤和爆炸伤。几乎所有（97.4%）患者均报告睡眠主诉。分别有 85.2%和 54.3%患者报告嗜睡和睡眠碎片化。发现阻塞性睡眠呼吸暂停综合征（OSAS）34.5%，55.2%患者存在失眠。发生爆炸伤的患者出现更多焦虑（50.6%比 20.0%，P=.002）和失眠（63%比 40%，P=.02），而钝器伤患者 OSAS 明显更多（54.3%比 25.9%，P=.003）。多变量分析显示，钝器伤是 OSAS 的显著预测因素（OR 3.09；95%CI 1.02-9.38；P=.047）。
创伤性脑损伤后睡眠中断很常见，大多数患者会出现慢性睡眠障碍。似乎睡眠障碍可能受到与战斗相关的创伤性脑损伤患者损伤机制的影响，钝器伤可能预测 OSAS 的发展。
