Walker James M, James Nathan T, Campbell Harlan, Wilson Steffanie H, Churchill Susan, Weaver Lindell K
PSG Professional Services, Inc, Farmington, Utah U.S.
Lovelace Biomedical Research, Albuquerque, New Mexico U.S.
Undersea Hyperb Med. 2016 Aug-Sept;43(5):549-566.
Baseline sleep characteristics were explored for 71 U.S. military service members with mild traumatic brain injury (mTBI) enrolled in a post-concussive syndrome clinical trial. The Pittsburgh Sleep Quality Index (PSQI), sleep diary, several disorder-specific questionnaires, actigraphy and polysomnographic nap were collected. Almost all (97%) reported ongoing sleep problems. The mean global PSQI score was 13.5 (SD=3.8) and 87% met insomnia criteria. Sleep maintenance efficiency was 79.1% for PSQI, 82.7% for sleep diary and 90.5% for actigraphy; total sleep time was 288, 302 and 400 minutes, respectively. There was no correlation between actigraphy and subjective questionnaires. Overall, 70% met hypersomnia conditions, 70% were at high risk for obstructive sleep apnea (OSA), 32% were symptomatic for restless legs syndrome, and 6% reported cataplexy. Nearly half (44%) reported coexisting insomnia, hypersomnia and high OSA risk. Participants with post-traumatic stress disorder (PTSD) had higher PSQI scores and increased OSA risk. Older participants and those with higher aggression, anxiety or depression also had increased OSA risk. The results confirm poor sleep quality in mTBI with insomnia, hypersomnia, and OSA risk higher than previously reported, and imply sleep disorders in mTBI may be underdiagnosed or exacerbated by comorbid PTSD.
对71名参与脑震荡后综合征临床试验的美国军人进行了基线睡眠特征研究，这些军人患有轻度创伤性脑损伤（mTBI）。收集了匹兹堡睡眠质量指数（PSQI）、睡眠日记、几份特定疾病问卷、活动记录仪和多导睡眠图小睡记录。几乎所有（97%）报告存在持续的睡眠问题。PSQI的平均全球得分是13.5（标准差=3.8），87%符合失眠标准。PSQI的睡眠维持效率为79.1%，睡眠日记为82.7%，活动记录仪为90.5%；总睡眠时间分别为288、302和400分钟。活动记录仪与主观问卷之间无相关性。总体而言，70%符合嗜睡条件，70%有阻塞性睡眠呼吸暂停（OSA）高风险，32%有不宁腿综合征症状，6%报告有猝倒。近一半（44%）报告同时存在失眠、嗜睡和OSA高风险。患有创伤后应激障碍（PTSD）的参与者PSQI得分更高，OSA风险增加。年龄较大的参与者以及攻击性、焦虑或抑郁程度较高的参与者OSA风险也增加。结果证实mTBI患者睡眠质量差，失眠、嗜睡和OSA风险高于先前报道，这意味着mTBI患者的睡眠障碍可能未得到充分诊断或因共病PTSD而加重。
