University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
NeuroRehabilitation. 2019;45(2):163-185. doi: 10.3233/NRE-192804.
To synthesize the current evidence on sleep disturbances in military service members (SMs) and veterans with traumatic brain injury (TBI).
An electronic literature search first identified abstracts published from 2008-2018 inclusively referencing sleep, TBI, and military personnel from Operation Enduring Freedom, Operation Iraqi Freedom, Operation New Dawn, and Persian Gulf veterans. Selection criteria eliminated studies on non-combat TBI, open or penetrating injuries, and articles where the relationship between sleep and TBI was not directly examined. Articles on all military branches and components, those currently serving and veterans-ranging from medical chart reviews to clinical trials, were included. Forty-one articles were selected for full text-review.
Twenty-four papers estimated the prevalence of sleep disturbances in TBI. Eight studies demonstrated the contribution of common co-occurring conditions, most notably posttraumatic stress disorder, to the relationship between disrupted sleep and TBI. Ten studies differentiated sleep profiles between military SMs and veterans with and without acute TBI and detected significant differences in sleep disturbances across the course of injury. Longitudinal studies were scarce but helped to establish the temporal relationship between sleep disturbances and TBI and isolate sleep-related mechanisms influencing TBI prognosis. Only three studies reported on interventions for improving sleep quality and TBI symptoms. Systematic research testing assessments and interventions that target sleep disturbances for improving sleep, TBI symptoms, and long-term functional outcomes were identified as critical knowledge gaps.
Findings unequivocally establish that sleep disturbances are highly prevalent in SMs and veterans with TBI. However, studies testing the effectiveness of treatments for improving sleep in military groups with TBI have been limited and their results inconsistent. This review highlights a critical opportunity for advancing military medicine through future research aimed at identifying and testing sleep-focused treatments in SMs and veterans with combat-related TBI.
综合目前关于创伤性脑损伤（TBI）军人和退伍军人睡眠障碍的证据。
电子文献检索首先确定了从 2008 年至 2018 年发表的摘要，其中包括睡眠、TBI 和来自持久自由行动、伊拉克自由行动、新黎明行动和波斯湾退伍军人的军事人员。选择标准排除了非战斗性 TBI、开放性或穿透性损伤以及未直接检查睡眠与 TBI 之间关系的研究。包括所有军事分支机构和组成部分、现役和退伍军人的文章，范围从病历审查到临床试验。选择了 41 篇文章进行全文审查。
24 篇论文估计了 TBI 患者睡眠障碍的患病率。八项研究表明，常见共病，尤其是创伤后应激障碍，对睡眠障碍与 TBI 之间的关系有贡献。十项研究区分了有和没有急性 TBI 的军人和退伍军人的睡眠模式，并在损伤过程中发现了睡眠障碍的显著差异。纵向研究很少，但有助于确定睡眠障碍与 TBI 之间的时间关系，并确定影响 TBI 预后的与睡眠相关的机制。只有三项研究报告了改善睡眠质量和 TBI 症状的干预措施。系统研究测试了针对改善睡眠、TBI 症状和长期功能结果的睡眠障碍评估和干预措施，被确定为关键的知识空白。
研究结果明确表明，睡眠障碍在 TBI 军人和退伍军人中非常普遍。然而，针对改善患有 TBI 的军人和退伍军人睡眠的治疗效果的研究有限，其结果不一致。本综述强调了通过未来旨在确定和测试针对与战斗相关的 TBI 的军人和退伍军人的睡眠为重点的治疗方法的研究，为推进军事医学提供了一个关键机会。
