Leng Yue, Byers Amy L, Barnes Deborah E, Peltz Carrie B, Li Yixia, Yaffe Kristine
From the Department of Psychiatry (Y. Leng, A.L.B., D.E.B., K.Y.), Department of Epidemiology and Biostatistics (A.L.B., D.E.B., K.Y.), and Department of Neurology (K.Y.), University of California, San Francisco; and San Francisco Veterans Affairs Health Care System (A.L.B., D.E.B., C.B.P., Y. Li., K.Y.), CA.
Neurology. 2021 Mar 30;96(13):e1792-e1799. doi: 10.1212/WNL.0000000000011656. Epub 2021 Mar 3.
To test the hypothesis that veterans with traumatic brain injury (TBI) have an increased subsequent risk of sleep disorders, we studied the longitudinal association between TBI and incident sleep disorders in nearly 200,000 veterans.
We performed a cohort study of all patients diagnosed with a TBI in the Veterans Health Administration system from October 1, 2001, to September 30, 2015, who were age-matched 1:1 to veterans without TBI. Veterans with prevalent sleep disorders at baseline were excluded. Development of sleep disorders was defined as any inpatient or outpatient diagnosis of sleep apnea, hypersomnia, insomnia, or sleep-related movement disorders based on ICD-9 codes after the first TBI diagnosis or the random selection date for those without TBI. We restricted the analysis to those with at least 1 year of follow-up. We used Cox proportional hazards models to examine the association between TBI and subsequent risk of sleep disorders.
The study included 98,709 veterans with TBI and 98,709 age-matched veterans without TBI (age 49 ± 20 years). After an average follow-up of 5 (1-14) years, 23,127 (19.6%) veterans developed sleep disorders. After adjustment for demographics, education, income, and medical and psychiatric conditions, those who had TBI compared to those without TBI were 41% more likely to develop any sleep disorders (hazard ratio 1.41 [95% confidence interval 1.37-1.44]), including sleep apnea (1.28 [1.24-1.32]), insomnia (1.50 [1.45-1.55]), hypersomnia (1.50 [1.39-1.61]), and sleep-related movement disorders (1.33 [1.16-1.52]). The association was stronger for mild TBIs, did not differ appreciably by presence of posttraumatic stress disorder, and remained after a 2-year time lag.
In 197,418 veterans without sleep disorders, those with diagnosed TBI had an increased risk of incident sleep disorders over 14 years. Improved prevention and long-term management strategies for sleep are needed for veterans with TBI.
为了验证创伤性脑损伤（TBI）退伍军人随后患睡眠障碍风险增加这一假设，我们研究了近20万名退伍军人中TBI与新发睡眠障碍之间的纵向关联。
我们对2001年10月1日至2015年9月30日期间在退伍军人健康管理系统中被诊断为TBI的所有患者进行了队列研究，这些患者与无TBI的退伍军人按1:1进行年龄匹配。排除基线时患有睡眠障碍的退伍军人。睡眠障碍的发生定义为在首次TBI诊断后或无TBI者的随机选择日期之后，根据ICD - 9编码进行的任何住院或门诊诊断的睡眠呼吸暂停、嗜睡、失眠或睡眠相关运动障碍。我们将分析限制在至少有1年随访的患者中。我们使用Cox比例风险模型来检验TBI与随后患睡眠障碍风险之间的关联。
该研究纳入了98,709名患有TBI的退伍军人和98,709名年龄匹配的无TBI退伍军人（年龄49±20岁）。平均随访5（1 - 14）年后，23,127名（19.6%）退伍军人出现了睡眠障碍。在对人口统计学、教育程度、收入以及医疗和精神状况进行调整后，与无TBI的退伍军人相比，患有TBI的退伍军人出现任何睡眠障碍的可能性高出41%（风险比1.41 [95%置信区间1.37 - 1.44]），包括睡眠呼吸暂停（1.28 [1.24 - 1.32]）、失眠（1.50 [1.45 - 1.55]）、嗜睡（1.50 [1.39 - 1.61]）和睡眠相关运动障碍（1.33 [1.16 - 1.52]）。这种关联在轻度TBI患者中更强，在有无创伤后应激障碍的情况下没有明显差异，并且在2年的时间滞后后仍然存在。
在197,418名无睡眠障碍的退伍军人中，被诊断为TBI的退伍军人在14年中患新发睡眠障碍的风险增加。患有TBI的退伍军人需要改进睡眠预防和长期管理策略。
