创伤后幸存者持续性失眠的风险因素：一项回顾性队列研究。

Risk factors of persistent insomnia among survivors of traumatic injury: a retrospective cohort study.

机构信息

Walter Reed National Military Medical Center, Bethesda, Maryland.

Uniformed Services University of the Health Sciences, Bethesda, Maryland.

出版信息

J Clin Sleep Med. 2021 Sep 1;17(9):1831-1840. doi: 10.5664/jcsm.9276.

DOI:10.5664/jcsm.9276

PMID:33928909

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8636356/

Abstract

STUDY OBJECTIVES

Insomnia is a diagnosis with broad health and economic implications that has been increasingly recognized in military service members. This trend was concurrent with an increase in traumatic wartime injuries. Accordingly, we sought to determine longitudinal predictors of persistent insomnia in combat veterans who sustained traumatic injuries.

METHODS

Retrospective cohort study of service members deployed to conflict zones from 2002 to 2016, with longitudinal follow-up in the Veterans Affairs and Military Health Systems. Two cohorts were derived: (1) service members who sustained traumatic injuries and (2) an age-, sex-, and service component-matched cohort of uninjured service members who deployed to a combat zone. Insomnia was defined using or codes.

RESULTS

The final population of 17,374 service members was followed from date of injury (or date of matched participant's injury) for a median of 8.4 (interquartile range, 5.3-10.7) years. Service members with traumatic injury were at significantly greater risk of developing insomnia than uninjured service members (hazard ratio = 1.43; 95% confidence interval, 1.30-1.58) after adjustment. Traumatic brain injury was associated with insomnia compared with patients without traumatic brain injury in the multivariable model: mild/unclassified traumatic brain injury (hazard ratio = 2.07; 95% confidence interval, 1.82-2.35) and moderate/severe/ penetrating traumatic brain injury (hazard ratio = 2.43; 95% confidence interval, 2.06-2.86). Additionally, burn injury (hazard ratio = 1.95; 95% confidence interval, 1.47-2.59) and amputation (hazard ratio = 1.61; 95% confidence interval, 1.26-2.06) significantly increased the risk of a diagnosis.

CONCLUSIONS

Traumatic injuries significantly predicted a diagnosis of insomnia after controlling for mental health disorders. Our findings strongly suggest the need for long-term surveillance of sleep disorders in trauma survivors.

CITATION

Haynes ZA, Collen JF, Poltavskiy EA, et al. Risk factors of persistent insomnia among survivors of traumatic injury: a retrospective cohort study. 2021;17(9):1831-1840.

摘要

研究目的

失眠是一种具有广泛健康和经济影响的诊断，在军人中越来越受到重视。这种趋势与战时创伤性损伤的增加同时发生。因此，我们试图确定在经历过创伤性损伤的战斗退伍军人中持续性失眠的纵向预测因素。

方法

这是一项对 2002 年至 2016 年期间部署到冲突地区的军人进行的回顾性队列研究，在退伍军人事务部和军事医疗系统中进行纵向随访。我们得出了两个队列：（1）遭受创伤性损伤的军人，以及（2）年龄、性别和服役成分与部署到战区的未受伤军人相匹配的队列。失眠的定义使用 ICD-9 或 ICD-10 编码。

结果

最终的 17374 名军人队列从受伤日期（或匹配参与者受伤日期）开始进行了中位数为 8.4 年（四分位间距，5.3-10.7 年）的随访。与未受伤的军人相比，遭受创伤性损伤的军人发生失眠的风险显著更高（风险比=1.43；95%置信区间，1.30-1.58），调整后差异仍有统计学意义。在多变量模型中，与没有创伤性脑损伤的患者相比，创伤性脑损伤与失眠相关：轻度/未分类创伤性脑损伤（风险比=2.07；95%置信区间，1.82-2.35）和中度/重度/穿透性创伤性脑损伤（风险比=2.43；95%置信区间，2.06-2.86）。此外，烧伤（风险比=1.95；95%置信区间，1.47-2.59）和截肢（风险比=1.61；95%置信区间，1.26-2.06）显著增加了诊断的风险。

结论

在控制精神健康障碍后，创伤性损伤显著预测了失眠的诊断。我们的研究结果强烈表明需要对创伤幸存者的睡眠障碍进行长期监测。

引文

Haynes ZA, Collen JF, Poltavskiy EA, et al. Risk factors of persistent insomnia among survivors of traumatic injury: a retrospective cohort study. 2021;17(9):1831-1840.