Primary Care Management of Sleep Disturbances Associated With Concussion/Mild Traumatic Brain Injury in Service Members and Veterans.

To develop an evidence and consensus-based clinical recommendation (CR) regarding primary care management of insufficient and disturbed sleep associated with concussion/mild traumatic brain injury (mTBI) in service members and veterans. A multidisciplinary expert working group (EWG) of 23 subject matter experts was selected by the Defense Health Agency (DHA) Traumatic Brain Injury Center of Excellence (TBICoE), based on relevant expertise and experience, from candidates nominated by DHA communities of interest. The TBICoE core working group (CWG) conducted a literature search using PubMed and Google Scholar databases for articles relevant to sleep and mTBI from 2014 to 2018. Resulting studies were reviewed by the CWG, and questions addressing gaps in the literature were formulated. Questions addressing gaps in the literature were distributed to the EWG, and consensus was achieved over the course of 5 online meetings. Based on the available evidence and EWG consensus, TBICoE developed a draft of the clinical recommendations and submitted it to the EWG for review and feedback. Feedback was adjudicated by TBICoE, and areas of nonconsensus were addressed via email utilizing a modified Delphi method. The evidence and EWG agree that addressing sleep early following mTBI is imperative to promoting recovery and preventing chronic mTBI symptoms, maladaptive sleep behaviors, and chronic sleep disorders. .