Trajectories of Insomnia in Adults After Traumatic Brain Injury.
Trajectories of Insomnia in Adults After Traumatic Brain Injury.
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成年人创伤性脑损伤后的神经冲动轨迹。
DOI：
10.1001/jamanetworkopen.2021.45310
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发表时间：
2022-01-04
影响因子：
13.8
通讯作者：
Transforming Research and Clinical Knowledge in Traumatic Brain Injury (TRACK-TBI) Investigators
中科院分区：
文献类型：
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作者：
Wickwire EM;Albrecht JS;Capaldi VF 2nd;Jain SO;Gardner RC;Werner JK;Mukherjee P;McKeon AB;Smith MT;Giacino JT;Nelson LD;Williams SG;Collen J;Sun X;Schnyer DM;Markowitz AJ;Manley GT;Krystal AD;Transforming Research and Clinical Knowledge in Traumatic Brain Injury (TRACK-TBI) Investigators
创伤性脑损伤 (TBI) 后 12 个月内失眠的自然史是怎样的？在一项大型队列研究《创伤性脑损伤的研究和临床知识转变》中对 2022 名成年人进行的分析中发现，失眠在 TBI 后 12 个月内很常见。确定了失眠的五种轨迹类别，并确定了包括性别、种族和民族、TBI病史、精神病史和计算机断层扫描状态在内的基线因素与失眠轨迹类别成员显着相关。这些发现表明，创伤性脑损伤后失眠很常见，应在康复初期进行评估。这项队列研究对 2022 名患有创伤性脑损伤的成年人进行了队列研究，基于使用标准化措施的系列评估，确定了受伤后 12 个月内失眠的独特轨迹。失眠在创伤性脑损伤 (TBI) 后很常见，会导致发病和长期后遗症。确定 TBI 后 12 个月内失眠的独特轨迹。在这项前瞻性队列研究中，使用潜在类别混合模型 (LCMM) 来模拟随时间推移的失眠轨迹，并将参与者分为不同的概况组。创伤性脑损伤研究和临床知识转化 (TRACK-TBI) 研究是一项纵向、多地点、观察性研究，其数据已上传至联邦机构间创伤性脑损伤存储库 (FITBIR) 数据库。参与者在 18 个参与的 I 级创伤中心中的 1 个中心入组，并在 TBI 受伤后 24 小时内入组。其他数据直接从 TRACK-TBI 研究人员处获得，未来将上传至 FITBIR。数据收集时间为2014年2月26日至2018年8月8日，分析时间为2020年7月1日至2021年11月15日。 创伤性脑损伤。失眠严重程度指数在第 2 周以及此后第 3、6 和 12 个月连续评估。最终样本包括来自 FITBIR 数据库和 TRACK-TBI 研究的 2022 名参与者（1377 [68.1%] 男性；平均 [SD] 年龄， 40.1 [17.2] 岁）。数据最适合 5 级 LCMM。在这些参与者中，1245 名（61.6%）报告有持续的轻度失眠症状（1 级）； 627 人 (31.0%) 最初报告有轻度失眠症状，但随着时间的推移会消失（2 级）； 91 人（4.5%）报告有持续的严重失眠症状（3 级）； 44 人 (2.2%) 最初报告有严重失眠症状，但在 12 个月后消失（4 级）； 15 名（0.7%）最初报告没有失眠症状，但到 12 个月时出现严重症状（5 级）。在多项 Logistic 回归模型中，确定了与失眠轨迹类别成员显着相关的几个因素，包括女性（比值比 [OR]，1.65 [95% CI，1.02-2.66]）、黑人种族（OR，2.36 [95% CI，1.39-4.01]）、精神疾病史（OR，2.21 [95% CI， 1.35-3.60]），并且在比较第 3 类和第 1 类时，计算机断层扫描的结果与颅内损伤一致（OR，0.36 [95% CI，0.20-0.65]）。这些结果表明成人 TBI 后失眠过程存在重要的异质性。需要做更多的工作来确定与这些失眠轨迹类别亚组相关的结果，并确定针对亚组的最佳治疗方法。
What is the natural history of insomnia in the 12 months after traumatic brain injury (TBI)? In this analysis of 2022 adults from the large cohort study Transforming Research and Clinical Knowledge in Traumatic Brain Injury, insomnia was common during the 12 months after TBI. Five trajectory classes of insomnia were identified, and baseline factors including sex, race and ethnicity, history of TBI, psychiatric history, and computed tomography status were identified as significantly associated with insomnia trajectory class membership. These findings suggest that insomnia is common after TBI and should be assessed early in recovery. This cohort study of 2022 adults with traumatic brain injury identifies unique trajectories of insomnia during the 12 months after injury based on serial assessment using standardized measures. Insomnia is common after traumatic brain injury (TBI) and contributes to morbidity and long-term sequelae. To identify unique trajectories of insomnia in the 12 months after TBI. In this prospective cohort study, latent class mixed models (LCMMs) were used to model insomnia trajectories over time and to classify participants into distinct profile groups. Data from the Transforming Research and Clinical Knowledge in Traumatic Brain Injury (TRACK-TBI) study, a longitudinal, multisite, observational study, were uploaded to the Federal Interagency Traumatic Brain Injury Repository (FITBIR) database. Participants were enrolled at 1 of 18 participating level I trauma centers and enrolled within 24 hours of TBI injury. Additional data were obtained directly from the TRACK-TBI investigators that will be uploaded to FITBIR in the future. Data were collected from February 26, 2014, to August 8, 2018, and analyzed from July 1, 2020, to November 15, 2021. Traumatic brain injury. Insomnia Severity Index assessed serially at 2 weeks and 3, 6, and 12 months thereafter. The final sample included 2022 participants (1377 [68.1%] men; mean [SD] age, 40.1 [17.2] years) from the FITBIR database and the TRACK-TBI study. The data were best fit by a 5-class LCMM. Of these participants, 1245 (61.6%) reported persistent mild insomnia symptoms (class 1); 627 (31.0%) initially reported mild insomnia symptoms that resolved over time (class 2); 91 (4.5%) reported persistent severe insomnia symptoms (class 3); 44 (2.2%) initially reported severe insomnia symptoms that resolved by 12 months (class 4); and 15 (0.7%) initially reported no insomnia symptoms but had severe symptoms by 12 months (class 5). In a multinomial logistic regression model, several factors significantly associated with insomnia trajectory class membership were identified, including female sex (odds ratio [OR], 1.65 [95% CI, 1.02-2.66]), Black race (OR, 2.36 [95% CI, 1.39-4.01]), history of psychiatric illness (OR, 2.21 [95% CI, 1.35-3.60]), and findings consistent with intracranial injury on computed tomography (OR, 0.36 [95% CI, 0.20-0.65]) when comparing class 3 with class 1. These results suggest important heterogeneity in the course of insomnia after TBI in adults. More work is needed to identify outcomes associated with these insomnia trajectory class subgroups and to identify optimal subgroup-specific treatment approaches.
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影响因子：
4.8
作者：
Bastien, Celyne H.;Vallieres, Annie;Morin, Charles M.
通讯作者：
Morin, Charles M.
影响因子：
7.2
作者：
Strauss, Vicky Y.;Jones, Peter W.;Jordan, Kelvin P.
通讯作者：
Jordan, Kelvin P.
DOI：
10.1176/appi.ajp.2012.12040432
发表时间：
2013-04
期刊：
The American journal of psychiatry
影响因子：
--
作者：
Germain A
通讯作者：
Germain A
影响因子：
29
作者：
Nelson, Lindsay D.;Temkin, Nancy R.;Zafonte, Ross
通讯作者：
Zafonte, Ross
影响因子：
3
作者：
Taylor, Brent C.;Hagel, Emily M.;Sayer, Nina A.
通讯作者：
Sayer, Nina A.