Sleep Disturbances Among Soldiers With Combat-Related Traumatic Brain Injury
Sleep Disturbances Among Soldiers With Combat-Related Traumatic Brain Injury
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DOI：
10.1378/chest.11-1603
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发表时间：
2012-09-01
期刊：
影响因子：
9.6
通讯作者：
Holley, Aaron B.
中科院分区：
文献类型：
--
作者：
Collen, Jacob;Orr, Nicholas;Holley, Aaron B.
背景：睡眠主诉在创伤性脑损伤患者中很常见。对这一人群的评估受到多种药物和共病疾病的困扰，很少有研究涉及与战斗有关的伤害。本研究的目的是评估战斗中遭受颅脑损伤的士兵中睡眠障碍的患病率。方法：研究设计为对从战斗中归来的轻、中度颅脑损伤的士兵进行回顾性研究。所有人都接受了全面的睡眠评估。结果：连续116例患者中，96.6%为男性(平均年龄31.1+/-9.8岁；平均BMI为27.8+/-4.1 kg/m(2))，29.5%和70.5%分别遭受钝挫伤和冲击伤。几乎所有人(97.4%)都报告了睡眠问题。85.2%的患者出现多眠现象，54.3%的患者出现睡眠障碍。阻塞性睡眠呼吸暂停综合征(OSAS)占34.5%，失眠占55.2%。冲击伤患者的焦虑(50.6%vs 20.0%，P=.002)和失眠(63%vs 40%，P=.02)明显高于钝挫伤患者(54.3%vs 25.9%，P=.003)。在多因素分析中，钝性损伤是OSAS的显著预测因素(OR，3.09；95%CI，1.02~9.38；P=0.047)。结论：颅脑损伤后睡眠障碍是常见的，大多数患者会发展成慢性睡眠障碍。与战斗相关的创伤性脑损伤患者的睡眠障碍可能会受到损伤机制的影响，钝性损伤可能预示着OSAS的发展。《胸部》2012；142(3)：622-630
Background: Sleep complaints are common among patients with traumatic brain injury. Evaluation of this population is confounded by polypharmacy and comorbid disease, with few studies addressing combat-related injuries. The aim of this study was to assess the prevalence of sleep disorders among soldiers who sustained combat-related traumatic brain injury.Methods: The study design was a retrospective review of soldiers returning from combat with mild to moderate traumatic brain injury. All underwent comprehensive sleep evaluations. We determined the prevalence of sleep complaints and disorders in this population and assessed demographics, mechanism of injury, medication use, comorbid psychiatric disease, and polysomnographic findings to identify variables that correlated with the development of specific sleep disorders.Results: Of 116 consecutive patients, 96.6% were men (mean age, 31.1 +/- 9.8 years; mean BMI, 27.8 +/- 4.1 kg/m(2)), and 29.5% and 70.5% sustained blunt and blast injuries, respectively. Nearly all (97.4%) reported sleep complaints. Hypersomnia and sleep fragmentation were reported in 85.2% and 54.3%, respectively. Obstructive sleep apnea syndrome (OSAS) was found in 34.5%, and 55.2% had insomnia. Patients with blast injuries developed more anxiety (50.6% vs 20.0%, P = .002) and insomnia (63% vs 40%, P = .02), whereas patients with blunt trauma had significantly more OSAS (54.3% vs 25.9%, P = .003). In multivariate analysis, blunt trauma was a significant predictor of OSAS (OR, 3.09; 95% CI, 1.02-9.38; P = .047).Conclusions: Sleep disruption is common following traumatic brain injury, and the majority of patients develop a chronic sleep disorder. It appears that sleep disturbances may be influenced by the mechanism of injury in those with combat-related traumatic brain injury, with blunt injury potentially predicting the development of OSAS. CHEST 2012; 142(3):622-630