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

Risk factors of persistent insomnia among survivors of traumatic injury: a retrospective cohort study.
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创伤幸存者持续性失眠的危险因素：一项回顾性队列研究。

DOI：
10.5664/jcsm.9276
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发表时间：
2021
期刊：
Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine
影响因子：
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通讯作者：
Ian J. Stewart
Ian J. Stewart
中科院分区：
--
文献类型：
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作者：
Zachary A Haynes;Jacob F. Collen;E. Poltavskiy;Lauren E. Walker;J. Janak;Jeffrey T. Howard;J. K. Werner;E. Wickwire;A. Holley;L. Zarzabal;Alan Sim;A. Gundlapalli;Ian J. Stewart

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研究目的 抑郁症是一种具有广泛健康和经济影响的诊断，在军队服役人员中越来越多地得到认可。这一趋势与战争创伤的增加同时出现。因此，我们试图确定长期失眠的纵向预测战斗退伍军人遭受创伤。 方法 对2002-2016年部署到冲突地区的服役人员进行回顾性队列研究，并对退伍军人事务和军事卫生系统进行纵向随访。得出两个队列：1）遭受创伤的服役人员和2）年龄，性别和服役成分匹配的部署到战区的未受伤服役人员队列。使用国际疾病分类第九次修订版或国际疾病分类第十次修订版临床修改代码定义Incidence。 结果 最终的17，374名服役人员从受伤之日（或匹配参与者受伤之日）开始随访，中位数为8.4（IQR 5.3-10.7）年。调整后，创伤性损伤的服务人员比未受伤的服务人员发生失眠的风险显著更大（HR=1.43，95%CI 1.30-1.58）。在多变量模型中，与无创伤性脑损伤（TBI）的患者相比，创伤性脑损伤（TBI）与失眠相关：轻度/未分类TBI（HR=2.07，95% CI 1.82-2.35），中度/重度/穿透性TBI（HR=2.43，95% CI 2.06-2.86）。此外，烧伤（HR=1.95，95% CI 1.47-2.59）和截肢（HR=1.61，95% CI 1.26-2.06）显著增加了诊断风险。 结论 在控制了心理健康障碍后，创伤性损伤显著预测了失眠症的诊断。我们的研究结果强烈建议需要长期监测创伤幸存者的睡眠障碍。
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 2002-2016, 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 International Classification of Diseases Ninth Revision or International Classification of Diseases Tenth Revision Clinical Modification 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 (IQR 5.3-10.7) years. Service members with traumatic injury were at significantly greater risk of developing insomnia than uninjured service members (HR=1.43, 95% CI 1.30-1.58) after adjustment. Traumatic brain injury (TBI) was associated with insomnia when compared to patients without TBI in the multivariable model: mild/unclassified TBI (HR=2.07, 95% CI 1.82-2.35), moderate/severe/penetrating TBI (HR=2.43, 95% CI 2.06-2.86). Additionally, burn injury (HR=1.95, 95% CI 1.47-2.59) and amputation (HR=1.61, 95% CI 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.