0904 Sleep Disorders in Veterans with Mild Traumatic Brain Injury

Abstract

Introduction: Military personnel are at high risk for traumatic brain injury (TBI). Hispanics are currently 11.4% of the activeduty military forces and the number of minority veterans is increasing. Hispanic ethnicity was reported to double the risk of mortality among veterans clinically diagnosed with TBI. Sleep disorders are common after traumatic brain injury. The purpose of this study was to characterize a population of Puerto Rican veterans with mild Traumatic Brain Injury (mTBI) and to determine the prevalence of chronic sleep disorders in the sample. Methods: The study was a retrospective evaluation of all patient records of veterans 21-89 years old with a diagnosis of mTBI enrolled in the Polytrauma Clinic at Veterans Affairs Caribbean Healthcare System from January 2010 to April 2017. There were 333 mTBI records reviewed. The data collected included demographics, medications, comorbidities, sleep disorders, type of TBI injury, brain magnetic resonance imaging (MRI), Epworth Sleepiness Scale (ESS) and Neurobehavioral Functioning Inventory (NFI) results. Results: Subjects were predominantly male (96%), with a mean age of 41 (range 21-89). Blast injury was present in 54% and non-blast in 45%. Eighty five percent were overweight or obese. Ninety three percent had depression, 93% anxiety, 81% cognitive disorders, 79% chronic pain, 77% post-traumatic stress disorder, 66% hypertension. All subjects were on polypharmacy and most had sleep complaints (84%). Ninety two percent had insomnia, 46% obstructive sleep apnea (OSA), 2.7% restless leg syndrome, 1.5% central sleep apnea, 1.2% narcolepsy, 1.2% REM sleep behavior disorder, 0.9% periodic leg movement disorder. Sixty six percent had other parasomnias such as nightmares or sleepwalking. ESS was abnormal in 82%, NFI in 95% and brain MRI in 16%. Conclusion: Insomnia, self-reported sleepiness and OSA are more common in Hispanic veterans than what has been published in non-Hispanic veterans. Chronic sleep disorders are highly prevalent in this sample of Puerto Rican veterans. Sleep disorders may contribute to the reported increased risk of mortality among Hispanic veterans with TBI.