0333 Objective Methods are Needed in the Diagnostic Assessment of Chronic Insomnia Following Mild Traumatic Brain Injury

Abstract

Introduction: Insomnia symptoms following mild traumatic brain injury (mTBI) -including concussion- are major predictors poor mTBI outcomes. Insomnia symptoms may be caused by specific sleep disorders that can be effectively treated, which in turn, may improve mTBI outcomes. Previous studies have focused on insomnia symptom assessment or evaluated samples with all TBI severities. To effectively manage insomnia following mTBI, it is important to move beyond symptom assessment and conduct a diagnostic sleep evaluation to understand which sleep disorders contribute to insomnia symptoms in this clinical group. Objective: Determine the prevalence of sleep disorders that contribute to chronic insomnia symptoms in a homogeneous and representative sample of patients with mTBI. Methods: Individuals with chronic insomnia symptoms following mTBI (N = 50; age 17-65; 64% females; 3 - 24 months post mTBI) participated in a multi-method sleep and circadian assessment, including a standard sleep and psychiatric interview, questionnaires, standard sleep diary, actigraphy, polysomnography and dim light melatonin onset test. Sleep and circadian disorders were diagnosed according to International Classification of Sleep Disorders criteria. Results: Insomnia disorder was the most common diagnosis (62%), followed by obstructive sleep apnea (OSA) - 44%; circadian rhythm sleep-wake disorders (CRSWD) - 26% and periodic limb movement disorder (PLMD) - 8%. The most common comorbid sleep disorder conditions were insomnia disorder and OSA (34%). Conclusion: OSA and CRSWD frequently occur among patients whose main presenting sleep symptom is chronic insomnia following a mTBI. Given that 72% of patients with insomnia symptoms had a specific sleep or circadian disorder (OSA, PLMD, or CRSWD) that require objective assessment methods, subjective assessment tools are insufficient for diagnostic purposes after a mTBI. Instead, strategically selected objective sleep and circadian assessment should be part of the diagnostic chronic insomnia evaluation following a mTBI.