TY - JOUR
T1 - Trajectories of Insomnia in Adults after Traumatic Brain Injury
AU - Wickwire, Emerson M.
AU - Albrecht, Jennifer S.
AU - Capaldi, Vincent F.
AU - Jain, Sonia O.
AU - Gardner, Raquel C.
AU - Werner, J. Kent
AU - Mukherjee, Pratik
AU - McKeon, Ashlee B.
AU - Smith, Michael T.
AU - Giacino, Joseph T.
AU - Nelson, Lindsay D.
AU - Williams, Scott G.
AU - Collen, Jacob
AU - Sun, Xiaoying
AU - Schnyer, David M.
AU - Markowitz, Amy J.
AU - Manley, Geoffrey T.
AU - Krystal, Andrew D.
N1 - Funding Information:
Conflict of Interest Disclosures: Dr Wickwire reported consulting for Dayzz, Eisai Inc, Purdue, and Merck & Co Inc and receiving institutional grants from Merck & Co Inc, and ResMed outside the submitted work. Dr Albrecht reported receiving grants from the US Department of Defense Psychological Health and Traumatic Brain Injury Research Program during the conduct of the study and grants from the Agency for Health Care Research and Quality and the AASM Foundation outside the submitted work. Dr Gardner reported receiving grants from the Weill Institute for Neurosciences during the conduct of the study and grants from the National Institutes of Health (NIH) and US Department of Defense outside the submitted work. Dr Mukherjee reported holding a patent for 15/782,005 pending UC Regents. Dr Giacino reported grants from the National Institutes of Neurological Disorders and Stroke (NINDS), NIH, and National Football League (NFL) during the conduct of the study. Dr Nelson reported receiving salary support from the NINDS during the conduct of the study and grants from the US Department of Defense, Centers for Disease Control and Prevention, Medical College of Wisconsin Advancing a Healthier Wisconsin Endowment, Medical Technology Enterprise Consortium, and NFL Foundation for unrelated research outside the submitted work. Dr Schnyer reported receiving grants from the NIH during the conduct of the study. Dr Markowitz reported receiving grants from the US Department of Defense TBI Endpoints Development Initiative and salary support from the US Department of Defense/MTEC TRACK-TBI NETWORK and US Department of Energy during the conduct of the study. Dr Manley reported receiving grants from the US Department of Defense TBI Endpoints Development Initiative, US Department of Defense TRACK-TBI Precision Medicine, and NIH-NINDS TRACK-TBI; research support from the US Department of Defense/MTEC TRACK-TBI NETWORK; support from the US Department of Energy for a precision medicine collaboration; funding for TRACK-TBI patient stipends and support to clinical sites from One Mind; and support for TRACK-TBI data curation efforts from Neurotruama Sciences LLC during the conduct of the study. Dr Krystal reported receiving grants from Janssen Pharmaceuticals, Axsome Therapeutics Inc, and Reveal Pharmaceuticals; serving on the advisory board for Adare Pharmaceuticals, Axsome Therapeutics Inc, Evecxia Therapeutics, Harmony Biosciences, Millenium Pharmaceuticals Inc, Angelini, Merck & Co Inc, Sage Therapeutics, Takeda Pharmaceutical Company Limited, and Otsuka Pharmaceutical Co, Ltd; consulting paid with stock options from BigHealth; consulting and serving on the advisory board for Eisai Co, Ltd, Janssen Pharmaceuticals, Jazz Pharmaceuticals plc, H Lundbeck A/S, and NeuraWell Therapeutics; consulting and serving on the advisory and data safety monitoring boards for Idorsia; and serving on the advisory and data safely monitoring boards for Neurocrine Biosciences Inc, outside the submitted work. No other disclosures were reported.
Funding Information:
Funding/Support: This research was supported by a grant from the US Department of Defense, Congressionally Mandated Medical Research Program, to the University of Maryland (contact principal investigator, Dr Wickwire); grant R01 NS110856 from the NINDS, NIH (Dr Nelson); grant R01 NS110944 from the NINDS (Dr Gardner); and grant W81XWH-18-1-0514 from the US Department of Defense (Dr Gardner).
Publisher Copyright:
© 2022 BMJ Publishing Group. All rights reserved.
PY - 2022/1/26
Y1 - 2022/1/26
N2 - Importance: Insomnia is common after traumatic brain injury (TBI) and contributes to morbidity and long-term sequelae. Objective: To identify unique trajectories of insomnia in the 12 months after TBI. Design, Setting, and Participants: 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. Exposures: Traumatic brain injury. Main Outcomes and Measures: Insomnia Severity Index assessed serially at 2 weeks and 3, 6, and 12 months thereafter. Results: 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. Conclusions and Relevance: 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..
AB - Importance: Insomnia is common after traumatic brain injury (TBI) and contributes to morbidity and long-term sequelae. Objective: To identify unique trajectories of insomnia in the 12 months after TBI. Design, Setting, and Participants: 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. Exposures: Traumatic brain injury. Main Outcomes and Measures: Insomnia Severity Index assessed serially at 2 weeks and 3, 6, and 12 months thereafter. Results: 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. Conclusions and Relevance: 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..
UR - http://www.scopus.com/inward/record.url?scp=85123878744&partnerID=8YFLogxK
U2 - 10.1001/jamanetworkopen.2021.45310
DO - 10.1001/jamanetworkopen.2021.45310
M3 - Article
C2 - 35080600
AN - SCOPUS:85123878744
SN - 2574-3805
VL - 5
SP - E2145310
JO - JAMA Network Open
JF - JAMA Network Open
IS - 1
ER -