Sleep disturbances among combatants with mild traumatic brain injury

to evaluate the level of sleep disorders in combatants with mild traumatic brain injury (TBI), to provide a comprehensive characterization of sleep disorders using the assessment of complaints, anamnesis data, neurological status, and ESS and PSQI questionnaires with the involvement of comparison groups of patients.bMethods and subjects. The study involved 117 patients who were divided into three groups: combatant patients with mild TBI (n=30) (study group № 1), combatant patients without TBI (n=30) (study group № 2), and group relative to healthy civilian respondents (n=57) (control group). A cross-sectional research design was used. Patients were evaluated using the Pittsburgh Sleep Quality Index (PSQI) and the Epworth Sleepiness Scale (ESS), as well as the frequency of complaints (inability to fall asleep, night awakenings, early awakenings, and nightmares), anamnesis (age, time since injury) and neurological status data. The method of statistical hypothesis testing for multiple comparisons with appropriate post-hoc calculations was used to compare the obtained results. Results. In study group №1, complaints about the inability to fall asleep were observed in 73.3% of cases, complaints about night awakenings — 46.7%, complaints about early awakenings — 23.3%, and complaints about nightmares — 20.0%. The age was 31 (24 — 40) years, and the time since the injury — 14 (8 — 28) days. A difference from the average values in other groups was found according to the χ2 criterion with correction for continuity (p<0.05). In the process of post hoc analysis using the Bonferroni correction, a statistically significant increased frequency of complaints of inability to fall asleep, early awakenings, and nightmares were found in study group №1 compared to other groups (p<0.05). The frequency of major deviations in neurological status among combatant patients was evaluated. The score on the ESS scale in the study group №1 — 8.1±3.6 points; in the study group №2 — 6 (4 — 8) points; in the control group — 4 (3 — 6) points. The difference in medians is statistically significant according to the Kruskal-Wallis test (p<0.001). Post-hoc comparisons using the Steel-Dwass test indicate that the values of this scale differ when comparing study group №1 and the control group (p<0.001) and study group №2 and the control group (p=0.008). PSQI score in study group №1 — 11.2±4.5 points; in the study group №2 — 7.5 (5 — 11) points; in the control group — 5 (4 — 8) points. The difference in medians is statistically significant according to the Kruskal-Wallis test (p<0.001). Post-hoc comparisons using the Steel-Dwass test indicate that the values of this scale differ when comparing study group №1 and study group №2 (p=0.02) and study group №1 and the control group (p<0.001). Conclusions. Comparisons of the frequency of complaints revealed a statistically significant increase in the frequency of complaints of inability to fall asleep, early awakenings, and nightmares in combatants with TBI. A statistically significant increased level of daytime dysfunction was found in this group of patients according to the ESS scale. A statistically significant decrease in sleep quality also was found in this group of patients according to the PSQI scale. The obtained data can be interpreted as a reflection of the increased prevalence of sleep disorders in patients with traumatic brain injury.