Traumatic brain injury and sleep in military and veteran populations: A literature review

Issue title: Why Military Neurorehabilitation Research is Relevant to Everyone

Guest editors: David X. Cifu and Sidney R. Hinds

Article type: Review Article

Authors: Landvater, Jeremy^a | Kim, Sharon^a | Caswell, Keenan^a | Kwon, Caroline^a | Odafe, Emamoke^a | Roe, Grace^a | Tripathi, Ananya^a | Vukovics, Christian^a | Wang, Jonathan^a | Ryan, Keith^a | Cocozza, Victoria^b | Brock, Matthew^b | Tchopev, Zahari^b | Tonkin, Brionn^{c; d} | Capaldi, Vincent^a | Collen, Jacob^a | Creamer, Jennifer^e | Irfan, Muna^{c; d} | Wickwire, Emerson M.^f | Williams, Scott^{a; g} | Werner Jr., J. Kent^{a; e; *}

Affiliations: [a] Uniformed Services University of the Health Sciences, Bethesda, MD, USA | [b] Wilford Hall Ambulatory Surgical Center, San Antonio, TX, USA | [c] University of Minnesota, Minneapolis, MN, USA | [d] Minneapolis Veterans Administration Medical Center, Minneapolis, MN, USA | [e] Walter Reed National Military Medical Center, Bethesda, MD, USA | [f] Department of Medicine, School of Medicine, University of Maryland, Baltimore, MD, USA | [g] Defense Health Headquarters, Falls Church, VA, USA

Correspondence: [*] Address for correspondence: J. Kent Werner, Jr., MD, PhD, E-mails: kent.werner@usuhs.edu and jkentwerner@gmail.com.

Abstract: BACKGROUND:Traumatic brain injury (TBI) is a hallmark of wartime injury and is related to numerous sleep wake disorders (SWD), which persist long term in veterans. Current knowledge gaps in pathophysiology have hindered advances in diagnosis and treatment. OBJECTIVE:We reviewed TBI SWD pathophysiology, comorbidities, diagnosis and treatment that have emerged over the past two decades. METHODS:We conducted a literature review of English language publications evaluating sleep disorders (obstructive sleep apnea, insomnia, hypersomnia, parasomnias, restless legs syndrome and periodic limb movement disorder) and TBI published since 2000. We excluded studies that were not specifically evaluating TBI populations. RESULTS:Highlighted areas of interest and knowledge gaps were identified in TBI pathophysiology and mechanisms of sleep disruption, a comparison of TBI SWD and post-traumatic stress disorder SWD. The role of TBI and glymphatic biomarkers and management strategies for TBI SWD will also be discussed. CONCLUSION:Our understanding of the pathophysiologic underpinnings of TBI and sleep health, particularly at the basic science level, is limited. Developing an understanding of biomarkers, neuroimaging, and mixed-methods research in comorbid TBI SWD holds the greatest promise to advance our ability to diagnose and monitor response to therapy in this vulnerable population.

Keywords: Traumatic brain injury, sleep, military, veteran, post traumatic stress disorder, sleep wake disorder, neuroinflammation

DOI: 10.3233/NRE-230380

Journal: NeuroRehabilitation, vol. 55, no. 3, pp. 245-270, 2024