Sex, race, psychiatric history, intracranial injury associated with increased prevalence of insomnia after a TBI

By Shelly Seth. This article was initially published in our Concussion Update newsletter; please consider subscribing.

Researchers Emerson M. Wickwire, PhD et al. conducted a longitudinal study of patients who had sustained a traumatic brain injury (TBI) to investigate the relationship between certain biological traits and insomnia incidence after injury. 

This study, published in JAMA Network Open, was conducted from 2014 to 2018 with 2,022 patients enrolled in various participating level 1 trauma clinics within 24 hours of injury. The vast majority of study participants (86.5%) had mild TBI. The researchers analyzed symptoms of persistent mild insomnia (61.6% of patients), mild insomnia symptoms that resolved over time (31.0%), persistent severe insomnia symptoms (4.5%), severe insomnia symptoms that resolved by 12 months (2.2%), and initially no insomnia symptoms but had severe symptoms by 12 months (0.7%). 

The researchers found that certain biological factors and previous injuries were correlated with a higher level of symptom severity. Multinomial logistic regression model analysis determined that female biological sex, Black race, history of psychiatric illness, or intracranial injury were associated with a higher severity level of insomnia symptoms post-TBI. 

The authors acknowledge that a major limitation of this study includes generalizability despite being a large sample with representation throughout the United States. These results, although preliminary, are necessary to consider when developing treatment plans for female and minority patients, as well as those who have a “history of psychiatric illness” or CT findings of intracranial injury. The quality of care that patients receive significantly determines their prognosis and long-term symptoms, meaning that trauma clinics should consider these factors when caring for patients.