Sleep Disturbance, Psychiatric, and Cognitive Functioning in Veterans with Mild to Moderate Traumatic Brain Injury

Henry J Orff, Amy J Jak, Amber M Gregory, Candice Colon, Dawn M Schiehser, Sean PA Drummond, James Lohr, Elizabeth W. Twamley

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Objective: For many Veterans, traumatic brain injury (TBI) can result in persistent post-concussive symptoms, of which sleep disturbances are among the most common. S disturbances have been shown to increase risk and/or exacerbate psychiatric and physical health problems in many different populations. However, few studies have examined the relationships among sleep, psychiatric, and cognitive functioning in Veterans with TBI. Methods: Retrospective chart reviews of 137 Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) Veterans with a history of mild to moderate TBI referred for cognitive rehabilitation at the Veteran Affairs San Diego Healthcare System. Results: 100% of Veterans reported clinically significant sleep disturbance (Pittsburgh Sleep Quality Inventory [PSQI] global scores >5). Veterans also reported clinically relevant impairments in sleep latency (50 minutes), total sleep time (5.5 hours), and sleep efficiency (77%). More severe sleep problems were related to greater endorsement of depressive, post-concussive, and post-traumatic stress disorder (PTSD) symptomatology. Conversely, sleep disturbance showed limited associations with objective neuropsychological assessment. Overall measures of affective functioning were significantly associated with global measures of sleep quality, though such relationships were not observed for quantitative measures of sleep. Conclusions: Veterans with mild to moderate TBI exhibit very high rates of sleep disturbance. Sleep disturbance is associated with higher levels of comorbid psychiatric symptomatology, particularly affective complaints. The high prevalence of sleep problems in Veterans with a history of TBI underscores a need to develop both a better understanding of etiologic mechanisms relating brain injury and sleep and a better clinical appreciation of the ramifications of sleep disturbance on daily functioning and recovery in individuals who experience TBI.
Original languageEnglish
Article number1000153
Number of pages6
JournalJournal of Sleep Disorders: Treatment and Care
Issue number2
Publication statusPublished - 19 Mar 2015
Externally publishedYes


  • traumatic brain injury
  • sleep disturbance
  • depression
  • PTSD
  • post-concussive symptoms
  • neuropsychological performance

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