S Vuletic1, K R Bell, S Jain, N Bush, N Temkin, J R Fann, K E Stanfill, S Dikmen, J A Brockway, F He, K Ernstrom, R Raman, G Grant, M B Stein, G A Gahm. 1. National Center for Telehealth and Technology (T2), Tacoma, Washington (Drs Vuletic, Bush, Stanfill, and Gahm); Departments of Rehabilitation Medicine (Drs Bell, Temkin, Dikmen, and Brockway), Neurological Surgery (Drs Temkin and Dikmen), Biostatistics (Drs Temkin and Fann), and Psychiatry and Behavioral Sciences (Dr Fann), University of Washington, Seattle; Department of Physical Medicine and Rehabilitation, University of Texas Southwestern, Dallas (Dr Bell); Departments of Family Medicine and Public Health (Drs Jain, Raman, and Stein and Messrs He and Ernstrom) and Psychiatry (Dr Stein), University of California San Diego, La Jolla; Department of Neurosurgery, Stanford University School of Medicine, Stanford, California (Dr Grant); and Defense Centers of Excellence (DCoE), Olympia, Washington (Dr Gahm).
Abstract
OBJECTIVE: Evaluate sleep quality, its correlates, and the effect of telephone-based problem-solving treatment (PST) in active duty postdeployment service members with mild traumatic brain injury (mTBI) SETTING: : Randomized clinical trial. PARTICIPANTS: Active duty service members with combat-related mTBI. STUDY DESIGN:Education-only (EO) and PST groups (N = 178 each) received printed study materials and 12 educational brochures. The PST group additionally received up to 12 PST telephone calls addressing participant-selected issues. Outcomes were evaluated postintervention (6 months) and at 12 months. MAIN MEASURE: Pittsburgh Sleep Quality Index. RESULTS:Sleep quality was manifestly poor in both groups at baseline (Pittsburgh Sleep Quality Index = 12.5 ± 4). Overall sleep quality was significantly different between the PST and EO groups at 6 months (P = .003) but not at 12 months. Longitudinally, PST significantly improved sleep quality at 6 months (P = .001) but not over the follow-up. Low sleep quality was associated with concussion symptoms, pain, depression, and posttraumatic stress disorder at all time points (P < .0001). CONCLUSIONS: Sleep disorders, common in postdeployment service members with mTBI, are strongly associated with the presence of pain, posttraumatic stress disorder, and depression. Telephone-based PST may be an effective therapeutic approach for reducing sleep disorders in this population. Research should focus on maintenance of treatment gains.
RCT Entities:
OBJECTIVE: Evaluate sleep quality, its correlates, and the effect of telephone-based problem-solving treatment (PST) in active duty postdeployment service members with mild traumatic brain injury (mTBI) SETTING: : Randomized clinical trial. PARTICIPANTS: Active duty service members with combat-related mTBI. STUDY DESIGN: Education-only (EO) and PST groups (N = 178 each) received printed study materials and 12 educational brochures. The PST group additionally received up to 12 PST telephone calls addressing participant-selected issues. Outcomes were evaluated postintervention (6 months) and at 12 months. MAIN MEASURE: Pittsburgh Sleep Quality Index. RESULTS: Sleep quality was manifestly poor in both groups at baseline (Pittsburgh Sleep Quality Index = 12.5 ± 4). Overall sleep quality was significantly different between the PST and EO groups at 6 months (P = .003) but not at 12 months. Longitudinally, PST significantly improved sleep quality at 6 months (P = .001) but not over the follow-up. Low sleep quality was associated with concussion symptoms, pain, depression, and posttraumatic stress disorder at all time points (P < .0001). CONCLUSIONS:Sleep disorders, common in postdeployment service members with mTBI, are strongly associated with the presence of pain, posttraumatic stress disorder, and depression. Telephone-based PST may be an effective therapeutic approach for reducing sleep disorders in this population. Research should focus on maintenance of treatment gains.
Authors: Murray B Stein; Sonia Jain; Joseph T Giacino; Harvey Levin; Sureyya Dikmen; Lindsay D Nelson; Mary J Vassar; David O Okonkwo; Ramon Diaz-Arrastia; Claudia S Robertson; Pratik Mukherjee; Michael McCrea; Christine L Mac Donald; John K Yue; Esther Yuh; Xiaoying Sun; Laura Campbell-Sills; Nancy Temkin; Geoffrey T Manley; Opeolu Adeoye; Neeraj Badjatia; Kim Boase; Yelena Bodien; M Ross Bullock; Randall Chesnut; John D Corrigan; Karen Crawford; Ramon Diaz-Arrastia; Sureyya Dikmen; Ann-Christine Duhaime; Richard Ellenbogen; V Ramana Feeser; Adam Ferguson; Brandon Foreman; Raquel Gardner; Etienne Gaudette; Joseph T Giacino; Luis Gonzalez; Shankar Gopinath; Rao Gullapalli; J Claude Hemphill; Gillian Hotz; Sonia Jain; Frederick Korley; Joel Kramer; Natalie Kreitzer; Harvey Levin; Chris Lindsell; Joan Machamer; Christopher Madden; Alastair Martin; Thomas McAllister; Michael McCrea; Randall Merchant; Pratik Mukherjee; Lindsay D Nelson; Florence Noel; David O Okonkwo; Eva Palacios; Daniel Perl; Ava Puccio; Miri Rabinowitz; Claudia S Robertson; Jonathan Rosand; Angelle Sander; Gabriela Satris; David Schnyer; Seth Seabury; Mark Sherer; Murray B Stein; Sabrina Taylor; Arthur Toga; Nancy Temkin; Alex Valadka; Mary J Vassar; Paul Vespa; Kevin Wang; John K Yue; Esther Yuh; Ross Zafonte Journal: JAMA Psychiatry Date: 2019-03-01 Impact factor: 21.596
Authors: Christine L Mac Donald; Jason Barber; Mary Jordan; Ann M Johnson; Sureyya Dikmen; Jesse R Fann; Nancy Temkin Journal: JAMA Neurol Date: 2017-07-01 Impact factor: 18.302