1084 TRAUMA EXPOSURE POTENTIATES THE RELATIONSHIP BETWEEN SLEEP AND CHRONIC PAIN IN VETERANS WITH TBI AND PTSD

• Published in: Sleep (New York, N.Y.) Vol. 40; no. suppl_1; p. A404
• Main Authors: Elliott, JE, Weymann, KB, Barsalou, Y, Opel, RA, Geiger, MR, Teutsch, P, Chau, AQ, Oken, BS, Heinricher, MM, Lim, MM
• Format: Journal Article
• Language: English
• Published: US Oxford University Press 28.04.2017
• Subjects: Chronic pain; Headaches; Insomnia; Pain; Post traumatic stress disorder; Sex offenders; Sleep; Trauma; Traumatic brain injury
• ISSN: 0161-8105; 1550-9109
• DOI: 10.1093/sleepj/zsx050.1083

Abstract Introduction: One of the main sequelae of mild traumatic brain injury (mTBI) is sleep-wake disturbances (e.g., excessive daytime sleepiness, insomnia and circadian rhythm disorders), which is present in 50–70% of civilians and Veterans with mTBI. In addition to sleep-wake disturbances, mTBI is commonly associated with headache and chronic pain. As the relationship between sleep-wake disturbances and chronic pain/headache may be potentiated by the co-existence of trauma, the purpose of this study is to describe the association between sleep-wake disturbances and pain in a large sample of Veterans without trauma exposure, with mTBI, with post-traumatic stress disorder (PTSD), and with co-morbid mTBI+PTSD. Methods: Veterans without trauma exposure (Control; n=309), with mTBI (n=117), with PTSD (n=130), and with comorbid mTBI and PTSD (mTBI+PTSD; n=96) were consented and enrolled from the VA Portland Health Care System Sleep Disorders Laboratory. Data collected included overnight in-lab polysomnography, self-reported sleep-wake disturbances assessed via the insomnia severity index (ISI), and the presence/severity of headache/pain as assessed via the NIH PROMIS Global Health scale. TBI and PTSD symptom severity was assessed using the Rivermead Post-Concussive Questionnaire (RPQ) and the PTSD Checklist (PCL-5), respectively. Results: Trauma exposure was associated with worse ISI scores (Control=13 ± 0.3, mTBI=15 ± 0.6, PTSD=18 ± 0.5, and mTBI+PTSD=19 ± 0.5; max=26). ISI was positively correlated with RPQ scores in mTBI Veterans (r=0.65, P<0.0001), and with PCL-5 scores in PTSD Veterans (r=0.31, P<0.0007). The prevalence of headaches increased with trauma exposure (Control=35%, mTBI=50%, PTSD=63%, mTBI+PTSD=72%). Additionally, the frequency of experiencing a headache >25% of days/month increased with trauma exposure (Control=35%, mTBI=69%, PTSD=67%, mTBI+PTSD=73%). Finally, self-reported global pain also increased with trauma exposure (Control=3.3 ± 0.1, mTBI=4.1 ± 0.2, PTSD=4.7 ± 0.2, and mTBI+PTSD=5.4 ± 0.2; max=6). Conclusion: The present study highlights how trauma exposure potentiates the association between sleep-wake disturbances and headache/pain in a large sample of Veterans with mTBI, PTSD, and co-morbid mTBI+PTSD. Future work will explore novel biomarkers using these subjects’ in-lab polysomnography data in association with measures of self-reported and quantitative pain. Support (If Any): NIH T32 AT002688 to JEE; VA OAA Nursing Postdoctoral Fellowship to KBW; VA Career Development Award #IK2 BX002712 and the Portland VA Research Foundation to MML.