RESUMEN
BACKGROUND: Traumatic brain injury (TBI) is a complex health problem in military veterans and service members (V/SM) that often involves comorbid vestibular impairment. Sleep apnea is another comorbidity that may exacerbate, and/or be exacerbated by, vestibular dysfunction. OBJECTIVE: To examine the relationship between sleep apnea and vestibular symptoms in V/SM diagnosed with TBI of any severity. DESIGN: Multicenter cohort study; cross-sectional sample. SETTING: In-patient TBI rehabilitation units within five Veterans Affairs (VA) Polytrauma Rehabilitation Centers. PARTICIPANTS: V/SM with a diagnosis of TBI (N = 630) enrolled in the VA TBI Model Systems study. INTERVENTION: Not applicable. METHODS: A multivariable regression model was used to evaluate the association between sleep apnea and vestibular symptom severity while controlling for relevant covariates, for example, posttraumatic stress disorder (PTSD). MAIN OUTCOME MEASURES: Lifetime history of sleep apnea was determined via best source reporting. Vestibular disturbances were measured with the 3-item Vestibular subscale of the Neurobehavioral Symptom Inventory (NSI). RESULTS: One third (30.6%) of the sample had a self-reported sleep apnea diagnosis. Initial analysis showed that participants who had sleep apnea had more severe vestibular symptoms (M = 3.84, SD = 2.86) than those without sleep apnea (M = 2.88, SD = 2.67, p < .001). However, when the data was analyzed via a multiple regression model, sleep apnea no longer reached the threshold of significance as a factor associated with vestibular symptoms. PTSD severity was shown to be significantly associated with vestibular symptoms within this sample (p < .001). CONCLUSION: Analysis of these data revealed a relationship between sleep apnea and vestibular symptoms in V/SM with TBI. The significance of this relationship was affected when PTSD symptoms were factored into a multivariable regression model. However, given that the mechanisms and directionality of these relationships are not yet well understood, we assert that in terms of clinical relevance, providers should emphasize screening for each of the three studied comorbidities (sleep apnea, vestibular symptoms, and PTSD).
Asunto(s)
Lesiones Traumáticas del Encéfalo , Síndromes de la Apnea del Sueño , Trastornos por Estrés Postraumático , Veteranos , Humanos , Estudios de Cohortes , Estudios Transversales , Lesiones Traumáticas del Encéfalo/complicaciones , Lesiones Traumáticas del Encéfalo/diagnóstico , Lesiones Traumáticas del Encéfalo/rehabilitación , Trastornos por Estrés Postraumático/diagnóstico , Trastornos por Estrés Postraumático/epidemiología , Trastornos por Estrés Postraumático/etiología , Síndromes de la Apnea del Sueño/diagnóstico , Síndromes de la Apnea del Sueño/epidemiología , Síndromes de la Apnea del Sueño/etiologíaRESUMEN
BACKGROUND AND PURPOSE: Post-stroke anxiety (PSA) is common and disabling. PSA should be considered as an important outcome in stroke. However, there is a lack of understanding of factors that may be linked to PSA. The purpose of this study was to determine the frequency of PSA and sociodemographic and clinical factors associated with PSA in a cohort of racially and ethnically diverse stroke patients. METHODS: We conducted a retrospective study of ischemic and hemorrhagic stroke patients seen in a stroke outpatient clinic from August 1, 2017 to June 30, 2018. Patients were eligible if a Generalized Anxiety Disorder 7-Item (GAD-7) instrument was available. GAD-7 scores greater than or equal to 10 indicated the presence of moderate to severe PSA. Multivariable logistic regression was used to identify independent sociodemographic and clinical factors associated with PSA. RESULTS: Records from 289 stroke patients with a GAD-7 instrument were analyzed. PSA was common (21%; GAD-7 ≥ 10). Fifty-seven percent of females had a GAD-7 greater than or equal to 10 compared to 41% of females who had a GAD-7 less than 10 (Pâ¯=â¯.03). Multivariable analysis found that self-reported nonmarried status (odds ratio, 3.27; 95% confidence interval, 1.44-7.44), excessive fatigue (odds ratio, 4.46; 95% confidence interval, 1.87-10.63), and depression (odds ratio, 1.24; 95% confidence interval, 1.16-1.33) were independently associated with PSA. CONCLUSIONS: PSA may occur more frequently in those who report non-married, excessive fatigue, or depression. Trials of PSA interventions should consider the potential impact of social support, depression, and comorbid conditions contributing to post-stroke fatigue, including sleep apnea.
Asunto(s)
Ansiedad/psicología , Isquemia Encefálica/psicología , Hemorragias Intracraneales/complicaciones , Ataque Isquémico Transitorio/psicología , Accidente Cerebrovascular/psicología , Adulto , Anciano , Ansiedad/diagnóstico , Ansiedad/epidemiología , Isquemia Encefálica/diagnóstico , Isquemia Encefálica/epidemiología , Comorbilidad , Depresión/epidemiología , Depresión/psicología , Fatiga/epidemiología , Fatiga/psicología , Femenino , Humanos , Hemorragias Intracraneales/diagnóstico , Hemorragias Intracraneales/psicología , Ataque Isquémico Transitorio/diagnóstico , Ataque Isquémico Transitorio/epidemiología , Masculino , Salud Mental , Persona de Mediana Edad , Pronóstico , Estudios Retrospectivos , Medición de Riesgo , Factores de Riesgo , Persona Soltera/psicología , Aislamiento Social , Accidente Cerebrovascular/diagnóstico , Accidente Cerebrovascular/epidemiología , Texas/epidemiologíaRESUMEN
BACKGROUND: Individuals who have sustained a TBI often present with complaints of disturbed sleep. Identifying sleep disorders in the TBI population has not been standardized. Much of the confusion may come from the heterogeneity of the research that has been conducted on sleep problems after traumatic brain injury. This review focused attention to current research findings in order to develop an evidenced-based approach to assessment of sleep disturbances within this unique population. OBJECTIVES: To review various methods used in the assessment of disorders of sleep after TBI and offer recommendations for best approaches for clinical assessment of sleep. METHODS: The authors describe various methods such as history, questionnaires, physical examination and objective sleep measurement, their usefulness and limitations based on the available evidence and experience for assessment of sleep in individuals who have sustained a TBI. RESULTS: An evidence-driven method for the assessment of sleep disorders following TBI is discussed. CONCLUSIONS: Through skilled assessment, clinicians can assess sleep following TBI and the most applicable interventions can be chosen with the hopes of reducing additional symptom burden and optimizing functioning.