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Insomnia, Fatigue, and Sleepiness in the First 2 Years After Traumatic Brain Injury: An NIDRR TBI Model System Module Study

Cantor, Joshua B. PhD, ABPP; Bushnik, Tamara PhD; Cicerone, Keith PhD; Dijkers, Marcel P. PhD; Gordon, Wayne PhD; Hammond, Flora M. MD; Kolakowsky-Hayner, Stephanie A. PhD, CBIST; Lequerica, Anthony PhD; Nguyen, Michael MS; Spielman, Lisa A. PhD

Journal of Head Trauma Rehabilitation: November/December 2012 - Volume 27 - Issue 6 - p E1–E14
doi: 10.1097/HTR.0b013e318270f91e
Original Articles

Objective: To determine the prevalence of insomnia and posttraumatic brain injury (TBI) fatigue (PTBIF) in individuals with moderate to severe TBI, to explore the relationship between PTBIF and insomnia and their association with outcomes.

Design: Cross-sectional study.

Setting: Five National Institute of Disability and Rehabilitation Research TBI Model Systems.

Participants: Three hundred thirty-four individuals with TBI who completed 1-year (n = 213) or 2-year (n = 121) follow-up interviews between 2008 and 2012.

Main Outcome Results: Insomnia occurred in 11% to 24% and PTBIF in 33% to 44% of the individuals. Insomnia and fatigue were both related to sleep disturbance, sleep hygiene, satisfaction with life, anxiety, and depression. PTBIF was associated with greater disability and sleepiness. Insomnia without fatigue was rare (2%-3%) but PTBIF without insomnia occurred in 21% to 23% of the individuals. Comorbidity occurred in 9% to 22% of the individuals.

Conclusions: Although PTBIF and insomnia are closely related and both associated with poorer quality of life, they are affected independently by a variety of factors, especially psychopathology and sleep quality. A majority of individuals with PTBIF do not have insomnia; and PTBIF appears to be related to disability severity and daytime sleepiness, where insomnia is not. Demographic and injury variables are not strong predictors of insomnia or PTBIF.

Mount Sinai School of Medicine, New York, New York (Drs Cantor, Dijkers, Gordon, and Spielman and Mr Nguyen); Rusk Institute for Rehabilitation Medicine, NYU Langone School of Medicine, New York, New York (Dr Bushnik); Johnson Rehabilitation Institute, Edison, New Jersey (Dr Cicerone), Carolinas Rehabilitation, Charlotte, North Carolina (Dr Hammond); Indiana University School of Medicine, Indianapolis (Dr Hammond); Santa Clara Valley Medical Center, Rehabilitation Research Center, San Jose, California (Drs Bushnik and Kolakowsky-Hayner); Kessler Foundation Research Center, West Orange, New Jersey (Dr Lequerica); and University of Medicine and Dentistry of New Jersey, Newwark, New Jersey (Dr Lequerica).

Corresponding Author: Joshua B. Cantor, PhD, ABPP, Department of Rehabilitation Medicine, Mount Sinai School of Medicine, One Gustave L. Levy Place, Box 1240, New York, NY 10029 (

This research was funded by National Institute on Disability and Rehabilitation Research grants H133A070033, H133A070038, H133A070042, H133A070037, and H133A070030 and carried out by Traumatic Brain Injury Model Systems Centers. The authors thank all the data collectors and participants in this research for their time and effort.

The authors declare no conflicts of interest.

© 2012 Lippincott Williams & Wilkins, Inc.