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Actigraphic and Sleep Diary Measures in Veterans With Traumatic Brain Injury: Discrepancy in Selected Sleep Parameters

Nazem, Sarra PhD; Forster, Jeri E. PhD; Brenner, Lisa A. PhD; Matthews, Ellyn E. PhD, AOCNS, CBSM

Section Editor(s): Nakase-Richardson, Risa PhD

Journal of Head Trauma Rehabilitation: March/April 2016 - Volume 31 - Issue 2 - p 136–146
doi: 10.1097/HTR.0000000000000225
Original Articles

Objective: To examine the discrepancy between sleep diary and actigraphic measures of sleep in Veterans with moderate-severe post–acute traumatic brain injury (TBI) and to explore whether these discrepancies vary according to participant characteristics.

Setting: VA Medical Center in the Rocky Mountain United States.

Participants: Nineteen males with moderate-severe post–acute TBI and insomnia symptoms as measured by the Insomnia Severity Index.

Design: Descriptive, cross-sectional.

Main Measures: Sleep diary, wrist actigraphy, Ohio State University TBI-Identification Method, Insomnia Severity Index, and Hospital Anxiety and Depression Scale.

Results: There was poor agreement between actigraphic and sleep diary measurements of (1) total sleep time, (2) wake after sleep onset, and (3) sleep onset latency. On average, actigraphy measured greater duration of all 3 sleep parameters. Discrepancies were not found to be associated with specific TBI characteristics or mood-related symptoms.

Conclusion: When measuring sleep-related outcomes among Veterans with moderate-severe post–acute TBI, notable mismatches were found between actigraphic and self-reported sleep diary data. Knowledge regarding measure-related limitations is important for both clinical and research practices among those with moderate-severe post–acute TBI.

Rocky Mountain Mental Illness Research, Education and Clinical Center (MIRECC), Denver, Colorado (Drs Nazem, Forster, Brenner, and Matthews); Departments of Psychiatry (Drs Nazem and Brenner), Physical Medicine and Rehabilitation (Drs Nazem, Forster, and Brenner), and Neurology (Dr Brenner), University of Colorado, Anschutz Medical Campus, Aurora; and University of Arkansas for Medical Sciences College of Nursing, Little Rock (Dr Matthews).

Corresponding Author: Sarra Nazem, PhD, Denver VAMC, Rocky Mountain Mental Illness Research, Education and Clinical Center (MIRECC), 1055 Clermont St, Denver, CO 80220 (

The authors received financial support for the research and/or authorship of this article from the Veterans Health Administration Rocky Mountain Mental Illness Research, Education and Clinical Center (MIRECC), Denver, Colorado.

All authors have read the final version of the manuscript and have made a substantial contribution to the research and final manuscript.

The views expressed in this article are those of the authors and do not necessarily represent the views of the Department of Veterans Affairs or the US government.

The authors declare no conflicts of interest.

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