Grant: Travel Awards - Institute Community Support

Disturbed sleep is a common symptom in both the acute and chronic phases after mild traumatic brain injury (mTBI) /concussion, and it persists in many patients over time. Disentangling the complex interplay between comorbid disorders, behavioral and psycho-social factors, through sex/gender lens, before and after the injury, will provide new insights into the processes underlying post-concussive sleep changes. We studied middle aged men and women who sustained concussion/mTBI at work. The clinical, diagnostic, and claim-related variables covering the period before and after the injury were collected from the medical and insurer files for each participant. To quantify the independent association between changes in refreshing sleep from pre- to post injury, selection of variables was based on the literature and a priory-defined hypotheses. We found that 12% of men and 27% of women experienced unrefreshing sleep before their injury. After injury, unrefreshing sleep was pervasive, affecting 91% of men and women. There were no consistently significant modifiers of refreshing sleep pre- or post- injury in either women or men, with the exception of job uncertainty, sleeping pill intake, and high body mass index in women. After controlling for confounding factors, changes in refreshing sleep from pre- to post- injury were linked to post-injury mood disorder in women and substance-related disorder in men. In men only, loss of refreshing sleep was associated with fatigue and diminished functional capacity. The sex specificity of the results suggests that aging women may react to adverse life events associated with concussion/mTBI differently than do men. Nonetheless, both men and women have specific needs for their sleep and mental health disorders to be dealt with simultaneously. Associations with daytime functional capacity uncover the unity of circuits controlling sleep and those that sub-serve mental and behavioral responses.