Effects of Blast- and Impact-Related Concussion on Persistent Sleep Problems.

Objective: Examine whether concussion mechanism of injury (high-level blast [HLB] vs impact) affects the likelihood of persistent sleep problems in a post-deployment military population.

Setting: Post-Deployment Health Assessment and Re-Assessment survey records completed upon return from deployment and approximately 6 months later.

Participants: Active duty enlisted US Marines who completed both assessments ( N = 64 464).

Design: This retrospective cohort study investigated US Marines deployed between 2008 and 2012. Logistic regression was used to examine persistent sleep problems 6 months after return from deployment.

Main measures: Self-reported sleep problems at reassessment were investigated as the outcome. Predictors included HLB-induced concussions (mbTBI vs none), impact-induced concussions (miTBI vs none), occupational risk of low-level blast, probable posttraumatic stress disorder (PTSD), depression, alcohol misuse, sleep problems upon deployment return, and relevant interactions, adjusting for sex and pay grade.

Results: With the exception of sex, all main effects in the model were associated with greater likelihood of reporting persistent sleep problems at reassessment. Sleep problems at return from deployment showed the strongest associations with likelihood of reporting sleep problems at reassessment, followed by mbTBI. The latter was exacerbated by PTSD and depression.

Conclusion: mbTBI (vs miTBI) may be more strongly associated with persistent sleep issues that warrant additional monitoring and treatment, particularly among those with probable PTSD and/or depression.