Article

There is a high prevalence of Operation Enduring Freedom/Operation
Iraqi Freedom veterans returning with the "polytrauma clinical triad" of pain,
posttraumatic stress disorder, and traumatic brain injury. This study examined
the effect of the polytrauma clinical triad on sleep disturbance, defined as
difficulty falling or staying asleep, a common problem in Operation Enduring
Freedom/Operation Iraqi Freedom veterans. DESIGN: A chart review was conducted
for 200 Operation Enduring Freedom/Operation Iraqi Freedom veterans evaluated at
a polytrauma outpatient clinic. Data that were abstracted included a sleep
disturbance severity index, diagnoses of posttraumatic stress disorder and
traumatic brain injury, and reported problems of pain. RESULTS: Sleep disturbance
was highly prevalent (93.5%) in this sample, in which the majority of traumatic
brain injury diagnoses were mild. In the multiple regression analysis,
posttraumatic stress disorder, pain, the interaction of traumatic brain injury
and posttraumatic stress disorder, and the interaction of posttraumatic stress
disorder and pain significantly accounted for sleep disturbance. As a separate
independent variable, traumatic brain injury was not associated with sleep
disturbance. CONCLUSIONS: Our preliminary results showed that posttraumatic
stress disorder and pain significantly contributed to sleep disturbance. When
traumatic brain injury or pain coexisted with posttraumatic stress disorder,
sleep problems worsened. In this clinical population, where the majority of
traumatic brain injury diagnoses tend to be in the mild category, traumatic brain
injury alone did not predict sleep disturbance. Through increased awareness of
pain, posttraumatic stress disorder, and traumatic brain injury, clinicians can
work collaboratively to maximize rehabilitation outcomes.

Langue : ANGLAIS