Sleep Quality in Returning Veterans: The Influence of Mild Traumatic Brain Injury

Objective: Sleep disturbance is a key behavioral health concern among Iraq and Afghanistan era veterans and is a frequent complaint among veterans with a history of mild traumatic brain injury (mTBI). Currently, it is unclear whether sleep disturbance is a core sequelae of mTBI or if it may be related to other behavioral health conditions that are commonly present in postdeployment veterans. The purpose of this study was to determine if history of mTBI is associated with poor sleep quality beyond combat exposure and behavioral health concerns, including posttraumatic stress disorder (PTSD), mood disorders, anxiety disorders, and substance use disorders. Research Method: Participants included 527 veterans who deployed after September 11, 2001, in support of the wars in Iraq and Afghanistan. Participants completed the Structured Clinical Interview for DSM-IV Disorders, Combat Exposure Scale, a structured clinical TBI interview, and the Pittsburgh Sleep Quality Index. Results: Deployment-related mTBI was associated with poor sleep quality independent of combat exposure, PTSD, mood disorders, anxiety disorders, and substance use disorders (B = 1.84, p = .001) an average of 6 years after the injury event. No interaction effects between deployment-related mTBI and combat exposure, PTSD, mood disorders, anxiety disorders, or substance use disorders on sleep quality were detected. Conclusions: Veterans with a history of mTBI sustained during deployment reported significantly poorer sleep quality than veterans without history of mTBI, even when considering combat exposure and behavioral health issues. Clinicians should consider mTBI as a potential contributor to sleep problems, even years after an injury event.