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Research

Research Project 3 - A Prospective Study of the Relationship Between Post-TBI Fatigue (PTBIF) and Insomnia

Principal Investigator: Joshua Cantor, Ph.D.
Collaborating Institutions, in addition to Mount Sinai:

• Carolinas Rehabilitation (contact: Flora Hammond, M.D.)
• JFK Johnson Rehabilitation Institute (contact: Keith Cicerone, Ph.D.)
• Kessler Medical Rehabilitation Research and Education Center (contact: Elie Elovic, Ph.D.)
• Santa Clara Valley Medical Center (contact: Tamara Bushnik, Ph.D.)

Overview: This is a study, coordinated and led by Mount Sinai, in which four of the other model system centers are collaborating (see above). It is a longitudinal study in the five years following TBI of the relationship between insomnia and PTBIF and the role of moderating and mediating variables. This project also has the potential of leading to improved treatment of insomnia and related fatigue.

Methods: In the study, data (see below) are being obtained from two samples of individuals with TBI enrolled in the National TBI Database. Sample 1 is expected to include 425-486 participants with complete Year 1 and 2 follow-up data. All subjects who are currently enrolled in the National TBI Database and due for Year 2 and Year 5 follow-ups during the 2007-2012 funding cycle are eligible for participation in Sample 2; this sample is expected to number 150. With members of the database willing to participate, telephone interviews at the time of Form II data collection are conducted; the additional data permits diagnosis of insomnia and evaluation of insomnia severity, as well as documents sleep disorder history, sleep hygiene, sleep quality and treatments received for sleep difficulties. Data are also collected on fatigue, daytime sleepiness, psychiatric distress, injury severity, substance use, income, employment status, level of functioning (DRS,FIM), life satisfaction and demographics.

Research Questions

1. What is the prevalence of insomnia and of fatigue in individuals with moderate-severe TBI at one, two and five years post injury?
2. How does the emergence of insomnia or PTBIF influence the other?
3. What variables are moderators or mediators of the relationship between insomnia and PTBIF (including known correlates of insomnia such as gender, injury severity, sleep hygiene, psychiatric distress, level of functioning, sleep medications)?
4. What variables (e.g., sleep medications) are related to resolution of insomnia and of fatigue?
5. What factors are associated with the temporal onset and duration of insomnia (at one, two and five years post injury)?
6. How do PTBIF and insomnia affect TBI outcomes (e.g., vocational status, life satisfaction, level of disability)?
7. What differences are found between individuals with PTBIF with co-morbid insomnia and those with PTBIF without insomnia (e.g., demographic, co-morbidities, outcomes)?