Polysomnographic differences following moderate-severe traumatic brain injury (TBI) among individuals with chronic pain

Wednesday, November 9, 2022

10:25 AM – 10:30 AM

Location: Station 5

Presenting Author(s)

Aaron M. Martin, PhD

Psyhologist
James A. Haley Veterans' Hospital
Tampa, Florida, United States

Non-presenting Author(s)

Shanti M. Pinto, MD

Assistant Professor
Department of Physical Medicine and Rehabilitation, UT-Southwestern, Dallas, TX
Dallas, Texas, United States
XT

Xinyu Tang, n/a

Mathematical Statistician
Tampa VA Research and Education Foundation
Rockville, Maryland, United States
Jeanne M. Hoffman, PhD

Professor
University of Washington
SEATTLE, Washington, United States
LW

Lara Wittine

Pulmonologist
James A. Haley Veterans' Hospital, United States
WW

William Walker

Physiatrist
VCU School of Medicine, United States
Daniel Schwartz, MD

Pulmonologist
James A. Haley Veterans' Hospital
Tampa, Florida, United States
Georgia Kane, MD, MD

Neurologist
Tampa VA, University of South Florida
Tampa, Florida, United States
CT

Curtis Takagishi, Ph.D.

Clinical Psychologist
James A. Haley Veterans' Hospital
Tampa, Florida, United States
Risa Nakase-Richardson, Ph.D.

Professor
University of South Florida and James A. Haley Veterans Hospital
Lutz, Florida, United States

Research Objectives: To determine is differences in objectively measured sleep related respiration exists between chronic pain cohorts post-TBI

Design: Longitudinal, retrospective cohort study

Setting: Six TBI Model Systems inpatient rehabilitation centers

Participants: 66 patients (mean age 42, 60% Caucasian, 82% male) admitted for neurorehablitation following injury were recruited to participate in a diagnostic effectiveness trial of polysomnography (PSG) and were followed between one and two-years post-injury as part of the TBIMS Pain Collaboratory study

Interventions: Non-intervention study. Fully attended, level-1 PSG, the criterion standard for sleep apnea diagnosis

Main Outcome Measures: PSG-derived respiratory indices and chronic pain status

Results: Three-quarters of participants met criteria for sleep apnea shortly after injury and approximately 61% endorsed chronic pain following TBI. Pairwise comparisons between those who did versus those who did not endorse chronic pain at follow-up revealed that chronic pain was associated with categorically worse apnea hypopnea indices (AHI) for both obstructive (15.7 versus 11.1 events per hour of sleep) and central sleep apneas (2.6 versus 0.8 events per hour). Additionally, those who went on to experience chronic pain were found to have worse oxygenation indices (19.6 events per hour), relative to their no pain counterparts (7.9 events per hour).

Conclusions: This study is the first to report on an association between objective, PSG-derived respiratory indices and chronic pain status following moderate to severe TBI, finding that worse sleep-related respiratory indices early in the recovery from TBI is associated with chronic pain at long-term follow-up. Sleep apnea is an important modifiable factor following that may contribute to long-term pain-related outcomes, but further research is needed to determine whether a causal link exists.

Author(s) Disclosures: PCORI, CER-1511-33005; VA TBI Model Systems Program of Research; GDIT; NIDILRR 90DPTB0008. Clinicaltrial.gov Registration Number: NCT03033901

Learning Objectives:

Understand the association between sleep disordered breath in early rehabilitation and chronic pain status in individuals with moderate to severe TBI.
Recognize the value of objective sleep assessment (i.e., polysomnography) in the context of early rehabilitation.
Identify gaps in understanding the relationship between sleep and pain chronification following TBI