Describe the prevalence of insomnia in TBI patients, understand separate trajectories of patient populations who suffer Insomnia post-TBI and discuss how post-TBI insomnia might be targeted for therapeutic trials.

Despite recent advances in awareness and national funding, post-TBI insomnia persists as a substantial societal health and economic burden. Research efforts to date have been hampered by inconsistent operational definitions and variable follow-up duration. As a result, little is known about the natural history of insomnia post-TBI, whose characterization is essential to improving recovery and long-term outcomes. We sought to identify clinically and biologically relevant subgroups of insomnia patients post-TBI which address this gap in literature.

TRACK-TBI is a longitudinal multi-site, observational study funded by a cooperative agreement from National Institute for Neurological Disorders and Stroke (NINDS U01 NS086090). Participants were identified via the Federal Intra-agency Traumatic Brain Injury Repository (FITBIR). Participants aged ≥17 years were recruited within 24 hours of TBI injury completing serial assessments over one-year. Active recruitment occurred at 18 Level 1 trauma centers. Latent Class Mixed Models were implemented using Insomnia Severity Index trajectories.

Of participants (n = 2,022), 61.6% reported consistent mild insomnia symptoms, 31.0% initially reported mild insomnia symptoms that resolved over time, 4.5% reported consistently severe symptoms, 2.2% initially reported severe symptoms that resolved by 12 months, and 0.7% initially reported no symptoms that became severe by 12 months. Five major patient trajectories were identified.

These data are the first to provide detailed longitudinal trajectory analysis for insomnia after TBI. Most participants’ insomnia improved over time, with one year risk consistent relative to the general population. However, nearly 10% of TBI patients suffered from severe persistent insomnia. More work is needed to better define predictors of these insomnia trajectory subgroups and identify optimal subgroup-specific treatment approaches.