PNNL

Abstract

Background. Mild traumatic brain injury (TBI) is associated with persistent sleep-wake dysfunction, including insomnia and circadian rhythm disruption, which can exacerbate functional outcomes including mood, pain and quality of life. Therapies to treat sleep-wake disturbances in those with TBI have been limited not only by marginal efficacy but also by poor patient acceptability or high patient/provider burden. Objective. Assess the feasibility and preliminary efficacy of a low-burden intervention (light therapy) to improve sleep in Veterans with TBI. Methods. Thirty-three Veterans with TBI were prospectively enrolled in a single arm, open label intervention using a lightbox (~10,000 lux) for 60-minutes every morning for 4-weeks. Pre- and post-intervention outcomes included questionnaires related to sleep, mood, TBI, post-traumatic stress disorder (PTSD), and pain; wrist actigraphy as a proxy for objective sleep; and blood-based biomarkers related to TBI and sleep. Results. The protocol was rated favorably by ~75% of participants, with adherence to the lightbox and actigraphy being ~87% and 97%, respectively. Post-intervention showed improvements in self-reported symptoms related to insomnia, mood, and pain; objective actigraphy-derived measures of sleep; and blood-based biomarkers related to peripheral pro-inflammatory cytokines. Multiple linear regression revealed comorbid PTSD was a significant contributor to response to treatment. Conclusions. Morning bright light therapy is a feasible and highly acceptable intervention that shows preliminary efficacy to treat disrupted sleep in Veterans with TBI. A full-scale randomized, placebo-controlled study is warranted to assess the full efficacy of light therapy to improve sleep, biomarkers, and other related symptoms in TBI.