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Poor sleep correlates with biomarkers of neurodegeneration in mild traumatic brain injury patients: a CENC study

Werner, J Kent, Shahim, Pashtun, Pucci, Josephine U, Lai, Chen, Raiciulescu, Sorana, Gill, Jessica M, Nakase-Richardson, Risa, Diaz-Arrastia, Ramon, Kenney, Kimbra·2021·Sleep

Abstract

Study Objectives: Sleep disorders affect over half of mild traumatic brain injury (mTBI) patients. Despite evidence linking sleep and neurodegeneration, longitudinal TBI-related dementia studies have not considered sleep. We hypothesized that poor sleepers with mTBI would have elevated markers of neurodegeneration and lower cognitive function compared to mTBI good sleepers and controls. Our objective was to compare biomarkers of neurodegeneration and cognitive function with sleep quality in warfighters with chronic mTBI. Methods: In an observational warfighters cohort (n = 138 mTBI, 44 controls), the Pittsburgh Sleep Quality Index (PSQI) was compared with plasma biomarkers of neurodegeneration and cognitive scores collected an average of 8 years after injury. Results: In the mTBI cohort, poor sleepers (PSQI ≥ 10, n = 86) had elevated plasma neurofilament light (NfL, x̅ = 11.86 vs 7.91 pg/mL, p = 0.0007, d = 0.63) and lower executive function scores by the categorical fluency (x̅ = 18.0 vs 21.0, p = 0.0005, d = –0.65) and stop-go tests (x̅ = 30.1 vs 31.1, p = 0.024, d = –0.37). These findings were not observed in controls (n = 44). PSQI predicted NfL (beta = 0.22, p = 0.00002) and tau (beta = 0.14, p = 0.007), but not amyloid β42. Poor sleepers showed higher obstructive sleep apnea (OSA) risk by STOP-BANG scores (x̅ = 3.8 vs 2.7, p = 0.0005), raising the possibility that the PSQI might be partly secondary to OSA. Conclusions: Poor sleep is linked to neurodegeneration and select measures of executive function in mTBI patients. This supports implementation of validated sleep measures in longitudinal studies investigating pathobiological mechanisms of TBI related neurodegeneration, which could have therapeutic implications.

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Research works printed but not linked: 45

  1. Shahim, 2018, Neurofilament light and tau as blood biomarkers for sports-related concussion, Neurology., 90, e1780, 10.1212/WNL.0000000000005518 · DOI
  2. Bogoslovsky, 2017, Increases of plasma levels of glial fibrillary acidic protein, tau, and amyloid β up to 90 days after traumatic brain injury, J Neurotrauma., 34, 66, 10.1089/neu.2015.4333 · DOI
  3. Gill, 2018, Glial fibrillary acidic protein elevations relate to neuroimaging abnormalities after mild TBI, Neurology., 91, e1385, 10.1212/WNL.0000000000006321 · DOI · Paper page
  4. Olsson, 2004, Marked increase of beta-amyloid(1–42) and amyloid precursor protein in ventricular cerebrospinal fluid after severe traumatic brain injury, J Neurol., 251, 870, 10.1007/s00415-004-0451-y · DOI
  5. Rubenstein, 2017, Comparing plasma phospho tau, total tau, and phospho tau-total tau ratio as acute and chronic traumatic brain injury biomarkers, JAMA Neurol., 74, 1063, 10.1001/jamaneurol.2017.0655 · DOI · Paper page
  6. Shahim, 2020, Neurofilament light as a biomarker in traumatic brain injury, Neurology., 95, e610, 10.1212/WNL.0000000000009983 · DOI · Paper page
  7. Shahim, 2017, Astroglial activation and altered amyloid metabolism in human repetitive concussion, Neurology., 88, 1400, 10.1212/WNL.0000000000003816 · DOI
  8. de Wolf, 2020, tau, neurofilament light chain and amyloid-β levels and risk of dementia; a population-based cohort study, Brain., 143, 1220, 10.1093/brain/awaa054 · DOI · Paper page
  9. Kang, 2009, Amyloid-beta dynamics are regulated by orexin and the sleep–wake cycle, Science., 326, 1005, 10.1126/science.1180962 · DOI · Paper page
  10. Ju, 2017, Slow wave sleep disruption increases cerebrospinal fluid amyloid-β levels, Brain., 140, 2104, 10.1093/brain/awx148 · DOI · Paper page
  11. Sprecher, 2017, Poor sleep is associated with CSF biomarkers of amyloid pathology in cognitively normal adults, Neurology., 89, 445, 10.1212/WNL.0000000000004171 · DOI
  12. Ju, 2019, Obstructive sleep apnea treatment, slow wave activity, and amyloid-β, Ann Neurol., 85, 291, 10.1002/ana.25408 · DOI
  13. Díaz-Román, 2020, Obstructive sleep apnea and Alzheimer’s disease-related cerebrospinal fluid biomarkers in mild cognitive impairment, Sleep.
  14. Ju, 2014, Sleep and Alzheimer disease pathology—a bidirectional relationship, Nat Rev Neurol., 10, 115, 10.1038/nrneurol.2013.269 · DOI · Paper page
  15. Chang, 2013, Sleep apnea and the risk of dementia: a population-based 5-year follow-up study in Taiwan, PLoS One., 8, e78655, 10.1371/journal.pone.0078655 · DOI
  16. Didonna, 2019, The role of neurofilament aggregation in neurodegeneration: lessons from rare inherited neurological disorders, Mol Neurodegener., 14, 19, 10.1186/s13024-019-0318-4 · DOI
  17. Collen, 2012, Sleep disturbances among soldiers with combat-related traumatic brain injury, Chest., 142, 622, 10.1378/chest.11-1603 · DOI
  18. Caldwell, 2019, The association of insomnia and sleep apnea with deployment and combat exposure in the entire population of US army soldiers from 1997 to 2011: a retrospective cohort investigation, Sleep., 42, 10.1093/sleep/zsz112 · DOI
  19. Balba, 2018, Increased sleep disturbances and pain in veterans with comorbid traumatic brain injury and posttraumatic stress disorder, J Clin Sleep Med., 14, 1865, 10.5664/jcsm.7482 · DOI
  20. O’Hara, 2005, Nocturnal sleep apnea/hypopnea is associated with lower memory performance in APOE epsilon4 carriers, Neurology., 65, 642, 10.1212/01.wnl.0000173055.75950.bf · DOI
  21. Lim, 2019, overlooked implications of disturbed sleep in traumatic brain injury, JAMA Neurol., 76, 114, 10.1001/jamaneurol.2018.3738 · DOI
  22. Vagnozzi, 2010, Assessment of metabolic brain damage and recovery following mild traumatic brain injury: a multicentre, proton magnetic resonance spectroscopic study in concussed patients, Brain., 133, 3232, 10.1093/brain/awq200 · DOI · Paper page
  23. Buysse, 1989, The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research, Psychiatry Res., 28, 193, 10.1016/0165-1781(89)90047-4 · DOI · Paper page
  24. Matsangas, 2018, The utility of the Pittsburgh Sleep Quality Index in US military personnel, Mil Psychol., 30, 360, 10.1080/08995605.2018.1478547 · DOI
  25. Walker, 2016, The Chronic Effects of Neurotrauma Consortium (CENC) multi-centre observational study: description of study and characteristics of early participants, Brain Inj., 30, 1469, 10.1080/02699052.2016.1219061 · DOI
  26. Lequerica, 2014, The factor structure of the Pittsburgh Sleep Quality Index in persons with traumatic brain injury. A NIDRR TBI model systems module study, NeuroRehabilitation., 35, 485, 10.3233/NRE-141141 · DOI
  27. Mac Donald, 2017, Outcome trends after US military concussive traumatic brain injury, J Neurotrauma., 34, 2206, 10.1089/neu.2016.4434 · DOI
  28. Azouvi, 2017, Neuropsychology of traumatic brain injury: an expert overview, Rev Neurol (Paris)., 173, 461, 10.1016/j.neurol.2017.07.006 · DOI · Paper page
  29. Riemann, 2015, The neurobiology, investigation, and treatment of chronic insomnia, Lancet Neurol., 14, 547, 10.1016/S1474-4422(15)00021-6 · DOI · Paper page
  30. Ozga, 2018, Executive (dys)function after traumatic brain injury: special considerations for behavioral pharmacology, Behav Pharmacol., 29, 617, 10.1097/FBP.0000000000000430 · DOI
  31. Diamond, 2013, Executive functions, Annu Rev Psychol., 64, 135, 10.1146/annurev-psych-113011-143750 · DOI · Paper page
  32. Delis, 2004, Reliability and validity of the Delis–Kaplan Executive Function System: an update, J Int Neuropsychol Soc., 10, 301, 10.1017/S1355617704102191 · DOI · Paper page
  33. Geary, 2011, Verbal learning strategy following mild traumatic brain injury, J Int Neuropsychol Soc., 17, 709, 10.1017/S1355617711000646 · DOI
  34. Soble, 2014, Normative Data for the Neurobehavioral Symptom Inventory (NSI) and post-concussion symptom profiles among TBI, PTSD, and nonclinical samples, Clin Neuropsychol., 28, 614, 10.1080/13854046.2014.894576 · DOI
  35. Cicerone, 1995, Persistent Postconcussive Syndrome: the structure of subjective complaints after mild traumatic brain injury, J Head Trauma Rehabil., 10, 1, 10.1097/00001199-199510030-00002 · doi:10.1097/00001199-199510030-00002 · Paper page
  36. Armistead-Jehle, 2010, Symptom validity test performance in U.S. veterans referred for evaluation of mild TBI, Appl Neuropsychol., 17, 52, 10.1080/09084280903526182 · DOI
  37. Baron, 1986, The moderator–mediator variable distinction in social psychological research: conceptual, strategic, and statistical considerations, J Pers Soc Psychol., 51, 1173, 10.1037/0022-3514.51.6.1173 · DOI · Paper page
  38. Sprecher, 2017, Poor sleep is associated with CSF biomarkers of amyloid pathology in cognitively normal adults, Neurology., 89, 445, 10.1212/WNL.0000000000004171 · DOI
  39. Ju, 2016, Obstructive sleep apnea decreases central nervous system-derived proteins in the cerebrospinal fluid, Ann Neurol., 80, 154, 10.1002/ana.24672 · DOI
  40. Fortea, 2018, Plasma and CSF biomarkers for the diagnosis of Alzheimer’s disease in adults with Down syndrome: a cross-sectional study, Lancet Neurol., 17, 860, 10.1016/S1474-4422(18)30285-0 · DOI
  41. Mattsson, 2016, Plasma tau in Alzheimer disease, Neurology., 87, 1827, 10.1212/WNL.0000000000003246 · DOI · Paper page
  42. Dobrowolska, 2014, Diurnal patterns of soluble amyloid precursor protein metabolites in the human central nervous system, PLoS One., 9, e89998, 10.1371/journal.pone.0089998 · DOI
  43. Motamedi, 2018, Elevated tau and interleukin-6 concentrations in adults with obstructive sleep apnea, Sleep Med., 43, 71, 10.1016/j.sleep.2017.11.1121 · DOI
  44. Christensen, 2020, Repetitive mild traumatic brain injury alters glymphatic clearance rates in limbic structures of adolescent female rats, Sci Rep., 10, 6254, 10.1038/s41598-020-63022-7 · DOI
  45. Kennedy, 2019, Correlates of depression in U.S. Military service members with a history of mild traumatic brain injury, 148

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Metadata

Authors
Werner, J. K., Shahim, P., Pucci, J. U., Lai, C., Raiciulescu, S., Gill, J. M., Nakase-Richardson, R., Diaz-Arrastia, R., & Kenney, K.
Affiliations
  • Department of Neurology, Uniformed Services University of Health Sciences, Bethesda, MD
  • National Institutes of Health, Bethesda, MD
  • Department of Internal Medicine, Sleep and Pulmonary Division, University of South Florida, Tampa, FL
  • Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
Venue
Sleep
Published
2020-12-06
Volume
44
Issue
6
ISSN
  • 0161-8105
  • 1550-9109
Cited by
34
References
13
Language
en
Funders
  • U.S. Army Medical Research and Material Command (W81XWH-13-2-0095)
  • U.S. Department of Defense (I01 CX001135)
  • VHA Central Office (HT0014)
  • U.S. Army Medical Research Acquisition Activity
  • National Institutes of Health

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CoChat. (2026). Citation check: Poor sleep correlates with biomarkers of neurodegeneration in mild traumatic brain injury patients: a CENC study. https://app.cochat.ai/papers/10.1093/sleep/zsaa272
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Werner, J. K., Shahim, P., Pucci, J. U., Lai, C., Raiciulescu, S., Gill, J. M., Nakase-Richardson, R., Diaz-Arrastia, R., & Kenney, K. (2021). Poor sleep correlates with biomarkers of neurodegeneration in mild traumatic brain injury patients: a CENC study. Sleep. https://doi.org/10.1093/sleep/zsaa272

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