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Aim

For veterans with mild traumatic brain injury, improved posttraumatic stress disorder severity and sleep correlated with symptomatic improvement. Robert L. Ruff, MD, PhD; Ronald G. Riechers II, MD; Xiao-Feng Wang, PhD; Traci Piero, NP‐C, MSN; Suzanne S. Ruff, PhD. Aim

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Aim

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  1. For veterans with mild traumatic brain injury, improved posttraumatic stressdisorder severity and sleep correlated with symptomatic improvement Robert L. Ruff, MD, PhD; Ronald G. Riechers II, MD; Xiao-Feng Wang, PhD; Traci Piero, NP‐C, MSN; Suzanne S. Ruff, PhD

  2. Aim • Evaluate 63 veterans with mild traumatic brain injury (mTBI) who also had headache, posttraumatic stress disorder (PTSD), and neurological deficits (NDs). • Determine whether improved headaches and cognitive function were associated with reduced PTSD severity, resolution of NDs, or both. • Relevance • Combat mTBI is often associated with PTSD; impaired sleep; and pain, particularly headaches.

  3. Method • We treated veterans with sleep hygiene counseling and oral prazosin. • At baseline, after 9 wk of sleep counseling and prazosin, and 6 mo after end of treatment, we assessed: • Headache severity. • Daytime sleepiness (Epworth Sleepiness Scale). • Cognitive function (Montreal Cognitive Assessment). • Presence of NDs (including impaired olfaction). • PTSD severity (PTSD Checklist-Military Version).

  4. Results • After 9 wk of sleep counseling and prazosin: • Headache severity decreased. • Cognitive function improved. • Daytime sleepiness diminished. • 6 mo after completing treatment: • Additional improvement in headache severity and daytime sleepiness occurred. • Improved cognitive function persisted. • Prevalence of NDs and olfaction scores didn’t change.

  5. Normalized values of variables at baseline, 9 wk after initiation of sleep hygiene counseling and prazosin treatment, and 6 mo after completion of 9 wk initiation period (final). ESS = Epworth Sleepiness Scale, Freq. = frequency, HA = headache, MOCA = Montreal Cognitive Assessment, OLF = olfaction, PCL-M = Posttraumatic Stress Disorder Checklist-Military Version.

  6. Conclusion • Prazosin combined with sleep hygiene counseling reduced severity of headaches, PTSD, and daytime sleepiness. • Presence of NDs didn’t change. • NDs we observed may only be markers of mild brain damage due to mTBI. • While NDs didn’t drive improved headache symptoms and cognitive scores, mTBI with loss of consciousness may predispose to PTSD.

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