Abstract
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.
Present therapies to treat sleep-wake disturbances in those with TBI
(e.g., cognitive behavioral therapy for insomnia) are limited by marginal
efficacy, poor patient acceptability, and/or high patient/provider burden.
Thus, this study aimed to assess the feasibility and preliminary efficacy
of morning bright light therapy, to improve sleep in Veterans with TBI
(NCT03578003). Thirty-three Veterans with history of TBI were
prospectively enrolled in a single-arm, open-label intervention using a
lightbox (~10,000 lux at the eye) 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/sleep. The protocol was rated favorably by ~75%
of participants, with adherence to the lightbox and actigraphy being ~87%
and 97%, respectively. Post-intervention improvements were observed in
self-reported symptoms related to insomnia, mood, and pain;
actigraphy-derived measures of sleep; and blood-based biomarkers related
to peripheral inflammatory balance. The severity of comorbid PTSD was a
significant positive predictor of response to treatment. Morning bright
light therapy is a feasible and acceptable intervention that shows
preliminary efficacy to treat disrupted sleep in Veterans with TBI. A
full-scale randomized, placebo-controlled study with longitudinal
follow-up is warranted to assess the efficacy of morning bright light
therapy to improve sleep, biomarkers, and other TBI related symptoms.