Associations of Nightmares and Sleep Disturbance With Neurobehavioral Symptoms Postconcussion

Objective: This study investigates the association of nightmares beyond general sleep disturbance on neurobehavioral symptoms in adults with mild traumatic brain injury (mTBI). Design: Secondary analysis of a concussion cohort study. Participants: One hundred and eleven adults older than 20 years with mTBI were recruited from a specialized concussion treatment center. Main Measures: Behavioral Assessment Screening Tool, Pittsburgh Sleep Quality Index, and self-report of nightmare frequency in the past 2 weeks. Results: Among adults with mTBI, nightmares accounted for the greatest amount of variability in negative affect (beta = .362, P < .001), anxiety (beta = .332, P < .001), and impulsivity (beta = .270, P < .001) after adjusting for age and sex. Overall sleep disturbance had the strongest association with depression (beta = .493, P < .001), fatigue (beta = .449, P < .001), self-reported executive dysfunction (beta = .376, P < .001), and overall burden from concussive symptoms (beta = .477, P < .001). Conclusions: Nightmares and sleep disturbance are differentially associated with variance in neurobehavioral symptoms. Nightmares were independently associated with neurobehavioral symptoms representing an excess of normal functioning (eg, anxiety, impulsivity), while general sleep disturbance was associated with neurobehavioral symptoms representing functioning below normal levels (eg, depression, fatigue, self-reported executive dysfunction). Clinical and research implications are discussed.