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Traumatic Brain InjuryNCT03998358

Characterization of Fatigue in Military Personnel With Traumatic Brain Injuries

An observational study of Traumatic Brain Injury and Neurobehavioral Manifestation, run by National Institute of Nursing Research (NINR) at 1 site in United States.

Withdrawn

Withdrawn. The study stopped before anyone enrolled.

Official record
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Trial summary

Background: People who have had a traumatic brain injury (TBI) often experience fatigue. Fatigue is the feeling tired all the time. Researchers want to learn more about how TBI and fatigue are related. Objective: To better understand fatigue after TBI in active duty military and veterans. Read more about this study

Who is it for?
Ages 25 to 40 years
How many people
0 participants
Where
1 siteUnited States
Study dates
19 Mar 2021to 19 Mar 2021
Phase
Observational
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 25 to 40 years
  • All sexes
  • No healthy volunteers
  • Adult

Study population: Up to 74 military personnel will be recruited into this protocol. All participants will have experienced their most recent TBI >= 6 months and <= 5 years prior to protocol participation.@@@@@@

Who may be able to join

  • Are 25 to 40 years of age
  • Are active duty service members or veterans
  • May be NIH employees/staff who are either active duty service members or veterans; except for those who are employed by NINR or subordinates, relatives, and/or co-workers of NINR employees/staff
  • Have sustained at least 1 TBI, >= 6 months and <= 5 years since their most recent TBI, which includes any self-reported loss of consciousness (LOC) established by the OSU during the pre-screening phone call
  • Are able to provide their own consent
  • Are able to understand the protocol, as shown by scoring a 6 out of 6 on a consent quiz

Who cannot join

  • Currently receiving treatment for a medical illness or recent injury that precludes protocol participation, may interfere with study participation, and/or should be treated/stabilized prior to study participation for safety reasons (e.g., cancer, recent fracture(s) requiring therapy and/or pain medication, severe infection). Individuals with stable medical conditions such as hypertension that are controlled by medication will be included.
  • Current physical health status will be assessed by self-report, history and physical exam by a credentialed physician or nurse practitioner, and standard laboratory tests.
  • Current unstable endocrine disorder (e.g., uncontrolled diabetes). Unstable endocrine disorders require treatment to ensure health and safety of the patient before participation is possible. Individuals with stable endocrine disorders (e.g., controlled diabetes) may participate in the protocol but they will be excluded from the hydrocortisone stimulation test. This will be assessed by self-report during the history and physical exam and by standard laboratory tests.
  • Have a major medical illness that is associated with fatigue (e.g., chronic fatigue [diagnosed prior to their TBI or less than 6 months following TBI], multiple sclerosis, or cancer). This will ensure that symptoms of fatigue are as a result of TBI and not another co-morbid illness. This will be assessed by self-report.
  • Currently consuming any of the following sleep modifying medications: benzodiazepines; benzodiazepine receptor agonists; opiates; or sedatives. These medications will directly affect the results of the PSG and actigraphy analysis, as such participants currently taking these medications will be excluded. This will be assessed by self-report.
  • Currently using the sleep modifying medications melatonin and/or Benadryl greater than 2 times per week and/or unable or unwilling refrain from using them during protocol participation. These medications will directly affect the results of the PSG and actigraphy analysis, as such participants who are unwilling/unable to refrain from using these medications will be excluded. This will be assessed by self-report.
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  • Current psychiatric condition for which immediate treatment is required to prevent harm to self or others such as active suicidality or active manic phase in someone who has bi-polar disorder. This is to ensure patient safety and care. This will be assessed by self-report and as part of the history and physical exam.
  • Are pregnant. Pregnancy is associated with increased fatigue and sleep disturbances, as such this condition will affect the outcomes of this analysis.his will be assessed by self-report. This will also be assessed on visit 2 by a urine pregnancy test. Individuals who are nursing are eligible but will not participate in the hydrocortisone stimulation test.
  • Received a diagnosis of severe obstructive sleep apnea (OSA) and/or current reliance on continuous positive airway pressure (CPAP) therapy to aid sleep. Severe OSA and CPAP use will directly affect the result s of this study, as such these participants will be excluded. This will be assessed by self-report.
  • Participant may be able to participate in the protocol but will not be able to have an MRI if they have any of the following:
  • Metal in the body such as pacemakers, stimulators, pumps, aneurysm clips, metallic prostheses, artificial heart valves, cochlear implants or shrapnel fragments, or if they are a welder or metal worker
  • Claustrophobia
  • Are not able to lie comfortably flat on their back for up to 60 minutes
  • Participant may be able to participate in the protocol but will not be able to have the hydrocortisone stimulation test if they have any of the following:
  • History of endocrine disorder or dysfunction (including thyroid, adrenal, pancreatic and pituitary disorders)
  • Abnormal lab values that may indicate endocrine disorder or dysfunction
  • Mother who is currently nursing an infant

Trial locations and contacts

1 site in 1 country.

United States1 site
  • National Institutes of Health Clinical Center

    Bethesda, Maryland, 20892

Other trials in United States

About this study

Background:

People who have had a traumatic brain injury (TBI) often experience fatigue. Fatigue is the feeling tired all the time. Researchers want to learn more about how TBI and fatigue are related.

Read more

Objective:

To better understand fatigue after TBI in active duty military and veterans.

Eligibility:

Active duty service members or veterans ages 25-40 who have sustained at least 1 TBI more than 6 months but less than 5 years ago

Design:

Participants will be screened with:

  • Medical history
  • Physical exam
  • Blood and urine tests

Participants will have Visit 1 the same day as screening. This will include questionnaires and interviews. These will be about their fatigue, quality of life, and health.

Participants will wear an activity monitor on their wrist and complete a sleep diary for 7 days at home.

Participants will have Visit 2: They will stay in the clinic for 2 nights. The visit will include:

  • Tests of memory, attention, and thinking
  • Placement of intravenous (IV) line: A needle will guide a thin plastic tube into the participant s arm vein.
  • 2 overnight sleeps tests: Participants brain waves will be recorded while they sleep. Small electrodes will be placed on the scalp. Monitors will be placed on the skin. These will measure breathing, heart rate, and movement. Blood will be drawn overnight through the IV line.
  • Optional hydrocortisone stimulation test: Participants will receive the hormone through the IV line. Blood will be drawn through the IV line 5 times over 1 hour.
  • Optional MRI: Participants will lie in a machine. This machine is a metal cylinder that takes pictures of the brain.
Read the detailed description

Objective: Traumatic brain injury (TBI) is the signature injury of recent wars. Fatigue is a pervasive and debilitating consequence of TBIs, experienced by up to 80% of military personnel following TBI. If present greater than 6 months post-injury, fatigue is classified as chronic and may hinder recovery and affect return to service in military personnel. However, the pathophysiology through which TBI results in fatigue symptomology remains unclear. This protocol will examine several pathways that have been hypothesized to underlie the association between TBI and fatigue including; sleep disturbances, neuroendocrine and mitochondrial abnormalities. Sleep disturbances and fatigue overlap and frequently co-occur after TBI. However, to date no published studies have investigated the association between objectively measured sleep and fatigue following TBI with and without significant fatigue in military personnel. The second pathway involves dysfunction of the neuroendocrine system, which participates in the regulation of sleep states, circadian function, and attention. Deficits in neuroendocrine function, including putative changes in crucial neuronal populations in the hypothalamus and in somatotrophic cells of the anterior pituitary will result in changes in regulatory hormones such as growth hormone (GH). Evidence suggests that disruptions to GH may be associated with fatigue, however, current findings are mixed. The final pathway may be through mitochondrial dysfunction. Early results from multiple fields have shown that decreased mitochondrial markers have been associated with fatigue, however few studies have looked at these predicted associations in TBI populations. It is evident that further research is needed to examine the relationships between TBI and fatigue. Thus, this protocol aims to identify the pathways associated with TBI and fatigue. Findings from this protocol may lead to novel targets for intervention and reduction of fatigue symptomology following TBI.

Aim: To identify factors that are associated with the persistence of fatigue symptomology, at or greater than 6 months post TBI.

Protocol population: Up to 74 military personnel will be recruited into this protocol. All participants will have experienced their most recent TBI >= 6 months and <= 5 years prior to protocol participation.

Design: We will compare military personnel who have sustained a TBI with and without subsequent fatigue symptomology. This protocol will have two visits, one outpatient and one inpatient to NIH which include:

Screening Visit: All participants will undergo a clinical evaluation of TBI history, fatigue, and complete self-report questionnaires. Participants will also be given an actigraph and sleep diary to take home and complete.

Sleep Visit: All participants will undergo two, consecutive, overnight polysomnography (PSG) tests, which includes one night of serial blood sampling to examine endocrine function and neuropeptide release. Over the two days, participants may also complete an optional hydrocortisone stimulation test and their mitochondrial respiratory profile will be assessed. During this in-patient stay, all participants will undergo neurocognitive testing and have an opportunity to undergo magnetic resonance imaging (MRI).

Keywords
Circadian Rhythm, Biomarkers, Neuroendocrine, Sleep, Traumatic Brain Injury
Medical subject headings
Brain Injuries, Traumatic, Neurobehavioral Manifestations, Sleep Wake Disorders, Fatigue

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

Study groups in NCT03998358
Study groupRoleWhat they receive
High FatigueTBI patients with significant fatigue as calculated by a score of >= 5.5 on the Fatigue Severity Scale
Low FatigueTBI patients without significant fatigue as calculated by a score of < 5.5 on the Fatigue Severity Scale

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Determine differences in objective sleep measures determined by actigraphy and PSG data in military personnel with and without fatigue following a TBI.

    The PSG will be scored by the Clinical Center Sleep Service within two weeks and will generate the following data: -Sleep Onset Latency (SOL): Is a measurement of the time taken to fall asleep from the time the lights were turned off. On average, this process takes approximately 20 minutes. - Sleep efficiency (SE): the number of minutes of sleep divided by the number of minutes in bed. Normal is approximately 85 to 90% or higher, but in-lab values are often less. -Sleep stages; From this information each 30-second epoch is scored as "awake" or one of 4 sleep stages: 1, 2, 3, and REM or Rapid Eye Movement sleep. Stages 1-3 are together called non-REM sleep. Non-REM sleep is distinguished from REM sleep, which is altogether different. Delta power for each stage will also be examined. The primary outcome being assessed will be delta power of SWS and REM between fatigued and non-fatigued.

    Measured: Study completion

Secondary outcomes (7)
  1. Determine differences in neurobehavioral and neurocognitive functioning in military personnel with and without fatigue following a TBI.

    Determine differences in neurobehavioral and neurocognitive functioning in military personnel with and without fatigue following a TBI

    Measured: Study Completion

  2. Describe differences in plasma concentration levels of neuroendocrine proteins during overnight hours in military personnel with and without fatigue following a TBI.

    Describe differences in plasma concentration levels of neuroendocrine proteins during overnight hours in military personnel with and without fatigue following a TBI.

    Measured: Study Completion

  3. Determine differences in neuroendocrine and mitochondrial functionality in military personnel with and without fatigue following a TBI.

    Determine differences in neuroendocrine and mitochondrial functionality in military personnel with and without fatigue following a TBI.

    Measured: Study Completion

  4. Compare group differences in level of fatigue between the two protocol visits.

    Compare group differences in level of fatigue between the two protocol visits.

    Measured: Study Completion

  5. Determine differences in perceived sleep quality (PSQI) and actual sleep quality as measured by actigraphy.

    Determine differences in perceived sleep quality (PSQI) and actual sleep quality as measured by actigraphy.

    Measured: Study Completion

  6. Compare volume of hypothalamus, attentional + arousal regions of interest as well as fractional anisotropy (FA), axial diffusivity (AD), radial diffusivity and white matter integrity using DTI in military personnel w and w/out fatigue following ...

    Compare volume of hypothalamus, attentional + arousal regions of interest as well as fractional anisotropy (FA), axial diffusivity (AD), radial diffusivity and white matter integrity using DTI in military personnel w and w/out fatigue following a TBI.

    Measured: Study Completion

  7. Determine if there are group differences in actigraphically measured sleep, light, and physical activity.

    Determine if there are group differences in actigraphically measured sleep, light, and physical activity.

    Measured: Study Completion

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted26 Jun 2019
  2. Study start19 Mar 2021
  3. Primary completion19 Mar 2021
  4. Study completion19 Mar 2021

Why it stopped: Recruitment method is no longer active.

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Observational
Observational model
Case-control
Time perspective
Prospective
Enrolment
0 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT03998358
Sponsor's protocol ID
190115
Other IDs
19-NR-0115
Status last verified
Mar 2021
First submitted
25 Jun 2019
Last updated
25 Mar 2021
Results posted
No

Questions about this trial

What is this clinical trial studying?

An observational study of Traumatic Brain Injury and Neurobehavioral Manifestation, run by National Institute of Nursing Research (NINR) at 1 site in United States.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 6 inclusion and 17 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: withdrawn, as of the sponsor's last update on 25 Mar 2021. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in United States. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

The study was withdrawn before enrolling participants, so there are no results.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Determine differences in objective sleep measures determined by actigraphy and PSG data in military personnel with and without fatigue following a TBI. (time frame: Study completion). It is what the study was designed to measure, not a finding.

Where can I read the original study information?
Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 25 Mar 2021.

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