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Sleep Parameters and Overnight Urinary Melatonin Production in Children With Persistent Post-concussion Symptoms
Karen M Barlow1, Katherine A Girgulis2, Genevieve Goldstein3
1Department of Paediatrics, University of Calgary, Calgary, Canada; Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Canada; Faculty of Medicine, Children's Health Research Centre, University of Queensland, St Lucia, Australia.
Insights
Children with persistent symptoms after mild traumatic brain injury (mTBI) report more sleep-related problems (SRPs). However, these issues were not linked to objective sleep patterns or melatonin levels in this study.
Area of Science:
- Pediatric Neurology
- Sleep Medicine
- Traumatology
Background:
- Sleep disturbance is a frequent yet poorly understood issue following mild traumatic brain injury (mTBI) in children.
- Understanding the biological underpinnings of sleep problems post-mTBI is crucial for effective management.
Purpose of the Study:
- To investigate sleep-related problems (SRPs), sleep-activity patterns, and melatonin production in children with varying recovery timelines after mTBI.
- To test the hypothesis that delayed recovery correlates with increased SRPs, abnormal sleep-activity, and reduced melatonin.
Main Methods:
- A prospective controlled cohort study involving 83 children with persistent symptoms, 26 recovered children, and 25 healthy controls.
- Evaluated SRPs via questionnaire, sleep actigraphy for 5-7 days, and assessed melatonin via overnight urine collection.
- Also assessed quality of life and mood disturbance using validated questionnaires.
Main Results:
- Children with persistent post-concussion symptoms reported significantly more SRPs compared to recovered children and controls.
- No significant differences were found in actigraphy-measured sleep parameters or urinary melatonin levels between the groups.
- SRPs and actigraphy findings did not correlate with anxiety or depression scores.
Conclusions:
- While children with persistent mTBI symptoms report more SRPs, these are not explained by objective sleep parameters or melatonin levels.
- The pathophysiology of sleep disturbances after pediatric mTBI requires further investigation.
Background:
Sleep disturbance is common after a mild traumatic brain injury (mTBI) in children, yet its biology is poorly understood. We aimed to explore sleep-related problems (SRPs), sleep-activity patterns, and endogenous melatonin production in children with different recovery trajectories following mTBI. We hypothesized that children with delayed recovery would have more SRPs and abnormal sleep-activity patterns, which would correlate with lower overnight melatonin production.
Methods:
In this prospective controlled cohort study, we enrolled 83 children with persistent symptoms, 26 children who had clinically recovered following mTBI, and 25 healthy controls. SRPs were evaluated using the sleep subscale of the Post-Concussion Symptom Inventory. Sleep actigraphy was performed for five to seven days at 37 (S.D. 7) days post-injury. Health-related quality of life and mood disturbance was assessed using the Child Health Questionnaire and the Behavior Assessment System for Children, respectively. Endogenous melatonin production was assessed using overnight urine collection.
Results:
The groups were similar in age (13.9 [S.D. 2.6] years) and sex (52% female). Regression analysis demonstrated increased SRP in the symptomatic group (9.0; 95% confidence interval: 7.6, 11.1) compared with the recovered group (1.6; 95% confidence interval: 1.0, 2.4) and controls (2.0; 95% confidence intervals: 1.2, 3.2). Actigraphy parameters and urinary melatonin levels were not significantly different between groups. Neither SRPs nor actigraphy parameters correlated with anxiety and depression scores.
Conclusions:
Although children with persistent post-concussion symptoms reported more SRPs, this was not related to actigraphy sleep parameters or melatonin production. Further research is warranted to understand the pathophysiology of post-traumatic sleep disturbance.
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