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Published on: November 19, 2012
Sleep and Executive Functioning in Pediatric Traumatic Brain Injury Survivors after Critical Care
Cydni N Williams1,2, Cindy T McEvoy3, Miranda M Lim4,5,6,7
1Pediatric Critical Care and Neurotrauma Recovery Program, Oregon Health & Science University, Portland, OR 97239, USA.
Insights
Sleep/wake disturbances (SWDs) in children hospitalized for traumatic brain injury (TBI) are linked to poorer executive function outcomes. Addressing SWDs may improve cognitive recovery after TBI.
Area of Science:
- Pediatric Neurology
- Neuroscience
- Sleep Medicine
Background:
- Traumatic brain injury (TBI) affects over 50,000 children annually, often leading to long-term cognitive issues.
- Sleep/wake disturbances (SWDs) are prevalent in over 50% of pediatric TBI cases, potentially hindering brain development and recovery.
Purpose of the Study:
- To investigate the association between SWDs and executive function outcomes in children aged 3-18 years with TBI.
- To determine if SWDs predict worse cognitive performance 1-3 months post-hospital discharge.
Main Methods:
- SWDs were identified using the Sleep Disturbances Scale for Children (t-scores ≥ 60).
- Executive function was assessed using the Global Executive Composite (GEC) and a Neurocognitive Index (NCI) derived from objective measures.
- Multiple linear regression analyses were employed to evaluate the relationship between SWDs and executive function, controlling for covariates.
Main Results:
- 68% of the 131 studied children exhibited clinically significant SWDs.
- Children with SWDs showed significantly worse median scores on both the GEC (56 vs. 45) and NCI (−0.02 vs. 0.42; p < 0.05).
- Multivariable analyses confirmed that SWDs were independently associated with worse GEC (β=7.8) and NCI (β=−0.4) outcomes.
Conclusions:
- SWDs are significantly associated with impaired executive function in children following TBI.
- Targeting SWDs presents a potential modifiable strategy to enhance cognitive outcomes in pediatric TBI survivors.
Abstract:
Over 50,000 children are hospitalized annually for traumatic brain injury (TBI) and face long-term cognitive morbidity. Over 50% develop sleep/wake disturbances (SWDs) that can affect brain development and healing. We hypothesized SWDs would portend worse executive function outcomes in children aged 3−18 years with TBI 1−3 months after hospital discharge. SWDs were defined using the Sleep Disturbances Scale for Children (t-scores ≥ 60). Outcomes included the Global Executive Composite (GEC, t-score) from the Behavior Rating Inventory of Executive Function, Second and Preschool Editions, and multiple objective executive function assessments combined through Principal Components Analysis into a Neurocognitive Index (NCI, z-score). Multiple linear regression evaluated associations between SWDs and executive function outcomes, controlling for covariates. Among 131 children, 68% had clinically significant SWDs, which were associated with significantly worse median scores on the GEC (56 vs. 45) and NCI (−0.02 vs. 0.42; both p < 0.05). When controlling for baseline characteristics and injury severity in multivariable analyses, SWDs were associated with worse GEC (β-coefficient = 7.8; 95% Confidence Interval = 2.5, 13.1), and worse NCI (β-coefficient = −0.4; 95% Confidence Interval = −0.8, −0.04). SWDs in children with TBI are associated with worse executive function outcomes after hospital discharge, and may serve as modifiable targets to improve outcomes.
