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Sleep Disturbance and Postconcussive Symptoms in Pediatric Mild Traumatic Brain Injury and Orthopedic Injury
Caroline A Luszawski1, Nori M Minich, Erin D Bigler
1Author Affiliations: Department of Psychology, University of Calgary, Calgary, Alberta (Ms Luszawski and Dr Yeates); Alberta Children's Hospital Research Institute, Calgary, Alberta (Ms Luszawski and Dr Yeates); Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta (Ms Luszawski and Dr Yeates); Department of Pediatrics, Case Western Reserve University, Cleveland, Ohio (Ms Minich, Dr Bacevice, and Dr Bangert); Rainbow Babies and Children's Hospital, University Hospitals Cleveland Medical Center, Cleveland, Ohio (Ms Minich and Dr Bacevice); Department of Psychology and Neuroscience, Brigham Young University, Provo, Utah and Departments of Neurology and Psychiatry, University of Utah, Salt Lake City, Utah (Dr Bigler); Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, Ohio (Dr Taylor); Department of Pediatrics, The Ohio State University, Columbus, Ohio (Drs Taylor, Cohen, and Zumberge); Emergency Medicine, Nationwide Children's Hospital, Columbus, Ohio (Dr Cohen); Department of Radiology, University Hospitals of Cleveland, Cleveland, Ohio (Dr Bangert); Radiology, Nationwide Children's Hospital, Columbus, Ohio (Dr Zumberge); Educational and Counselling Psychology, University of British Columbia, Vancouver, British Columbia (Dr Tomfohr-Madsen); Neurosciences Program, Alberta Children's Hospital, Calgary, Alberta (Dr Brooks); and Departments of Pediatrics, Clinical Neurosciences, and Psychology, University of Calgary, Calgary, Alberta (Dr Brooks).
Objective:
Sleep disturbance (SD) is common after pediatric mild traumatic brain injury (mTBI) and may predict increased postconcussive symptoms (PCS) and prolonged recovery. Our objective was to investigate the relation of SD with PCS in children with mTBI and those with orthopedic injury (OI).
Setting:
Emergency departments (EDs) at 2 children's hospitals in the Midwestern United States.
Participants:
Children and adolescents aged 8 to 16 years old diagnosed with either a mTBI ( n = 143) or OI ( n = 74) and recruited within 24 hours postinjury.
Design:
Observational, prospective, concurrent cohort study with longitudinal follow-up.
Main Measures:
Parents rated children's preinjury sleep retrospectively shortly after injury, and postinjury sleep at 3 and 6 months postinjury, using the Sleep Disorders Inventory for Students. Parents rated children's preinjury symptoms retrospectively in the emergency department, and parents and children rated PCS at 3 and 6 months, using the Health and Behavior Inventory and the Postconcussive Symptom Interview. Weekly ratings on the Health and Behavior Inventory were also obtained remotely.
Results:
Postinjury SD was modestly but not significantly higher in the mTBI group compared to the OI group ( P = .060, d = 0.32). Children with mTBI who were symptomatic postacutely based on parent ratings had worse parent-rated sleep outcomes at 3 and 6 months postinjury compared to children who were not symptomatic. Greater preinjury SD also predicted more postinjury SD and more severe PCS regardless of injury type.
Conclusions:
The results suggest potential bidirectional associations between SD and PCS after mTBI. Studies of treatments for SD following pediatric mTBI are needed.
