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Published on: January 20, 2023
Cross-Lagged Associations Among Sleep, Headache, and Pain in Pediatric Mild Traumatic Brain Injury: An A-CAP Study
Safira Dharsee1, Ali Hassan, Melanie Noel
1Author Affiliations: Department of Psychology (Ms Dharsee), Department of Psychology (Dr Noel), Faculty of Kinesiology (Dr Bender), Departments of Pediatrics and Emergency Medicine, Cumming School of Medicine (Dr Freedman), Department of Psychology, Alberta Children's Hospital Research Institute, and Hotchkiss Brain Institute (Dr Yeates), University of Calgary, Calgary, Alberta, Canada; Department of Radiology and Diagnostic Imaging (Mr Hassan), University of Alberta, Edmonton, Alberta, Canada; Department of Psychology, Université de Montréal and CHU Sainte-Justine Azrieli Research Center, Montréal, Québec, Canada; Department of Pediatrics (Dr Craig), University of Alberta and Stollery Children's Hospital, Edmonton, Alberta, Canada; Department of Pediatrics (Dr Doan), University of British Columbia and BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada; Department of Pediatric Emergency Medicine, Department of Pediatrics (Dr Gravel), CHU Sainte-Justine Hospital Research Center, Université de Montréal, Montréal, Québec, Canada; Departments of Pediatrics and Emergency Medicine (Dr Zemek), University of Ottawa and Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada.
Objective:
To test cross-lagged associations among sleep, headache, and pain in pediatric mild traumatic brain injury (mTBI).
Setting, Participants, Design:
Children and adolescents aged 8.0 to 16.9 years who sustained a mTBI and presented to 1 of 5 pediatric emergency departments across Canada completed assessments at 1-week, 3 months, and 6 months post-injury as part of a larger prospective cohort study.
Main Measures:
Sleep disturbance was measured using 7 sleep items from the Child Behaviour Checklist. Sleep duration was measured using average weekday and weekend sleep from the Healthy Lifestyle Behaviours Questionnaire. Pain intensity was measured using an 11-point numerical rating scale. Headache severity and associated functional impairment were measured using the Headache Impact Test and 1 item from the Health and Behaviour Inventory. Analyses included trivariate-indicator random-intercept cross-lagged panel models.
Results:
Of 633 recruited children, 563 were included in the current study. Headache showed significant within-person, bidirectional, cross-lagged associations with sleep disturbance and duration, as well as with pain intensity. More specifically, worse headache predicted greater sleep disturbance (1-week to 3 months and 3 months to 6 months: B s = .47, P s ≤ .013) and shorter sleep duration (1-week to 3 months: B = -.21, P = .006), while greater sleep disturbance predicted worse headache (1-week to 3 months: B = .08, P = .001). Worse headache also predicted higher pain intensity (1-week to 3 months & 3 months to 6 months: B s ≥ 1.27, P s < .001), while higher pain intensity predicted worse headache (3 months to 6 months: B s ≥ .03, P s ≤ .042). No cross-lagged associations involving sleep disturbance or duration with pain intensity were significant.
Conclusions:
Significant bi-directional, cross-lagged associations exist between headache and both sleep and pain. The findings suggest that early intervention for headaches may help prevent later sleep disturbance and pain after pediatric mTBI.
