The Association Between Sleep and Emotional Functioning in Pediatric Mild Traumatic Brain Injury: A Scoping Review

The primary aim of this scoping review was to summarize existing research on the association between sleep and emotional functioning in pediatric mild traumatic brain injury (mTBI). Topics of interest were: (1) whether the association differs in children with mTBI versus other children; (2) whether the association changes over time post-injury; and (3) the directionality of the association (i.e., whether unidirectional or bidirectional). A systematic search of the literature was conducted pertaining to studies conducted with children (ages 0-18) with mTBI. To be included, studies must have reported on the association of sleep and emotional functioning; any measures of the two factors were eligible for inclusion. APA PsycInfo, Embase, Ovid MEDLINE, Scopus, and SPORTDiscus were searched for relevant studies. A total of 922 studies were independently screened and reviewed, and a total of nine studies were extracted, which included 1254 participants (mTBI n = 1054, controls n = 173). Samples were drawn primarily from hospital emergency departments, concussion clinics, and/or sports medicine clinics but also included children recruited through a school/community concussion surveillance program. Six of the included studies were prospective, and three were cross-sectional. Four studies included control groups. Most included studies reported at least one significant association between sleep and emotional functioning, such that poor sleep and emotional difficulties were positively correlated. None of the included studies reported on whether the association differed between children with mTBI and other children. Additionally, no study examined whether the association changed over time, or whether sleep and emotional functioning had bidirectional relationships. The available evidence suggests that sleep and emotional functioning are associated in children with mTBI, but further research is needed to determine the directionality of the association and whether the strength of the association differs in children with mTBI.