Sleep difficulties and their impact on recovery following mild traumatic brain injury in children

Abstract

Objective: To determine the frequency of sleep difficulties in children following mild traumatic brain injury (TBI) over time and explore the role of sleep on recovery and behaviour.

Methods: Longitudinal study of 109 children aged between 8–16 years who had experienced a mild TBI, with an embedded case control study. Parents completed assessments of the child’s sleep quality, symptoms and behaviour at baseline, 1, 6 and 12 months post-injury. Regression analyses explored the impact of poor sleep on 12-month outcomes. Healthy control children were assessed at one time point for comparison to determine the longer-term impact of brain injury on sleep.

Results: The number of children experiencing poor sleep quality peaked 1-month post-injury (39%), reducing to 28% 12-months post-injury. Poor sleep quality at 1-month was associated with increased frequency and severity of symptoms and poorer behavioural outcomes 1 year post-TBI. Cases with TBI were significantly more likely to have sleep difficulties 1-year post-injury than controls (Odds ratio = 3.09).

Conclusions: Sleep difficulties are common following mild TBI in children and are predictive of longer-term outcomes. Identifying children with sleep difficulties post-injury and providing support to facilitate sleep may improve their longer-term functioning.

Keywords:

• Epidemiology
• traumatic brain injury
• sleep
• longitudinal
• children

Acknowledgements

We thank the research team for their dedication and performance, in addition to staff at the New Zealand Accident Compensation Corporation, New Zealand Health Information Service; Waikato District Health Board; Waikato University Staff, Schools and sports clubs in the Hamilton and Waikato region. We thank the many doctors, nurses and rehabilitation professionals and service providers such as ABI Management and administrative staff within and outside Hamilton who referred patients into the study. Additionally, we would like to thanks the participants and their families. We thank Helen McDonald for her administrative support for the study.

We would like to acknowledge all members of the BIONIC Research Group who contributed to the conduct of the BIONIC study and the analysis presented in this manuscript. BIONIC and COBIC Study Research Group Members: Valery Feigin, Alice Theadom, Kelly Jones, Kathryn McPherson, Amy Jones, Braden Te Ao, Paul Brown, Peggy Fairbairn-Dunlop (Auckland University of Technology); Suzanne Barker-Collo, Rob Kydd, P. Alan Barber, Varsha Parag, Shanthi Ameratunga (University of Auckland), Nicola Starkey (University of Waikato), Tony Dowell (University of Otago), Michael Kahan, Grant Christey (Waikato DistrIct Health Board), Natalie Hardaker (Accident Compensation Corporation).

Declaration of interest

This work was funded by the Health Research Council of New Zealand (09/063A, 11/192). Alice Theadom was co-funded by ABI Management Rehabilitation and Kathryn McPherson held the Laura Fergusson Trust Chair. The authors report no conflicts of interest.