Megan Brooks

June 16, 2015

SEATTLE — Children who sustain traumatic brain injury (TBI) are more likely to experience greater daytime sleepiness, sleep disturbances, and poorer overall sleep quality, and to have impaired emotional, physical, and social functioning, when compared with children without TBI, a small study suggests.

"For clinicians treating children with TBI, it's worth asking children or their parents about their sleep," principal investigator Kimberly Allen, PhD, RN, from the Center for Narcolepsy, Sleep and Health Research, Department of Women Children and Family Health Science, University of Illinois-Chicago, noted in an interview with Medscape Medical News.

She presented the study at SLEEP 2015: the Annual Meeting of the Associated Professional Sleep Societies.

Research Gaps

Pediatric TBI is common. Each year in the United States over 500,000 children are admitted to the hospital with a TBI. The short- and long-term consequences can include motor and sensory impairments; cognitive, emotional, and psychosocial impairments; and sleep problems, although sleep is less well studied, Dr Allen said.

She and her colleagues assessed the sleep of 15 children with TBI (3 with mild TBI, 5 with moderate TBI, 6 with severe TBI, and 1 with unknown TBI severity) compared with that of 15 healthy children, matched on age, race, and maternal education level. The children were about 11 years of age on average. Those with TBI were an average of 594 days post-injury (range, 26 to 1076 days).

As hypothesized, compared with healthy children, children with TBI demonstrated statistically significant increases in daytime sleepiness on the modified Epworth Sleepiness Scale (P = .03), poorer sleep quality on the Child Sleep Wake Scale (P = .001), and poorer functional status on the Pediatric Quality of Life Inventory (P < .001). Overall, the effect sizes were "high and clinically relevant," the researchers note in their poster.

"Sleep is something physicians need to ask about in children with TBI," Dr Allen said.

She noted that "in most studies of pediatric TBI and sleep, sleep has been a secondary aim, not a primary aim," and they haven't used standardized sleep measures.

"This study," Dr Allen said, "provides a first glance at what children with TBI look like in terms of sleep compared to their peers that are healthy, typically developing children. We need more research in this area."

It should be noted, she added, that most children with TBI were hospitalized for more than 1 week and required rehabilitation, which may play a role in why they experienced daytime sleepiness, poorer sleep quality, and poorer functional status.

"Important" Study

Reached by email for comment, Suresh Kotagal, MD, consultant in neurology, pediatrics and sleep medicine, Mayo Clinic, Rochester, Minnesota, said, "The results are important as they address an important gap in pediatric sleep medicine, i.e., hypersomnia, that develops after head injury."

Dr Kotagal, who wasn't involved in the study, said there are likely "multiple factors underlying excessive daytime sleepiness after head injury. To start with, one has to consider variables prior to trauma that can impact sleep such as hyperactivity and anxiety. The head injury itself could also lead to central neurotransmitter imbalance or hypocretin deficiency that predispose to drowsiness. Medications utilized in head injured children such as antiepileptic drugs and antispasticity agents like baclofen can also contribute to drowsiness."

"Pediatric physical medicine and rehabilitation programs need to pay more attention to post-traumatic hypersomnia as an important treatable symptom that influences cognitive function and the overall quality of life," Dr Kotagal told Medscape Medical News.

Shalini Paruthi, MD, fellow of the American Academy of Sleep Medicine and director of the Pediatric Sleep and Research Center at SSM Cardinal Glennon Children's Medical Center, St. Louis, Missouri, told Medscape Medical News that sleep in children with TBI "hasn't been studied enough, so it's great to have this pilot data. Being able to recognize that sleep problems might be part of the TBI effects is very important."

"As part of comprehensive care for our kids who have traumatic brain injuries, we should also be thinking about their sleep. Better sleep may have an impact on healing. We don't know that yet, but it's possible," added Dr Paruthi, who wasn't involved in the study.

The study was supported by a grant from the University of Washington. The authors, Dr Kotagal, and Dr Paruthi have disclosed no relevant financial relationships.

SLEEP 2015: Annual Meeting of the Associated Professional Sleep Societies. Poster 1050. Presented June 8, 2015.


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