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      The Longitudinal Course, Risk Factors, and Impact of Sleep Disturbances in Children with Traumatic Brain Injury

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          Abstract

          This study aimed to examine the prevalence and trajectory of sleep disturbances and their associated risk factors in children up to 24 months following a traumatic brain injury (TBI). In addition, the longitudinal association between sleep disturbances and children's functional outcomes was assessed. This was a prospective study of a cohort of children with TBI and a comparison cohort of children with orthopedic injury (OI). Parental reports of pre-injury sleep disturbances were compared to reports of post-injury changes at 3, 12, and 24 months. Risk factors for sleep disturbances were examined, including severity of TBI, presence of psychosocial problems, and pain. Sleep disturbances were also examined as a predictor of children's functional outcomes in the areas of adaptive behavior skills and activity participation. Both cohorts (children with TBI and OI) displayed increased sleep disturbances after injury. However, children with TBI experienced higher severity and more prolonged duration of sleep disturbances compared to children with OI. Risk factors for disturbed sleep included mild TBI, psychosocial problems, and frequent pain. Sleep disturbances emerged as significant predictors of poorer functional outcomes in children with moderate or severe TBI. Children with TBI experienced persistent sleep disturbances over 24 months. Findings suggest a potential negative impact of disturbed sleep on children's functional outcomes, highlighting the need for further research on sleep in children with TBI.

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          Most cited references38

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          A national evaluation of the effect of trauma-center care on mortality.

          Ellen J MacKenzie, Frederick Rivara, Gregory Jurkovich … (2006)
          Hospitals have difficulty justifying the expense of maintaining trauma centers without strong evidence of their effectiveness. To address this gap, we examined differences in mortality between level 1 trauma centers and hospitals without a trauma center (non-trauma centers). Mortality outcomes were compared among patients treated in 18 hospitals with a level 1 trauma center and 51 hospitals non-trauma centers located in 14 states. Patients 18 to 84 years old with a moderate-to-severe injury were eligible. Complete data were obtained for 1104 patients who died in the hospital and 4087 patients who were discharged alive. We used propensity-score weighting to adjust for observable differences between patients treated at trauma centers and those treated at non-trauma centers. After adjustment for differences in the case mix, the in-hospital mortality rate was significantly lower at trauma centers than at non-trauma centers (7.6 percent vs. 9.5 percent; relative risk, 0.80; 95 percent confidence interval, 0.66 to 0.98), as was the one-year mortality rate (10.4 percent vs. 13.8 percent; relative risk, 0.75; 95 percent confidence interval, 0.60 to 0.95). The effects of treatment at a trauma center varied according to the severity of injury, with evidence to suggest that differences in mortality rates were primarily confined to patients with more severe injuries. Our findings show that the risk of death is significantly lower when care is provided in a trauma center than in a non-trauma center and argue for continued efforts at regionalization. Copyright 2006 Massachusetts Medical Society.
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            Traumatic brain injury in the United States: A public health perspective.

            D Thurman, C M ALVERSON, K. Dunn … (1999)
            Traumatic brain injury (TBI) is a leading cause of death and disability among persons in the United States. Each year, an estimated 1.5 million Americans sustain a TBI. As a result of these injuries, 50,000 people die, 230,000 people are hospitalized and survive, and an estimated 80,000-90,000 people experience the onset of long-term disability. Rates of TBI-related hospitalization have declined nearly 50% since 1980, a phenomenon that may be attributed, in part, to successes in injury prevention and also to changes in hospital admission practices that shift the care of persons with less severe TBI from inpatient to outpatient settings. The magnitude of TBI in the United States requires public health measures to prevent these injuries and to improve their consequences. State surveillance systems can provide reliable data on injury causes and risk factors, identify trends in TBI incidence, enable the development of cause-specific prevention strategies focused on populations at greatest risk, and monitor the effectiveness of such programs. State follow-up registries, built on surveillance systems, can provide more information regarding the frequency and nature of disabilities associated with TBI. This information can help states and communities to design, implement, and evaluate cost-effective programs for people living with TBI and for their families, addressing acute care, rehabilitation, and vocational, school, and community support.
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              Sleep deprivation and pain perception.

              Jürgen-Christian Krieg, Stefan Lautenbacher, Bernd Kundermann (2006)
              Chronically painful conditions are frequently associated with sleep disturbances, i.e. changes in sleep continuity and sleep architecture as well as increased sleepiness during daytime. A new hypothesis, which has attracted more and more attention, is that disturbances of sleep cause or modulate acute and chronic pain. Since it is well-known that pain disturbs sleep the relationship between the two has since recently been seen as reciprocal. To fathom the causal direction from sleep to pain we have reviewed experimental human and animal studies on the effects of sleep deprivation on pain processing. According to the majority of the studies, sleep deprivation produces hyperalgesic changes. Furthermore, sleep deprivation can interfere with analgesic treatments involving opioidergic and serotoninergic mechanisms of action. The still existing inconsistency of the human data and the exclusive focus on REM sleep deprivation in animals so far do not allow us to draw firm conclusions as to whether the hyperalgesic effects are due to the deprivation of specific sleep stages or whether they result from a generalized disruption of sleep continuity.
              Article 0 comments Cited 149 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Title: Journal of Neurotrauma
                Abbreviated Title: Journal of Neurotrauma
                Publisher: Mary Ann Liebert Inc
                ISSN (Print): 0897-7151
                ISSN (Electronic): 1557-9042
                Publication date Created: January 2012
                Publication date (Print): January 2012
                Volume: 29
                Issue: 1
                Pages: 154-161
                Affiliations
                [1 ]Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, Washington.
                [2 ]Department of Pediatrics, University of Washington, Seattle, Washington.
                [3 ]Harborview Injury Prevention and Research Center, University of Washington, Seattle, Washington.
                [4 ]Department of Rehabilitation Medicine, University of Washington, Seattle, Washington.
                [5 ]Department of Epidemiology, University of Washington, Seattle, Washington.
                [6 ]Department of Rehabilitation Psychology, Seattle Children's Hospital, Seattle, Washington.
                [7 ]Department of Biostatistics, University of Washington School of Public Health, Seattle, Washington.
                [8 ]Department of Neurological Surgery, University of Washington, Seattle, Washington.
                [9 ]Department of Emergency Medicine, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
                Article
                DOI: 10.1089/neu.2011.2126
                PMC ID: 3253307
                PubMed ID: 22029569
                SO-VID: 763c1b8c-b905-4217-b9d8-9cbacb13e693
                Copyright © © 2012
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