Research Reports - Association of daytime somnolence with executive functioning in the first 6 months after adolescent traumatic brain injury

PM R. 2013 Jul;5(7):554-62

Osorio MB, Kurowski BG, Beebe D, Taylor HG, Brown TM, Kirkwood MW, Wade SL

OBJECTIVE: To determine the relationship between severity of injury and
self-reports and parent reports of daytime somnolence in adolescents after
traumatic brain injury (TBI), and to determine the relationship between daytime
somnolence and self-report and parent report of executive functioning in daily
life.
DESIGN: Cross-sectional study conducted within the first 6 months (mean ±
standard deviation 14.97 ± 7.51 weeks) after injury. Partial correlation
controlling for injury severity was used to examine the associations of TBI
severity with daytime somnolence and the association of daytime somnolence with
executive functioning.
SETTING: Outpatient visits at 3 children's hospitals and 2 general hospitals with
pediatric trauma commitment.
PARTICIPANTS: A total of 102 adolescents, 12-18 years old, who sustained
moderate-to-severe TBI (n = 60) or complicated mild TBI (n = 42).
MAIN OUTCOME MEASUREMENTS: Parent-report Sleepiness Scale, Epworth Sleepiness
Scale (youth report), Behavior Rating Inventory of Executive Function (BRIEF)
(self-report and maternal report).
RESULTS: Adolescents who sustained moderate-to-severe TBI had increased daytime
somnolence compared with those with complicated mild injuries in the parent
report but not in the youth report. Based on the parent report, 51% of
adolescents with moderate-to-severe TBI showed significant daytime somnolence
compared with 22% of those with complicated mild TBI. The parent report of
daytime somnolence was associated with executive dysfunction on both the BRIEF
self-report and parent report; however, the youth report of daytime somnolence
was associated only with the BRIEF self-report.
CONCLUSIONS: The parent report of daytime somnolence correlated with TBI severity
and predicted executive functioning difficulties of the teens in everyday
circumstances. Although a correlation between daytime somnolence and executive
dysfunction were also apparent on self-report, this did not differ based on
injury severity. Teens tended to report fewer difficulties with executive
function, which suggests that the teens have decreased awareness of their
impairments.

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