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

PM R. 2013 Jan 29. pii: S1934-1482(12)01713-3

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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