Research Reports - Sleep problems and their relationship to cognitive and behavioral outcomes in children with traumatic brain injury

J Neurotrauma. 2014 Jul 15;31(14):1305-12

Shay N(1), Yeates KO, Walz NC, Stancin T, Taylor HG, Beebe DW, Caldwell CT, Krivitzky L, Cassedy A, Wade SL

Abstract This study examined the effect of traumatic brain injury (TBI) in young
children on sleep problems and the relationship of sleep problems to
neuropsychological and psychosocial functioning. Participants were drawn from an
ongoing longitudinal study of injury in young children recruited from 3 to 6
years of age. They constituted three groups: orthopedic injury (OI; n=92),
complicated mild/moderate TBI (mTBI; n=55); and severe TBI (sTBI; n=20).
Caregivers completed the Children's Sleep Habits Questionnaire (CSHQ), as well as
ratings of behavioral adjustment, adaptive functioning, and everyday executive
function at 1, 6, 12, and 18 months postinjury. Retrospective ratings of
preinjury sleep and psychosocial functioning were obtained at the initial
assessment. Children completed neuropsychological testing at all occasions.
Children with complicated mTBI demonstrated more total sleep problems than
children with OI at 6 months postinjury, but not at 12 or 18 months. Children
with sTBI displayed more bedtime resistance and shorter sleep duration than those
with complicated mTBI or OI at several occasions. Across groups, total sleep
problems predicted more emotional and behavioral problems and worse everyday
executive function as rated by parents across follow-up occasions. In contrast,
sleep problems were generally not related to neuropsychological test performance.
The results suggest that young children with TBI demonstrate more sleep problems
than children with injuries not involving the head. Sleep problems, in turn,
significantly increase the risk of poor psychosocial outcomes across time, but
are not associated with worse neuropsychological test performance.

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