A Longitudinal Investigation of Sleep and Daytime Wakefulness in Children and Youth With Concussion

Abstract

A high proportion of adults who sustain a concussion identify changes in their sleep during the acute stage, typically reporting an increased need for sleep or nonrestful sleep. Our understanding of sleep following concussion is less well understood within a pediatric population. In this study, we investigated the trajectory of sleep and daytime sleepiness in a prospective cohort of 40 children and youth (6–18 years old) with concussion, 40 age-and sex-matched healthy children and youth, and 40 with upper-extremity orthopedic injury. Evaluations occurred during the acute stage (<2 weeks) and at 3-, 6-, and 12-month postinjury using the Sleep Disturbance Scale for Children and the Postconcussion Symptom Scale. There were no significant differences within- or between-group differences in sleep across all four time points with analysis of the groups as a whole. When groups were divided by age (6–11 and 12– < 18 years), there was a significant difference in the ability to initiate sleep for the younger concussed group during the acute stage, compared with healthy controls, as well as significantly greater daytime nap duration that decreased over time. Significant correlations were also found between the frequency and duration of daytime naps and Postconcussion Symptom Scale total score and subscores (cognitive, physical/migraine, mood, and sleep) in the concussed group during the acute stage. Our results suggest that in a group with noncomplicated concussion, children and youth have transient alterations in daytime sleepiness that are related to concussion symptoms. Younger children may be more vulnerable to disturbances in sleep and daytime wakefulness.

Report of Early Childhood Traumatic Injury Observations & Symptoms: Preliminary Validation of an Observational Measure of Postconcussive Symptoms

“…Sleep and comfort-seeking symptoms were consistently elevated in the younger group PA and 1-month postinjury. While sleep disturbances are known PCS,32,33 comfort-seeking is a novel category that was included in REACTIONS to better represent behaviors typical of early childhood mTBI; this factor may have particular value in identifying PCS in an age-appropriate manner.…”

“…Given the lack of any validated PCS measure for children 5 years of age and younger, and the need for a developmentally appropriate approach to documenting PCS in preverbal and emerging talkers, the objectives of this work are to report the development of an observational PCS measure for use with infants, toddlers, and preschoolers, and to provide preliminary validation information for the Report of Early Childhood Traumatic Injury Observations & Symptoms (REAC-TIONS) inventory. Specifically, the study aimed to (i) document the process for REACTIONS domain and item selection; (ii) report acute (24-48 h), postacute (7-14 days), and persistent (25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)…”

Daily Morning Blue Light Therapy for Post-mTBI Sleep Disruption: Effects on Brain Structure and Function

“…Among the myriad of neurobiological consequences faced by individuals who have sustained a mild traumatic brain injury, sleep disruption is among the most common and the most persistent ( 15 – 19 ). Up to 90% of individuals who sustain a mTBI report some form of sleep disruption—including insomnia, frequent wakefulness after sleep onset, and a general sense of poor sleep quality ( 19 – 24 )—or associated complaints of increased daytime fatigue or sleepiness that interferes with one or more activities of daily living ( 25 – 28 ). These sleep-related complaints often go untreated and may persist for months to years post-injury.…”

Assessment and Treatment of Concussion in the Pediatric Population

“…There was no difference between the four groups; however, when the groups were divided by age 6 to 11 and 12 to 18 years, there was a significant difference in the ability to initiate sleep for the younger concussed group during the acute stage compared with the healthy controls. 69 Compared with males, females reported higher levels of sleep disturbances after a single concussion; however, levels of sleep disturbance equalized after repeated concussions. Females with higher levels of sleep disturbance have more headaches and more mood changes requiring medical treatment.…”