Outcomes of Subjective Sleep–Wake Disturbances Twenty Years after Traumatic Brain Injury in Childhood

Abstract

Sleep-wake disturbances (SWD) are frequent following traumatic brain injury (TBI) in childhood. However, outcomes of SWD following transition into young adulthood remain unknown. This study investigated prevalence and factors associated with subjective sleep quality, insomnia, and excessive daytime sleepiness in young adults with a history of childhood TBI. Participants included 54 young adults with mild (n = 14), moderate (n = 27), and severe (n = 13) TBI (age: mean = 27.7, SD = 3.3), and 13 typically developing controls (TDC) (age: mean = 25.9, SD = 2.2). SWD were assessed using the Pittsburgh Sleep Quality Index (PSQI), Insomnia Severity Index (ISI), and Epworth Sleepiness Scale (ESS). Compared with TDC, young adults with TBI reported a trend toward poorer sleep quality (F[1, 63] = 3.85, p = 0.054, η = 0.06), with a higher risk in participants after moderate TBI (mean = 2.40, SD = 0.56) than after severe TBI (mean = 1.89, SD = 0.62: p = 0.015). However, the groups did not differ on symptoms of insomnia and excessive daytime sleepiness, and SWD were less frequent after severe TBI at 20 years post-injury. Poor sleep quality in young adults with TBI was associated with high levels of anxiety and pain, and pain was also associated with higher risk of insomnia and excessive daytime sleepiness. Our findings indicate that sustaining TBI in childhood can increase risk of SWD in young adulthood, particularly following moderate TBI. Routine assessments and treatment of SWD, as well as anxiety and pain in children with TBI, should therefore continue into adulthood.

Ceftriaxone Treatment Preserves Cortical Inhibitory Interneuron Function via Transient Salvage of GLT-1 in a Rat Traumatic Brain Injury Model

“…As extensively reported in the literature, TBI effects extend far beyond the mechanical damage, with continuing excitotoxic neuronal injury (Li et al 2002;Hardingham and Bading 2003;Goforth et al 2011;Luo et al 2011;Choo et al 2012;Algattas and Huang 2014;Lai et al 2014;Patel et al 2014) leading to chronic sequelae, such as PTE, insomnia, and neurocognitive dysfunction (Christensen et al 2009;Wright et al 2014;Pugh et al 2015;Azouvi et al 2017;Wilson et al 2017;Wood 2017;Botchway et al 2018;DeGrauw et al 2018;Elliott et al 2018;Kalmbach et al 2018). That these long-term consequences appear after latent periods of weeks to months after the initial trauma suggests the underlying pathological processes are slow, yet pathologic shifts in cortical E:I balance are likely initiated during the critical subacute post-traumatic period and may be amenable to therapeutic interventions (Miyazaki et al 1989;Lyeth et al 1990).…”

Neuroprotection, Photoperiod, and Sleep

“…Botchway et al [46] reported that even 20 years after a TBI in childhood, young adulthood present increased risk of SWD and that this is more common after a moderate TBI than after a severe one.…”