Sleep-Wake Disturbances and Fatigue after Pediatric Traumatic Brain Injury: A Systematic Review of the Literature

Abstract

Sleep-wake disturbances (SWD) after traumatic brain injury (TBI) are frequently reported and can persist several years post-injury. The adult literature covering this topic is exhaustive; numerous robust studies using objective measures of sleep and advanced methodologies support the presence of SWD post-TBI. Despite being the leading cause of morbidity in children and adolescents, however, relatively few studies exist investigating SWD and symptoms of fatigue after pediatric TBI. We undertook a systematic search of the literature in PsycINFO, MEDLINE, CINAHL, and Web of Science databases with the aim of documenting persistent fatigue and SWD after pediatric TBI. Terms and keywords pertaining to TBI, children/adolescents, and sleep/fatigue were used, and of the 461 articles initially identified, 24 studies met our inclusion criteria. According to the results of the literature search, SWD and fatigue are common after pediatric TBI. The methodologies used in the studies reported varied widely, however, and were mainly subjective (e.g., questionnaires and interviews with caregivers). Moreover, no study targeted preschool children despite the fact that there is evidence regarding the critical importance of sleep for appropriate cognitive development, especially in high-order cognitive functioning. In sum, the results of the studies analyzed were consistent with the presence of SWD and fatigue after pediatric TBI, but there is a lack of information concerning this relationship in younger children. The use of more objective measures, such as actigraphy, could bring better insight to the impact of TBI on the quality of children's sleep.

Sleep, Sleep Disorders, and Mild Traumatic Brain Injury. What We Know and What We Need to Know: Findings from a National Working Group

“…Various self-report instruments have been used in studies of adult and pediatric patients with TBI [39][40][41]. To date, only the Pittsburgh Sleep Quality Index and the Epworth Sleepiness Scale have been validated against objective measures of sleep in patients with TBI [42][43][44][45][46].…”

“…However, self-reported sleep does not always capture the nature or severity of underlying organic sleep pathology or clinical sleep disorder. Further, self-report can be compromised based on injury-related cognitive impairment, recency or salience effects (i.e., remembering only the most recent or unusual experiences), or reliance on data from indirect sources such as caregivers or parents of children [40]. For example, patients in hospitals or institutionalized settings (e.g., following polytrauma) have sleep-wake schedules and daily routines imposed upon them and are also frequently disrupted by medical practitioners and monitoring, which may mask existing sleep problems or contribute to the development of new sleep difficulties [47].…”

A review of sleep disturbances following traumatic brain injury

“…Recent reviews of sleep disturbances in pediatric patients following TBI demonstrated that most studies focused on adolescents and used subjective measures to evaluate symptoms (Gagner et al 2015;Hung et al 2014;Beebe et al 2007). However, sleep disturbances were common post-injury and included excessive daytime sleepiness, increased sleep latency and circadian rhythm disruption, though the latter was not as common (Gagner et al 2015). One such prospective study of 15 patients demonstrated that sleep onset and maintenance difficulties were significantly increased in the TBI group when compared to their siblings (Sumpter et al 2013).…”

Interventions for managing weight change following paediatric acquired brain injury: a systematic review

“…One of the most typically reported concerns following paediatric ABI is depleted stamina. 4 Given this, it is noteworthy that none of the included papers specified stamina as either a primary or secondary outcome. Consideration as to how interventions may improve stamina and consequent function needs to be present in future studies.…”

“…3 Impaired stamina is a wellrecognized feature post-ABI, with disordered appetite and inadequate nutrition compounding this effect. 4 Children with ABI face greater risk of developing obesity than the general population. 2 In one study investigating adverse effects in survivors following childhood low grade glioma, cumulative incidence of being overweight (body mass index [BMI] <30 but ≥25) or obese (BMI ≥30) at 5, 10, and 15 years was 18%, 35%, and 53% respectively.…”