Sleep-Wake Disturbances After Acquired Brain Injury in Children Surviving Critical Care - PubMed

Sleep-Wake Disturbances After Acquired Brain Injury in Children Surviving Critical Care - PubMed

Sleep-Wake Disturbances After Acquired Brain Injury in Children Surviving Critical Care

Cydni N Williams 1, Mary E Hartman 2, Cindy T McEvoy 3, Trevor A Hall 4, Miranda M Lim 5, Steven A Shea 6, Madison Luther 7, Kristin P Guilliams 8, Rejean M Guerriero 9, Christopher C Bosworth 10, Juan A Piantino 11

Affiliations 

• PMID: 31735567
 
• PMCID: PMC7042044 (available on 2021-02-01)
 
• DOI: 10.1016/j.pediatrneurol.2019.08.010

Free PMC article

Abstract

Background: Sleep-wake disturbances are underevaluated among children with acquired brain injury surviving critical care. We aimed to quantify severity, phenotypes, and risk factors for sleep-wake disturbances.

Methods: We performed a prospective cohort study of 78 children aged ≥3 years with acquired brain injury within three months of critical care hospitalization. Diagnoses included traumatic brain injury (n = 40), stroke (n = 11), infectious or inflammatory disease (n = 10), hypoxic-ischemic injury (n = 9), and other (n = 8). Sleep Disturbances Scale for Children standardized T scores measured sleep-wake disturbances. Overall sleep-wake disturbances were dichotomized as any total or subscale T score ≥60. Any T score ≥70 defined severe sleep-wake disturbances. Subscale T scores ≥60 identified sleep-wake disturbance phenotypes.

Results: Sleep-wake disturbances were identified in 44 (56%) children and were classified as severe in 36 (46%). Sleep-wake disturbances affected ≥33% of patients within each diagnosis and were not associated with severity of illness measures. The most common phenotype was disturbance in initiation and maintenance of sleep (47%), although 68% had multiple concurrent sleep-wake disturbance phenotypes. One third of all patients had preadmission chronic conditions, and this increased risk for sleep-wake disturbances overall (43% vs 21%, P = 0.04) and in the traumatic brain injury subgroup (52% vs 5%, P = 0.001).

Conclusions: Over half of children surviving critical care with acquired brain injury have sleep-wake disturbances. Most of these children have severe sleep-wake disturbances independent of severity of illness measures. Many sleep-wake disturbances phenotypes were identified, but most children had disturbance in initiation and maintenance of sleep. Our study underscores the importance of evaluating sleep-wake disturbances after acquired brain injury.

Keywords: Brain injury; Critical care outcomes; Pediatric; Sleep; Sleep-wake disorders; Trauma.

Copyright © 2019 Elsevier Inc. All rights reserved.

Conflict of interest statement

Disclosures: The authors have no conflicts of interest or financial relationships relevant to this article to disclose

Similar articles

• Increased Sleep Need and Reduction of Tuberomammillary Histamine Neurons after Rodent Traumatic Brain Injury.

  Noain D, Büchele F, Schreglmann SR, Valko PO, Gavrilov YV, Morawska MM, Imbach LL, Baumann CR.J Neurotrauma. 2018 Jan 1;35(1):85-93. doi: 10.1089/neu.2017.5067. Epub 2017 Oct 27.PMID: 28762870
• Persistent Sleep Disturbances Independently Predict Poorer Functional and Social Outcomes 1 Year After Mild Traumatic Brain Injury.

  Chan LG, Feinstein A.J Head Trauma Rehabil. 2015 Nov-Dec;30(6):E67-75. doi: 10.1097/HTR.0000000000000119.PMID: 25931180
• Sleep-Wake Disturbances After Traumatic Brain Injury: Synthesis of Human and Animal Studies.

  Sandsmark DK, Elliott JE, Lim MM.Sleep. 2017 May 1;40(5):zsx044. doi: 10.1093/sleep/zsx044.PMID: 28329120 Free PMC article. Review.
• Evaluation of tentorial length and angle in sleep-wake disturbances after mild traumatic brain injury.

  Yaeger K, Alhilali L, Fakhran S.AJR Am J Roentgenol. 2014 Mar;202(3):614-8. doi: 10.2214/AJR.13.11091.PMID: 24555599
• Sleep and wake disturbances following traumatic brain injury.

  Duclos C, Dumont M, Wiseman-Hakes C, Arbour C, Mongrain V, Gaudreault PO, Khoury S, Lavigne G, Desautels A, Gosselin N.Pathol Biol (Paris). 2014 Oct;62(5):252-61. doi: 10.1016/j.patbio.2014.05.014. Epub 2014 Aug 7.PMID: 25110283 Review.