Citation

Luther M, Poppert Cordts KM, Williams CN. Sleep 2020; ePub(ePub): ePub.

Affiliation

Division of Pediatric Critical Care, Department of Pediatrics, Oregon Health & Science University and Doernbecher Children's Hospital, Portland, Oregon.

Copyright

(Copyright © 2020, American Academy of Sleep Medicine, Publisher Associated Professional Sleep Societies)

DOI

10.1093/sleep/zsaa083

PMID

32328648

Abstract

STUDY OBJECTIVES: Sleep is vital for brain development and healing after injury, placing children with sleep wake disturbances (SWD) after traumatic brain injury (TBI) at risk for worse outcomes. We conducted a systematic review to quantify SWD after pediatric TBI including prevalence, phenotypes, and risk factors. We also evaluated interventions for SWD and the association between SWD and other post-traumatic outcomes.

METHODS: Systematic searches were conducted in MEDLINE, PsychINFO, and reference lists for English language articles published from 1999-2019 evaluating sleep or fatigue in children hospitalized for mild complicated, moderate, or severe TBI. Two independent reviewers assessed eligibility, extracted data, and assessed risk of bias using the Newcastle-Ottowa Score for observational studies.

RESULTS: Among 966 articles identified in the search, 126 full text articles were reviewed, and 24 studies were included (11 prospective, 9 cross-sectional, and 4 case studies). Marked heterogeneity was found in study populations, measures defining SWD, and time from injury to evaluation. Studies showed at least 20% of children with TBI had trouble falling or staying asleep, fatigue, daytime sleepiness, and nightmares. SWD are negatively correlated with post-traumatic cognitive, behavioral, and quality of life outcomes. No comparative intervention studies were identified. Risk of bias was moderate-high for all studies often related to lack of validated or objective SWD measures and small sample size. Heterogeneity precluded meta-analyses.

CONCLUSIONS: SWD are important morbidities after pediatric TBI, though current data is limited. SWD have implications for TBI recovery, and may represent a modifiable target for improving outcomes after pediatric TBI.

© Sleep Research Society 2020. Published by Oxford University Press on behalf of the Sleep Research Society. All rights reserved. For permissions, please e-mail journals.permissions@oup.com.

Language: en

Keywords

brain injury; outcomes; pediatric; quality of life; sleep