SLEEP PROBLEMS FOLLOWING MODERATE-TO-SEVERE PEDIATRIC TRAUMATIC BRAIN INJURY: PRESENCE, NATURE, LONG-TERM PATTERN, AND RELATIONSHIP TO NEUROPSYCHOLOGICAL DEFICITS

Neuropsychological sequelae of pediatric moderate-to-severe traumatic brain injury (TBI) include deficits in a wide range of cognitive domains, with significant impairments evident in some children many years after injury. In addition to cognitive deficits, research with adult and pediatric TBI survivors has documented sleep problems, though the nature and course of these problems in children remains poorly understood. The present study attempted to clarify the presence, nature, long-term pattern, and injury-related predictors of sleep problems, as well as the relationship between sleep and neuropsychological impairment, post moderate-to-severe TBI. It capitalized on archival longitudinal data that had been collected over the course of several years post-injury in a sample of children who sustained moderate-to-severe TBI, as compared to children who sustained only orthopedic injuries. Mixed-model repeated measures analyses of covariance (ANCOVA) indicated substantial divergence between the groups; there were no differences in baseline (pre-injury) sleep problems, but more sleep problems for the TBI group at all post-injury time points. Follow-up analyses revealed that the type of sleep problems reported post-TBI were characteristic of dyssomnias, with no differences between the two groups in parasomnias. Two series of multivariate linear regression analyses were also performed, one attempting to predict sleep problems based on injury characteristic data and the second to predict neuropsychological sequelae by post-injury sleep problems. None of the resulting regression equations were significant. This study is the first to document both short- and long-term sleep problems post pediatric TBI, with a differential impact on dyssomnias and no evidence of abatement even 4-years post-injury. Future research is needed to clarify the contributors to sleep problems post-TBI, as well as the relationship between post-injury sleep problems and daytime functioning.