Saturday, October 18, 2014

Sleep and Childhood Concussion - Brain Injury. Often Problematic. Often Overlooked.

Following brain injury, sleep disorders are often overlooked in the care of children, teens and young adults. JR
Sleep disorders in children with traumatic brain injury: a case of serious neglect

  1. Gregory Stores1,* and
  2. Rachel Stores2
Article first published online: 12 MAY 2013

"Findings in the following recent studies illustrate the frequent persistence of disturbed sleep, which clearly has implications for rehabilitation. Castriotta et al.[9] reported the presence of sleep disturbance in 46% of adult patients at least 3 months after TBI; Baumann et al.[10]described 72% of adults with TBI as having sleep disturbances 6 months after the injury that were not present before the accident; Fogelberg et al.[11] found persistent sleep difficulties in 44% of rehabilitation patients 1 year after TBI, and in the subsequent study by Baumann's group[12] such sleep problems were shown to be still present 3 years after injury in two-thirds of patients.
Studies of TBI and sleep disturbance in children are few, and the findings can be inconsistent.
 Using retrospective parental reports for pre-injury sleep and repeated prospective post-injury assessments up to 2 years, Beebe et al.[13] described children aged 6 to 12 years with severe TBI as being at increased risk for post-injury sleep problems compared with those with moderate TBI and a comparison group of children with only an orthopaedic injury. I
n contrast, a small group of 7- to 12-year-old children with a mild TBI 6 months before assessment were said to have greater sleep disturbance than children with orthopaedic injuries.[14] 
In a small-scale study, Kaufman et al.[15] found that adolescents who had suffered a minor head injury 3 years previously still complained of severe sleep disturbances and showed polysomnographic and actometry results in keeping with their complaints. 
Subsequently, researchers from the same group followed a larger number of adolescents who had suffered a minor head injury up to 6 years previously, and found that over a quarter still had subjective sleep disturbance.[16]
A more recent prospective study over 2 years of children aged up to 17 years of age who had experienced TBI confirmed a higher rate of sleep disturbance (with more prolonged duration) than comparison children who had experienced an orthopaedic injury.[17] 
Risk factors included pain, psychosocial factors, and mild TBI, which has been reported to be possibly more closely correlated with an increased likelihood of sleep disturbance than severe forms of TBI.[18] The counter-intuitive recurrent theme that mild TBI particularly seems to predispose to sleep disturbance is just one of the many current imponderables in this area of enquiry."


The aim of this study was to review the basic aspects of sleep disturbance in children with traumatic brain injury (TBI).


A search was performed on reports of sleep disturbances in children who had suffered TBI. Adults with TBI were also considered to anticipate the nature and significance of such disturbances in younger patients. Types of reported sleep disturbance were noted and their possible aetiology and management considered.


Sleep disturbance has consistently been associated with TBI but the literature suggests that this aspect of patient care is often inadequately considered and there has been little research on the subject, especially in relation to children. Excessive daytime sleepiness is often mentioned, less so insomnia and parasomnias, but there is little information about the specific sleep disorders underlying these problems.


Sleep disorders with potentially important developmental consequences have been neglected in the care of children with TBI. Screening for sleep problems should be routine and followed, if indicated, by a detailed diagnosis of the child's underlying specific sleep disorder, the possible aetiology of which includes neuropathology and potential medical, psychological, or psychiatric comorbidities. Appropriate assessments and modern treatment options are now well defined although generally underutilized. Further well-designed research is needed for which guidelines are available.

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