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Sleep and Executive Functioning in Pediatric Traumatic Brain Injury Survivors after Critical Care

Williams, Cydni N., McEvoy, Cindy T., Lim, Miranda M., Shea, Steven A., Kumar, Vivek, Nagarajan, Divya, Drury, Kurt, Rich-Wimmer, Natalia, Hall, Trevor A.·2022·Children
DOI 10.3390/children9050748
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Abstract

Over 50,000 children are hospitalized annually for traumatic brain injury (TBI) and face long-term cognitive morbidity. Over 50% develop sleep/wake disturbances (SWDs) that can affect brain development and healing. We hypothesized SWDs would portend worse executive function outcomes in children aged 3–18 years with TBI 1–3 months after hospital discharge. SWDs were defined using the Sleep Disturbances Scale for Children (t-scores ≥ 60). Outcomes included the Global Executive Composite (GEC, t-score) from the Behavior Rating Inventory of Executive Function, Second and Preschool Editions, and multiple objective executive function assessments combined through Principal Components Analysis into a Neurocognitive Index (NCI, z-score). Multiple linear regression evaluated associations between SWDs and executive function outcomes, controlling for covariates. Among 131 children, 68% had clinically significant SWDs, which were associated with significantly worse median scores on the GEC (56 vs. 45) and NCI (−0.02 vs. 0.42; both p < 0.05). When controlling for baseline characteristics and injury severity in multivariable analyses, SWDs were associated with worse GEC (β-coefficient = 7.8; 95% Confidence Interval = 2.5, 13.1), and worse NCI (β-coefficient = −0.4; 95% Confidence Interval = −0.8, −0.04). SWDs in children with TBI are associated with worse executive function outcomes after hospital discharge, and may serve as modifiable targets to improve outcomes.

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Cited by

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Metadata

Authors
Williams, C. N., McEvoy, C. T., Lim, M. M., Shea, S. A., Kumar, V., Nagarajan, D., Drury, K., Rich-Wimmer, N., & Hall, T. A.
Affiliations
  • Pediatric Critical Care and Neurotrauma Recovery Program, Oregon Health & Science University, Portland, OR 97239, USA
  • Division of Neonatology, Department of Pediatrics, Oregon Health & Science University, Portland, OR 97239, USA
  • Department of Neurology, Oregon Health & Science University, Portland, OR 97239, USA
  • Oregon Institute of Occupational Health Sciences, Oregon Health & Science University, Portland, OR 97239, USA
  • Division of Pediatric Critical Care, Department of Pediatrics, Oregon Health & Science University, Portland, OR 97239, USA
ORCID
Venue
Children
Publisher
MDPI AG
Published
2022-05-19
Volume
9
Issue
5
Pages
748
ISSN
2227-9067
DOI
10.3390/children9050748
Cited by
10
References
7
Language
en
Licence
creativecommons.org/licenses/by/4.0/ (vor)
Funders
National Heart Lung and Blood Institute (K23HL150229-01)

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