Affiliation:
1. Pediatric Critical Care and Neurotrauma Recovery Program, Oregon Health & Science University, Portland, OR
2. Division of Child and Adolescent Psychiatry, Department of Psychiatry, University of Nebraska Medical Center, Omaha, NE
3. Division of Pediatric Critical Care, Department of Pediatrics, Oregon Health & Science University and Doernbecher Children’s Hospital, Portland, OR
Abstract
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 posttraumatic outcomes.
Methods
Systematic searches were conducted in MEDLINE, PsychINFO, and reference lists for English language articles published from 1999 to 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 posttraumatic cognitive, behavioral, and quality of life outcomes. No comparative intervention studies were identified. The 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 are limited. SWD have implications for TBI recovery and may represent a modifiable target for improving outcomes after pediatric TBI.
Funder
Agency for Healthcare Research and Quality
Publisher
Oxford University Press (OUP)
Subject
Physiology (medical),Clinical Neurology
Cited by
16 articles.
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