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Persistent Sleep Disturbances Independently Predict Poorer Functional and Social Outcomes 1 Year After Mild Traumatic Brain Injury

Chan, Lai Gwen MRCP, MRCPsych; Feinstein, Anthony MPhil, PhD, FRCP

Journal of Head Trauma Rehabilitation: November/December 2015 - Volume 30 - Issue 6 - p E67–E75
doi: 10.1097/HTR.0000000000000119
Original Articles
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Objective: To investigate the effect of sleep disturbances on functional and social outcomes after mild traumatic brain injury.

Setting: Outpatient traumatic brain injury clinic in a tertiary trauma center.

Participants: A total of 374 mild traumatic brain injury patients were assessed within 3 months of injury and followed up every 3 months for 1 year.

Design: Analysis of a historical cohort in a naturalistic clinical setting.

Main measures: At each visit, symptoms of concussion and psychological distress and indices of functional and social outcomes were measured with the Rivermead Postconcussion Questionnaire, 28-item General Health Questionnaire, and Rivermead Head Injury Follow-up Questionnaire, respectively. Changes in outcome scores over time were explored using repeated measures analysis of variance and compared between subjects with persistent (SD) and recovered (SR) sleep disturbances. Predictors of functional/social outcome were determined using linear regression.

Results: The percentages of subjects reporting sleep disturbances at each time point were 71.9%, 57.2%, 55.1%, and 53.7%, respectively. For functional and social outcomes, significant effects of time (F3,315 = 9.54; P < .001), group (SD vs SR) F1,317 = 5.32; P = .022, and time X group interaction F3,315 = 4.14; P = .007 were found. Persistent sleep disturbance (P = 0.011) and higher symptom burden at 6 months postinjury (P < .0001) were independent predictors of poorer outcome.

Conclusion: Sleep disturbance, independent of psychological distress, is an important prognostic factor of functional and social outcomes after mild traumatic brain injury.

Supplemental Digital Content is Available in the Text.

Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada (Dr Chan), and, Department of Psychological Medicine, Tan Tock Seng Hospital, Jalan Tan Tock Seng, Singapore (Dr Chan); and Department of Psychiatry, University of Toronto and Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada (Dr Feinstein).

Corresponding Author: Lai Gwen Chan, MRCP, MRCPsych, Department of Psychological Medicine, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore 308433 (lai_gwen_chan@ttsh.com.sg).

Supplemental digital content is available for this article. Direct URL citation appears in the printed text and is provided in the HTML and PDF versions of this article on the journal's Web site (www.headtraumarehab.com).

The authors declare no conflicts of interest.

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