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Sleep Disturbance in Children With Moderate or Severe Traumatic Brain Injury Compared With Children With Orthopedic Injury

Bogdanov, Stefan, DCP/MSc; Brookes, Naomi, MPsych (Clinical); Epps, Adrienne, MBBS; Naismith, Sharon L., PhD; Teng, Arthur, MBBS; Lah, Suncica, PhD

The Journal of Head Trauma Rehabilitation: March/April 2019 - Volume 34 - Issue 2 - p 122–131
doi: 10.1097/HTR.0000000000000426
Pediatric TBI 2019

Objectives: To characterize the sleep disturbance in children with moderate or severe traumatic brain injury (TBI), and to identify associated factors.

Setting: An urban tertiary pediatric healthcare facility.

Participants: Children aged 5 to 15 years with a moderate TBI (n = 21), severe TBI (n = 23), or an orthopedic injury (OI; n =38) comparable in age, gender, and socioeconomic status.

Design: Cohort study.

Measures: Primary: Sleep Disturbance Scale for Children (SDSC). Secondary: Injury-specific factors (TBI severity, age at injury, and time since injury), and other factors of interest (sleep hygiene; pain intensity; difficulties with internalizing, externalizing, or attention/hyperactivity; parental distress; and parental knowledge of TBI).

Results: On the SDSC, parents rated children with moderate TBI (but not severe TBI) as experiencing greater overall sleep disturbance, as well as excessive somnolence and sleep breathing disturbance, relative to OI controls. Children with severe TBI (but not moderate TBI) were rated as experiencing greater disturbance with initiating and maintaining sleep. The moderate and severe TBI groups did not differ on any of the sleep outcomes. Only 3 factors were associated with sleep disturbance in the combined TBI group: (1) lower TBI severity with greater excessive somnolence; (2) greater internalizing difficulties with greater overall sleep disturbance, and disturbance with initiating and maintaining sleep specifically; and (3) younger age at injury with greater overall sleep disturbance, and sleep breathing disturbance specifically.

Conclusion: Children with moderate or severe TBI experience greater overall and/or specific forms of sleep disturbance. Different forms of sleep disturbance may be associated with different factors.

School of Psychology (Drs Bogdanov and Lah) and Brain and Mind Centre and Charles Perkins Centre (Dr Naismith), University of Sydney, Camperdown, Australia; Rehab2Kids Rehabilitation Unit (Ms Brookes and Dr Epps) and Department of Sleep Medicine (Dr Teng), Sydney Children's Hospital, Randwick, Australia; School of Paediatrics and Women's Health, University of New South Wales, Kensington, Australia (Dr Teng); and ARC Centre of Excellence in Cognition and Its Disorders, Macquarie University, North Ryde, Australia (Dr Lah).

Corresponding Author: Stefan Bogdanov, DCP/MSc, School of Psychology, The University of Sydney, NSW 2006, Australia (

The authors thank Dr Angus Gray for his assistance with recruitment of children with orthopedic injuries at the Sydney Children's Hospital, Randwick.

The authors declare no conflicts of interest.

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