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A Systematic Review of Sleep-Wake Disturbances in Childhood Traumatic Brain Injury

Relationship with Fatigue, Depression, and Quality of Life

Botchway, Edith N., MSc; Godfrey, Celia, DPsych; Anderson, Vicki, PhD; Catroppa, Cathy, PhD

The Journal of Head Trauma Rehabilitation: November 28, 2018 - Volume Publish Ahead of Print - Issue - p
doi: 10.1097/HTR.0000000000000446
Original Article: PDF Only

Objective: To systematically appraise the literature on the prevalence, types, and predictors of sleep-wake disturbances (SWD), and on the relationship between SWD, fatigue, depression, and quality of life in children and adolescents with traumatic brain injury (TBI).

Methods: MEDLINE, PubMed, PsychInfo, Web of Science, and EMBASE databases were searched, reference lists of retrieved articles were also searched for relevant articles, and study methods were evaluated for risk of bias.

Results: Of the 620 articles assessed, 16 met inclusion criteria. Sleep-wake disturbances were common in childhood TBI. The most common types of SWD reported were insomnia and excessive daytime sleepiness, with mild TBI participants showing a trend toward more sleep maintenance insomnia, while sleep-onset insomnia was typical in those with moderate-severe TBI. Predictors of SWD reported in studies involving mild TBI participants included TBI severity, male sex, preexisting SWD, high body weight, and depression; while injury severity and internalizing problems were associated with SWD in moderate-severe TBI participants. Sleep-wake disturbances were also associated with fatigue and poor quality of life following TBI.

Conclusion: Sleep-wake disturbances are highly prevalent in childhood TBI, regardless of injury severity. Routine assessments of SWD in survivors of childhood TBI are recommended.

Murdoch Children's Research Institute, Melbourne, Australia (Ms Botchway and Drs Godfrey, Anderson, and Catroppa); The Royal Children's Hospital, Melbourne, Australia (Ms Botchway and Drs Godfrey, Anderson, and Catroppa); and Departments of Paediatrics (Ms Botchway and Drs Anderson and Catroppa) and Psychology (Drs Anderson and Catroppa), The University of Melbourne, Melbourne, Australia.

Corresponding Author: Edith N. Botchway, MSc, Clinical Sciences, Murdoch Children's Research Institute, 50 Flemington Rd, Parkville, Victoria, Australia 3052 ( or

The authors thank Poh Chau, Deputy Librarian, The Royal Children's Hospital, Melbourne, for her assistance with the literature search on MEDLINE.

E.N.B. is funded by The University of Melbourne International Fee Remission and the Melbourne International Research Scholarships, C.G. contributed in-kind, V.A. is funded by a National Health and Medical Research Council Senior Practitioner Fellowship, and C.C. is funded by a Murdoch Children's Research Institute Career Development Award.

The authors declare no conflicts of interest.

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