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

Cydni N. Williams, Cindy T. McEvoy, Miranda Lim, Steven A. Shea, Vivek Kumar, Divya Nagarajan, Kurt Drury, Natalia Rich-Wimmer, Trevor A. Hall

Research output: Contribution to journalArticlepeer-review

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.

Original languageEnglish (US)
Article number748
JournalChildren
Volume9
Issue number5
DOIs
StatePublished - May 2022

Keywords

  • brain injury
  • critical care
  • pediatric
  • sleep

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

Fingerprint

Dive into the research topics of 'Sleep and Executive Functioning in Pediatric Traumatic Brain Injury Survivors after Critical Care'. Together they form a unique fingerprint.

Cite this