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

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

doi:10.3390/children9050748

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

Children (Basel). 2022 May 19;9(5):748. doi: 10.3390/children9050748.

Authors

Cydni N Williams^{1

2}, Cindy T McEvoy³, Miranda M Lim^{4

5

6

7}, Steven A Shea⁸, Vivek Kumar¹, Divya Nagarajan², Kurt Drury², Natalia Rich-Wimmer^{1

9}, Trevor A Hall^{1

9}

Affiliations

¹ Pediatric Critical Care and Neurotrauma Recovery Program, Oregon Health & Science University, Portland, OR 97239, USA.
² Division of Pediatric Critical Care, Department of Pediatrics, Oregon Health & Science University, Portland, OR 97239, USA.
³ Division of Neonatology, Department of Pediatrics, Oregon Health & Science University, Portland, OR 97239, USA.
⁴ Department of Neurology, Oregon Health & Science University, Portland, OR 97239, USA.
⁵ Division of Pulmonary and Critical Care Medicine, Department of Medicine, Oregon Health & Science University, Portland, OR 97239, USA.
⁶ Department of Behavioral Neuroscience, Oregon Health & Science University, Portland, OR 97239, USA.
⁷ VA Portland Health Care System, Oregon Health & Science University, Portland, OR 97239, USA.
⁸ Oregon Institute of Occupational Health Sciences, Oregon Health & Science University, Portland, OR 97239, USA.
⁹ Division of Pediatric Psychology, Department of Pediatrics, Oregon Health & Science University, Portland, OR 97239, USA.

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.

Keywords: brain injury; critical care; pediatric; sleep.

Abstract

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