The Impact of Sleep Disturbances on Health-Related Quality of Life in Children With Acquired Brain Injury After Critical Care

Amy Colagiovanni Morrison; Trevor A Hall; Vivek Kumar; Cydni N Williams

doi:10.1016/j.pediatrneurol.2023.01.002

The Impact of Sleep Disturbances on Health-Related Quality of Life in Children With Acquired Brain Injury After Critical Care

Pediatr Neurol. 2023 Apr:141:25-33. doi: 10.1016/j.pediatrneurol.2023.01.002. Epub 2023 Jan 11.

Authors

Amy Colagiovanni Morrison¹, Trevor A Hall², Vivek Kumar³, Cydni N Williams⁴

Affiliations

¹ Oregon Health & Science University, Pediatric Critical Care and Neurotrauma Recovery Program, Portland, Oregon. Electronic address: colagiov@ohsu.edu.
² Oregon Health & Science University, Pediatric Critical Care and Neurotrauma Recovery Program, Portland, Oregon; Division of Pediatric Psychology, Department of Pediatrics, Oregon Health & Science University, Portland, Oregon.
³ Oregon Health & Science University, Pediatric Critical Care and Neurotrauma Recovery Program, Portland, Oregon.
⁴ Oregon Health & Science University, Pediatric Critical Care and Neurotrauma Recovery Program, Portland, Oregon; Division of Pediatric Critical Care, Department of Pediatrics, Oregon Health & Science University, Portland, Oregon.

PMID: 36739796
PMCID: PMC10040440
DOI: 10.1016/j.pediatrneurol.2023.01.002

Abstract

Background: Over 60,000 children with acquired brain injury (ABI) in the United States require admission to pediatric intensive care units annually. Over 50% suffer sleep-wake disturbances (SWDs) months after discharge. Given the importance of sleep to brain repair, we hypothesized that SWD would be associated with poorer health-related quality of life (HRQOL).

Methods: Cross-sectional analysis of prospectively collected data in children with ABI aged 3 to 18 years evaluated 1 to 3 months after critical care hospitalization (N = 151). SWD measured by Sleep Disturbances Scale for Children and defined as T-score ≥60 signifying moderate-severe risk of sleep disorders. HRQOL measured by Pediatric Quality of Life Inventory, which defines minimal clinically important difference as 4.5 points in total score. Secondary outcomes included scores for Physical, Emotional, Social, and School Function domains. SWD groups were compared with Mann-Whitney tests. Multiple linear regression evaluated association between SWD and HRQOL controlling for patient and ABI characteristics. Significance was defined as P < 0.05.

Results: SWDs were present in 66% (n = 100). HRQOL total score was significantly lower in children with SWD (median = 70; interquartile range [IQR] = 54, 80) versus without (median = 85; IQR = 67, 94; P < 0.001). Median scores in emotional, social, and school domains were significantly lower in SWD group (all P < 0.01). When controlling for age, sex, critical care interventions, preadmission comorbidities, and decline from preadmission Functional Status Scale, presence of SWD significantly reduced HRQOL total score nearly three times minimal clinically important difference (β-coefficient = -12.1; 95% confidence Interval = -17.9, -6.2).

Conclusions: SWD following ABI significantly decreased HRQOL overall and across multiple health domains. Sleep is potentially modifiable. Our data support future studies targeting sleep to improve outcomes after ABI.

Keywords: Brain injuries; Circadian rhythm; Intensive care units; Pediatric; Quality of life; Sleep disorders.

Publication types

Research Support, N.I.H., Extramural

MeSH terms

Brain Injuries*
Child
Cross-Sectional Studies
Humans
Quality of Life / psychology
Sleep
Sleep Wake Disorders* / etiology

Grants and funding

K23 HL150229/HL/NHLBI NIH HHS/United States