Subjective and objective sleep outcomes in young adults who sustained traumatic brain injury in childhood: relationship with fatigue, depression, and quality of life

Abstract

Background: Traumatic Brain Injury (TBI) is highly prevalent in children and often associated with impairments in several functional domains including sleep. Sleep-wake disturbances (SWD) are common in children with TBI and are associated with functional impairments in several domains. While some children may recover from SWD in the short-term postinjury, others may experience persistent symptoms, until late adolescence. Although not explored in children with TBI, studies involving adults with TBI have associated SWD with fatigue and depression symptoms, with these symptoms often co-occurring and impacting quality of life (QoL). In addition, no study has investigated sleep-wake outcomes in adulthood following childhood TBI. This thesis is aimed at evaluating outcomes of subjective and objective sleep, fatigue, depression, and QoL, and the relationship between these outcomes in a sample of young adults with a history of childhood TBI. Also examined were the relationships between sleep outcomes and injury-related factors, socio-demographic factors, mental health, lifestyle factors, and medication use.

Methods: The study used a longitudinal prospective design with a cross-sectional assessment of sleep outcomes. Participants included 54 young adults with childhood TBI (mild, moderate, and severe) and 13 typically developing control (TDC) participants matched to the TBI group on age, sex, and socioeconomic status at the time of recruitment. SWD were assessed subjectively with questionnaires and objectively using 14 days actigraphy recording, and all other evaluations were subjective.

Results: At 20 years postinjury, subjective sleep outcomes were generally favorable in young adults who sustained TBI in childhood, although moderate TBI was associated with poorer subjective sleep quality compared to severe TBI. With the exception of objective sleep duration, no other objective sleep parameter was significantly associated with history of childhood TBI or TBI severity. Fatigue, depression, and QoL outcomes were also similar between study groups. Nonetheless, poor subjective sleep quality was significantly associated with evening chronotype, increased use of tobacco and psychotropic medications, greater symptoms of anxiety and pain, as well as increased symptoms of fatigue and depression, and reduced health status in the TBI group.

Conclusions: Evidence from this first evaluation of SWD in young adulthood following childhood TBI revealed favorable outcomes in SWD, fatigue, depression, and QoL at this developmental stage postinjury, although a subgroup of this TBI sample presented with problems in these domains. Poor subjective sleep quality in the TBI group was associated with less severe TBI, mental health and physiological factors, behavioural factors, and QoL. These findings provide preliminary insight into these outcomes at this stage postinjury and highlight the important influence of sleep in these related domains, particularly, fatigue, depression, and QoL. Clinicians are encouraged to routinely assess sleep and these related outcomes in young adults who have sustained TBI in childhood to identify those at risk of poor outcomes and improve very-long-term outcomes in this TBI population.