Sleep disturbances following pediatric traumatic brain injury

Traumatic brain injury (TBI) remains a glaring issue for public health in the United States, particularly in children and adolescents. One of the most frequent complaints of patients following TBI is the presence of sleep disturbances (SD). Bodily injury in children and adolescents also presents a public health concern as well. The association between pediatric TBI and SD is vastly understudied, and even less is known regarding SD after bodily injury. Importantly, SD in children and adolescents has been linked independently to a number of adverse health outcomes, such as internalizing behavior problems. Additionally, posttraumatic stress symptoms have been linked to traumatic injury and to SD. The current study aimed to investigate chronic SD after TBI and bodily injury in children and adolescents, as well as relations between SD, internalizing behavior problems, and posttraumatic stress after injury. Study design utilized data from 8-15 year olds following TBI, extracranial/bodily injury (EI), and typically developing children. At 6 and 12-month time points, mixed model analyses of variance were used to assess group differences in SD, internalizing behavior problems, and posttraumatic stress, while multiple mediation models analyzed mechanisms of action. SD was significantly positively associated with severity of injury in the EI group. SD was higher in injury groups than in typically developing children when TBI and EI groups were combined. Internalizing behavior problems were higher in both injury groups. SD and internalizing behavior problems had a persisting bidirectional association where each mediated the other in each injury group when compared to typically developing children. Posttraumatic stress symptoms did not vary between injury groups and were not mediated by SD after injury. Findings are relevant for further understanding and clinical management of SD and their relation to internalizing problems after traumatic injury.