Department of Paediatrics, University of Calgary, Calgary, Canada; Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Canada; Faculty of Medicine, Children's Health Research Centre, University of Queensland, St Lucia, Australia.
Department of Clinical Neurosciences, University of Calgary, Calgary, Canada; Section of Pediatrics, Alberta Children's Hospital, Calgary, Canada.
Pediatr Neurol. 2020 Apr;105:27-34. doi: 10.1016/j.pediatrneurol.2019.11.006. Epub 2019 Dec 17.
Sleep disturbance is common after a mild traumatic brain injury (mTBI) in children, yet its biology is poorly understood. We aimed to explore sleep-related problems (SRPs), sleep-activity patterns, and endogenous melatonin production in children with different recovery trajectories following mTBI. We hypothesized that children with delayed recovery would have more SRPs and abnormal sleep-activity patterns, which would correlate with lower overnight melatonin production.
In this prospective controlled cohort study, we enrolled 83 children with persistent symptoms, 26 children who had clinically recovered following mTBI, and 25 healthy controls. SRPs were evaluated using the sleep subscale of the Post-Concussion Symptom Inventory. Sleep actigraphy was performed for five to seven days at 37 (S.D. 7) days post-injury. Health-related quality of life and mood disturbance was assessed using the Child Health Questionnaire and the Behavior Assessment System for Children, respectively. Endogenous melatonin production was assessed using overnight urine collection.
The groups were similar in age (13.9 [S.D. 2.6] years) and sex (52% female). Regression analysis demonstrated increased SRP in the symptomatic group (9.0; 95% confidence interval: 7.6, 11.1) compared with the recovered group (1.6; 95% confidence interval: 1.0, 2.4) and controls (2.0; 95% confidence intervals: 1.2, 3.2). Actigraphy parameters and urinary melatonin levels were not significantly different between groups. Neither SRPs nor actigraphy parameters correlated with anxiety and depression scores.
Although children with persistent post-concussion symptoms reported more SRPs, this was not related to actigraphy sleep parameters or melatonin production. Further research is warranted to understand the pathophysiology of post-traumatic sleep disturbance.
儿童轻度创伤性脑损伤（mTBI）后常出现睡眠障碍，但睡眠障碍的生物学机制尚不清楚。我们旨在探讨 mTBI 后不同恢复轨迹患儿的睡眠相关问题（SRP）、睡眠-活动模式和内源性褪黑素生成。我们假设恢复延迟的患儿会有更多的 SRP 和异常的睡眠-活动模式，这与夜间褪黑素生成减少有关。
在这项前瞻性对照队列研究中，我们纳入了 83 名持续存在症状的患儿、26 名 mTBI 后临床康复的患儿和 25 名健康对照。使用创伤后症状问卷的睡眠子量表评估 SRP。在受伤后 37（S.D. 7）天内进行了 5-7 天的睡眠活动记录仪监测。使用儿童健康问卷和儿童行为评估系统分别评估健康相关生活质量和情绪障碍。使用过夜尿液收集评估内源性褪黑素生成。
三组在年龄（13.9[S.D.2.6]岁）和性别（52%女性）方面相似。回归分析显示，症状组的 SRP 增加（9.0；95%置信区间：7.6，11.1），而恢复组（1.6；95%置信区间：1.0，2.4）和对照组（2.0；95%置信区间：1.2，3.2）则较低。各组间的活动记录仪参数和尿褪黑素水平无显著差异。SRP 和活动记录仪参数均与焦虑和抑郁评分无关。
尽管持续性创伤后症状患儿报告了更多的 SRP，但这与活动记录仪睡眠参数或褪黑素生成无关。需要进一步研究以了解创伤后睡眠障碍的病理生理学。
