小儿轻度创伤性脑损伤和骨科损伤中的睡眠障碍与脑震荡后症状
Sleep Disturbance and Postconcussive Symptoms in Pediatric Mild Traumatic Brain Injury and Orthopedic Injury.
作者信息
Luszawski Caroline A, Minich Nori M, Bigler Erin D, Taylor H Gerry, Bacevice Ann, Cohen Daniel M, Bangert Barbara A, Zumberge Nicholas A, Tomfohr-Madsen Lianne M, Brooks Brian L, Yeates Keith Owen
机构信息
Author Affiliations: Department of Psychology, University of Calgary, Calgary, Alberta (Ms Luszawski and Dr Yeates); Alberta Children's Hospital Research Institute, Calgary, Alberta (Ms Luszawski and Dr Yeates); Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta (Ms Luszawski and Dr Yeates); Department of Pediatrics, Case Western Reserve University, Cleveland, Ohio (Ms Minich, Dr Bacevice, and Dr Bangert); Rainbow Babies and Children's Hospital, University Hospitals Cleveland Medical Center, Cleveland, Ohio (Ms Minich and Dr Bacevice); Department of Psychology and Neuroscience, Brigham Young University, Provo, Utah and Departments of Neurology and Psychiatry, University of Utah, Salt Lake City, Utah (Dr Bigler); Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, Ohio (Dr Taylor); Department of Pediatrics, The Ohio State University, Columbus, Ohio (Drs Taylor, Cohen, and Zumberge); Emergency Medicine, Nationwide Children's Hospital, Columbus, Ohio (Dr Cohen); Department of Radiology, University Hospitals of Cleveland, Cleveland, Ohio (Dr Bangert); Radiology, Nationwide Children's Hospital, Columbus, Ohio (Dr Zumberge); Educational and Counselling Psychology, University of British Columbia, Vancouver, British Columbia (Dr Tomfohr-Madsen); Neurosciences Program, Alberta Children's Hospital, Calgary, Alberta (Dr Brooks); and Departments of Pediatrics, Clinical Neurosciences, and Psychology, University of Calgary, Calgary, Alberta (Dr Brooks).
出版信息
J Head Trauma Rehabil. 2025;40(3):157-166. doi: 10.1097/HTR.0000000000001005. Epub 2024 Sep 13.
OBJECTIVE
Sleep disturbance (SD) is common after pediatric mild traumatic brain injury (mTBI) and may predict increased postconcussive symptoms (PCS) and prolonged recovery. Our objective was to investigate the relation of SD with PCS in children with mTBI and those with orthopedic injury (OI).
SETTING
Emergency departments (EDs) at 2 children's hospitals in the Midwestern United States.
PARTICIPANTS
Children and adolescents aged 8 to 16 years old diagnosed with either a mTBI ( n = 143) or OI ( n = 74) and recruited within 24 hours postinjury.
DESIGN
Observational, prospective, concurrent cohort study with longitudinal follow-up.
MAIN MEASURES
Parents rated children's preinjury sleep retrospectively shortly after injury, and postinjury sleep at 3 and 6 months postinjury, using the Sleep Disorders Inventory for Students. Parents rated children's preinjury symptoms retrospectively in the emergency department, and parents and children rated PCS at 3 and 6 months, using the Health and Behavior Inventory and the Postconcussive Symptom Interview. Weekly ratings on the Health and Behavior Inventory were also obtained remotely.
RESULTS
Postinjury SD was modestly but not significantly higher in the mTBI group compared to the OI group ( P = .060, d = 0.32). Children with mTBI who were symptomatic postacutely based on parent ratings had worse parent-rated sleep outcomes at 3 and 6 months postinjury compared to children who were not symptomatic. Greater preinjury SD also predicted more postinjury SD and more severe PCS regardless of injury type.
CONCLUSIONS
The results suggest potential bidirectional associations between SD and PCS after mTBI. Studies of treatments for SD following pediatric mTBI are needed.
目的
睡眠障碍（SD）在小儿轻度创伤性脑损伤（mTBI）后很常见，并且可能预示着脑震荡后症状（PCS）增加以及恢复时间延长。我们的目的是研究mTBI患儿和骨科损伤（OI）患儿中SD与PCS之间的关系。
背景
美国中西部两家儿童医院的急诊科。
参与者
8至16岁的儿童和青少年，诊断为mTBI（n = 143）或OI（n = 74），并在受伤后24小时内招募。
设计
观察性、前瞻性、同期队列研究，并进行纵向随访。
主要测量指标
家长在受伤后不久回顾性地对孩子受伤前的睡眠进行评分，并在受伤后3个月和6个月对受伤后的睡眠进行评分，使用学生睡眠障碍量表。家长在急诊科回顾性地对孩子受伤前的症状进行评分，家长和孩子在3个月和6个月时对PCS进行评分，使用健康与行为量表和脑震荡后症状访谈。还通过远程方式获得了对健康与行为量表的每周评分。
结果
与OI组相比，mTBI组受伤后的SD略有升高，但无显著差异（P = 0.060，d = 0.32）。根据家长评分，急性后期有症状的mTBI患儿在受伤后3个月和6个月时，家长评定的睡眠结果比无症状的患儿更差。无论损伤类型如何，受伤前SD较高也预示着受伤后SD更多以及PCS更严重。
结论
结果表明mTBI后SD与PCS之间可能存在双向关联。需要开展针对小儿mTBI后SD的治疗研究。
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