Sleepy heads: The role of sleep in recovery from mild traumatic brain injury in children

Transcription

1 Markin Undergraduate Student Research Program in Health & Wellness Sleepy heads: The role of sleep in recovery from mild traumatic brain injury in children Katie Girgulis E. Crowe, V. Kirk, & K. Barlow (Faculty Mentor) Cumming School of Medicine

2 Overview Background information Sleep and mild traumatic brain injury (mtbi) How did we study this? What did we find? Bigger picture what does it all mean? Limitations and future directions

3 Sleep disturbance is a common complaint Experienced by close to 50% of individuals post- TBI Hypersomnia Delayed sleep onset Frequent arousals Pathogenesis is largely unexplored Barlow et al Pediatrics 126(2): e374-e381 Barlow J Child Neurol doi: / Barlow et al Pediatric Neurology doi: /j.pediatrneurol Castriotta et al. J Clin Sleep Med 3(4): Ryu et al Can J Neurol Sci 36(4):

4 Actigraphy Wrist-worn accelerometer Advantages: Objective measurement Relatively inexpensive Non-invasive Monitor multiple days and nights Worn in normal sleeping environment Actiwatch 2

5 Research Question When compared to children who are asymptomatic following a mtbi and uninjured children: Do children who are symptomatic at onemonth post-mtbi have: delayed sleep phase? decreased sleep efficiency?

6 Study design A prospective, controlled, observational study 1 month Head injury 5 7 days Questionnaires PCSI Sleep monitoring Actiwatch 2 Sleep diary Actigraphy results

7 Actigraphy parameters Sleep Total sleep time Sleep onset latency Sleep efficiency Wake after sleep onset (WASO) Activity Ekblom et al. (2012) cut-off values % low, moderate, high, and vigorous activity Low Moderate High Vigorous counts / 15 s Ekblom et al J Phys Act Health 9: Jette et al Clin Cardiol 13:

8 Sleep interval Activity levels 11:00 PM 9:15 AM Sleep onset latency Wake Sleep } binary scoring Sleep efficiency = (time asleep / time in bed) x 100

9 Uninjured control Asymptomatic Symptomatic n = Age (years) ± ± ± 2.63 Male Anxiety 31.82% 50.00% 46.15% 0% 22.22% 34.62% p =.008 Post-injury PCSI 4.57 ± ± ± p <.001

10 12 p <.001 p <.001 PCSI: Sleep score Pre-injury Post-injury 0 3 Control Asymptomatic Symptomatic Mean Response Control Asymptomatic Symptomatic Symptomatics scored significantly higher on all questions (p<.05) 0 Trouble fallingsleeping more Sleeping less asleep than usual than usual Drowsy Fatigue

11 700 Total sleep time 70 Sleep onset latency Total sleep time (min) Onset latency (min) Control Asymptomatic Symptomatic 0 Control Asymptomatic Symptomatic p >.05 for all actigraphy sleep parameters

12 100 Sleep Efficiency 90 WASO Sleep Efficiency (%) WASO (min) Control Asymptomatic Symptomatic 0 Control Asymptomatic Symptomatic p >.05 for all actigraphy sleep parameters

13 Sleep diary & activity analyses Naps: rarely reported in ALL groups Accuracy of sleep diary (diary watch agreement ) Bedtime = ± 25 min Total sleep = ± 90 min Activity distribution: 52% low, 35% moderate, 8% high, 5% vigorous Similar in ALL groups

14 Take-home message Symptomatic children subjectively report greater sleep disturbance NOT confirmed with actigraphy or sleep diary Sleep diary is fairly representative of sleep Reliable for clinicians without Actiwatches One-month after mtbi, children who are symptomatic are similarly active as asymptomatic and uninjured children

15 Limitations Actigraphy is not polysomnography Estimate of sleep based on activity levels (arm movements) No information about sleep stages de Souza et al Sleep 26(1): Kanady et al J Sleep Res 20:

16 Future directions Study sleep with both polysomnography and actigraphy Confirm the current findings Any differences in sleep stages? Analyze relationship between pre-injury anxiety levels and perceived sleep disturbance post-mtbi Repeated sleep monitoring during recovery i.e. 1 week, 1 month, 3 months, 12 months Investigate the relationship between activity and mtbi recovery in symptomatic children

17 Thanks! Markin Undergraduate Student Research Program in Health & Wellness Dr. Karen Barlow Dr. Val Kirk Erica Crowe Trevor Seeger Tina Samuel Lorenzo Marcil Julie McSweeney Trevor Low