Do sleep difficulties exacerbate deficits in sustained attention following traumatic brain injury?

AbstractSustained attention has been shown to be vulnerable following traumatic brain injury (TBI). Sleep restriction and disturbances have been shown to negatively affect sustained attention. Sleep disorders are common but under-diagnosed after TBI. Thus, it seems possible that sleep disturbances may exacerbate neuropsychological deficits for a proportion of individuals who have sustained a TBI. The aim of this prospective study was to examine whether poor sleepers post-TBI had poorer sustained and general attentional functioning than good sleepers post-TBI. Retrospective subjective, prospective subjective, and objective measures were used to assess participants’ sleep. The results showed that the poor sleep group had significantly poorer sustained attention ability than the good sleep group. The differences on other measures of attention were not significant. This study supports the use of measures that capture specific components of attention rather than global measures of attention, and highlights the importance of assessing and treating sleep problems in brain injury rehabilitation. (JINS, 2010, 16, 17–25.)

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Executive Functions and Their Relation to Sleep Following Mild Traumatic Brain Injury in Preschoolers

Journal of the International Neuropsychological Society ◽

10.1017/s1355617718000401 ◽

2018 ◽

Vol 24 (8) ◽

pp. 769-780 ◽

Cited By ~ 12

Author(s):

Catherine Landry-Roy ◽

Annie Bernier ◽

Jocelyn Gravel ◽

Miriam H. Beauchamp

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Executive Functioning ◽

Executive Functions ◽

Sleep Disturbances ◽

Sleep Problems ◽

Poor Sleep ◽

Healthy Children ◽

Post Injury ◽

Mild Tbi

AbstractObjectives:Traumatic brain injury (TBI) sustained during childhood is known to impact children’s executive functioning. However, few studies have focused specifically on executive functioning after preschool TBI. TBI has also been associated with sleep disturbances, which are known to impair executive functions in healthy children. The aim of this study was to investigate executive functions in preschoolers with mild TBI, and to determine the role of sleep in the links between TBI and executive functioning.Methods:The sample was drawn from a longitudinal study and included 167 children, aged 18 to 60 months, divided into 2 groups: children with accidental mild TBI (n=84) and typically developing children (n=83). Children were assessed 6 months post-injury on executive function measures (inhibition and cognitive flexibility) and sleep measures (actigraphy data and parental rating of sleep problems).Results:The two groups did not differ in their executive abilities. However, relative to controls, children with mild TBI and shorter nighttime sleep duration or increased sleep problems exhibited poorer executive functions.Conclusions:These results support a “double hazard” effect, whereby the combination of sleep disturbances and mild TBI results in poorer executive functions. The findings highlight the importance of assessing and monitoring the quality of sleep even after mild head injuries. Poor sleep may place children at risk for increased cognitive difficulties. (JINS, 2018,24, 769–780)

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P111 Sleep disturbances are associated with poor neurobehavioural outcomes following traumatic brain injury: A study of military service members and veterans

SLEEP Advances ◽

10.1093/sleepadvances/zpab014.154 ◽

2021 ◽

Vol 2 (Supplement_1) ◽

pp. A57-A57

Author(s):

C Pattinson ◽

T Brickell ◽

J Bailie ◽

L Hungerford ◽

S Lippa ◽

...

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Military Service ◽

Sleep Disturbances ◽

Tissue Injury ◽

Soft Tissue Injury ◽

Service Member ◽

Service Members ◽

Poor Sleep ◽

Military Service Members

Abstract Introduction Sleep disturbances are pervasively reported in military service members and veterans, especially following traumatic brain injury (TBI). The purpose of this study was to examine the association between sleep disturbances and neurobehavioural outcomes in a large group of U.S. military service members and veterans, with and without a history of TBI. Methods Participants were enrolled into the Defense and Veterans Brain Injury Center/Traumatic Brain Injury Center of Excellence, 15-Year Longitudinal TBI study (N = 606). Participants self-reported sleep disturbances (PROMIS 8A) and neurobehavioral symptoms. Data were analyzed using analysis of variance with post-hoc comparisons. Four groups were analyzed separately: uncomplicated mild TBI (MTBI; n=218); complicated mild, moderate, severe, or penetrating - combined TBI (CTBI; n=118); injured controls (IC, i.e., orthopedic or soft-tissue injury without TBI; n=162); and non-injured controls (NIC; n=108). Results Participants in the MTBI group reported the highest proportion of moderate-severe sleep disturbances (66.5%) compared to the IC (54.9%), CTBI (47.5%), and NIC groups (34.3%). Participants classified as having Poor Sleep reported significantly worse scores on almost all TBI-QOL scales compared to those classified as having Good Sleep, regardless of TBI severity or even the presence of TBI (ps<.05, Cohen’s ds>.3). Discussion This study demonstrates that sleep disturbances remain a prevalent and debilitating concern in service member and veteran populations. Regardless of group (injured or NIC), sleep disturbances were common and were associated with significantly worse neurobehavioral functioning. When assessing and treating neurobehavioural symptoms, it is important to assess sleep, especially in service member and veteran populations.

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A-117 Sleep Disruption has a Stronger Influence on Self-reported Neurobehavioral Status than Traumatic Brain Injury in U.S. Military Service Members and Veterans

Archives of Clinical Neuropsychology ◽

10.1093/arclin/acaa068.117 ◽

2020 ◽

Vol 35 (6) ◽

pp. 910-910

Author(s):

Lange R ◽

French L ◽

Bailie J ◽

Hungerford L ◽

Lippa S ◽

...

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Military Service ◽

Service Members ◽

Sleep Disruption ◽

Poor Sleep ◽

Mild Tbi ◽

Military Service Members ◽

Good Sleep ◽

Neurobehavioral Outcome

Abstract Objective To examine the relation between sleep disruption and neurobehavioral outcome following mild, moderate, and severe traumatic brain injury (TBI). Methods Participants were 509 U.S. military service members/veterans divided into four groups: uncomplicated mild TBI (n = 183; MTBI); complicated mild TBI and moderate–severe TBI (n = 96; STBI); injured controls (n = 138; IC); and non-injured controls (n = 92; NIC). Participants completed a 2-hour neurobehavioral test battery 12 or more months post-injury that included the PTSD Checklist and 13 scales from the TBI-Quality of Life (TBI-QOL). Using the TBI-QOL Sleep Disturbance scale, participants were classified into two ‘Sleep’ subgroups: Poor Sleep (55 T or higher) or Good Sleep (50 T or lower). Results A higher proportion of the MTBI group was classified as having Poor Sleep (79.2%) compared to the IC (64.5%) and STBI (58.3%) groups; and all were higher than the NIC group (40.2%). In each group separately, participants with Poor Sleep had significantly worse scores on all TBI-QOL scales compared to those with Good Sleep (all p’s < .001, d = .68 to d = 1.98). Participants with Poor Sleep consistently had worse TBI-QOL scores regardless of TBI severity or the presence/absence of TBI (all p’s < .05). Additionally, there was a significant interaction between Sleep and PTSD. Both factors combined resulted in worse outcome than either factor alone (p’s < .05). Conclusions Poor Sleep had a very strong influence on self-reported neurobehavioral outcome, and a greater influence on outcome than TBI severity or the presence/absence of TBI. Poor Sleep may be a useful ‘risk factor’ that can be used clinically to identify individuals in need of early intervention.

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Pediatric Sleep Difficulties after Moderate–Severe Traumatic Brain Injury

Journal of the International Neuropsychological Society ◽

10.1017/s1355617713000465 ◽

2013 ◽

Vol 19 (7) ◽

pp. 829-834 ◽

Cited By ~ 30

Author(s):

Ruth E. Sumpter ◽

Liam Dorris ◽

Thomas Kelly ◽

Thomas M. McMillan

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Behavioral Problems ◽

Sleep Problems ◽

Sleep Onset ◽

Self Report ◽

Sleep Habits ◽

Severe Tbi ◽

Pediatric Tbi ◽

Sleep Difficulties

AbstractThe objective of this study is to systematically investigate sleep following moderate–severe pediatric traumatic brain injury (TBI). School-aged children with moderate–severe TBI identified via hospital records were invited to participate, along with a school-age sibling. Subjective reports and objective actigraphy correlates of sleep were recorded: Children's Sleep Habits Questionnaire (CSHQ), Sleep Self-Report questionnaire (SSR), and 5-night actigraphy. TBI participants (n= 15) and their siblings (n= 15) participated. Significantly more sleep problems were parent-reported (CSHQ:p= 0.003;d= 1.57), self-reported (SSR:p= 0.003;d= 1.40), and actigraph-recorded in the TBI group (sleep efficiency:p= 0.003;d= 1.23; sleep latency:p= 0.018;d= 0.94). There was no evidence of circadian rhythm disorders, and daytime napping was not prevalent. Moderate–severe pediatric TBI was associated with sleep inefficiency in the form of sleep onset and maintenance problems. This preliminary study indicates that clinicians should be aware of sleep difficulties following pediatric TBI, and their potential associations with cognitive and behavioral problems in a group already at educational and psychosocial risk. (JINS, 2013,19, 1–6)

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020 Sleep Quality Affects the Plasma Exosomal MicroRNA Expression Profile in Military Personnel with Traumatic Brain Injury

SLEEP ◽

10.1093/sleep/zsab072.019 ◽

2021 ◽

Vol 44 (Supplement_2) ◽

pp. A9-A10

Author(s):

Sara Mithani ◽

Jacqueline Leete ◽

Josephine Pucci ◽

Viivan Guedes ◽

Kimbra Kenney ◽

...

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Sleep Quality ◽

Military Personnel ◽

Sleep Disturbances ◽

Poor Sleep ◽

Ptsd Symptoms ◽

Poor Sleep Quality ◽

Disturbed Sleep ◽

Exosomal Microrna

Abstract Introduction Disordered sleep is a critical issue facing the US military due to its negative impact on maintaining force readiness, health, and well-being. Traumatic brain injury (TBI) is highly prevalent among military personnel and commonly co-occurs with disturbed sleep: up to 89% of military service members with TBI report poor sleep quality. Disturbed sleep is a hallmark of post-traumatic stress disorder (PTSD), which often coexists with TBI, with upward of 90% of patients with PTSD reporting some form of sleep disturbance. The pathophysiological mechanisms underlying sleep disturbances in TBI patients remain elusive. Exosomal microRNA (exomiRs), which are implicated in intracellular communication, may provide novel insight into molecular networks related to sleep disturbances in TBI patients. Methods ExomiR was extracted from plasma samples of 108 post-9/11 military personnel, and veterans with a history of mild TBI enrolled in a multicenter prospective longitudinal study. ExomiR profiling analysis was conducted using nCounter Human v3 miRNA Expression Panel with 798 microRNA probes. Sleep quality was assessed using the global score on the Pittsburgh Sleep Quality Index (PSQI), and symptoms of PTSD were measured with the PTSD Checklist for DSM-5 (PCL-5). Generalized linear models and Spearman’s correlations were constructed to analyze the relationship between levels of exomiR and global PSQI score. Results We found 17 exomiR that were significantly (P < 0.05) associated with sleep quality and 11 exomiR significantly associated with PTSD symptoms. Two exomiR, has-miR-1268a and has-miR-139-5p, were significantly associated with both sleep quality and PTSD symptoms. The top three significant exomiR associated with sleep quality were hsa-miR-1250-5p (r = 0.2295, p = 0.0171), hsa-miR-3615(r = 0.2207, p = 0.0229), and hsa-miR-122-5p(r = 0.2069, p = 0.0132). Conclusion Overall, these findings suggest that analysis of exosomal miRNA expression may provide novel insights into the underlying pathobiology of sleep quality in military personnel with mild TBI, independent of PTSD symptoms. Further research is needed to understand the biological underpinnings of poor sleep quality in individuals with TBI and to determine causal links. Support (if any) Intramural Research Program at the NINR, Department of Defense, Chronic Effects of Neurotrauma Consortium (CENC) Award W81XWH-13-2-0095 and Department of Veterans Affairs CENC Award I01 CX001135.

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