Sleep-Wake Disturbances Impact Approximately Half of Children With Acquired Brain Injury

Young boy in ICU hospital bed
Young boy in ICU hospital bed

Sleep-wake disturbances affect approximately 50% of children with acquired brain injury, and many children with preadmission chronic conditions have an increased risk for sleep-wake disturbances, a study in Pediatric Neurology suggests.

A total of 78 children (median age, 9.9 years) with acquired brain injury who had been released from critical care hospitalization within 3 months were enrolled in the prospective cohort study. Children were diagnosed with traumatic brain injury (n=40), stroke (n=11), infectious or inflammatory disease (n=10), hypoxic-ischemic injury (n=9), or other (n=8). The “other” diagnosis category included carbon monoxide, hemolytic uremic syndrome, severe sepsis, hippocampal necrosis after polypharmacy ingestion, and refractory status epilepticus. Sleep-wake disturbances were measured using standardized T scores from the Sleep Disturbances Scale for Children parent-reported, 26-item validated questionnaire.

Approximately 56% (n=44) of children had sleep-wake disturbances, with 46% (n=36) of these children having severe disturbances. In each diagnosis subgroup, the prevalence of sleep-wake disturbances was ≥33%. Approximately 47% of children with acquired brain injury had disturbance in the initiation and maintenance of sleep, which represented the most common phenotype in the sample. In addition, 68% of children had multiple concurrent sleep-wake disturbance phenotypes.

Chronic conditions prior to admission were observed in one-third of patients. The presence of preadmission chronic conditions was associated with sleep-wake disturbances in patients with traumatic brain injury (52% with disturbances vs 5% without disturbances; P =.001). Overall, the presence of preadmission chronic conditions was associated with an increased risk for sleep-wake disturbances (43% vs 21%; P =.04).

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Limitations of the study include the small and unique patient population as well as the short follow-up and lack of preinjury sleep measures.

The researchers concluded that “sleep-wake disorders offer a potentially modifiable target to improve recovery after acquired brain injury.” They emphasized that these findings “underscore the importance of systematically evaluating sleep in these children.”


Williams CN, Hartman ME, McEvoy CT, et al. Sleep-wake disturbances after acquired brain injury in children surviving critical care [published online August 26, 2019]. Pediatr Neurol. doi:10.1016/j.pediatrneurol.2019.08.010