Sleep outcomes in pediatric mild traumatic brain injury: a systematic review and meta-analysis of prevalence and contributing factors

OBJECTIVE: The aim was to determine the prevalence of disturbed sleep in children who sustained mild traumatic brain injury (mTBI). METHODS: We conducted electronic searches of three databases MEDLINE, PsychINFO and EMBASE against pre-determined inclusion/exclusion criteria. We used the Newcastle-Ottawa Scale to assess the risk of bias. RESULTS: Forty-four articles met the inclusion criteria. The risk of bias was mainly rated as moderate to high. Meta-analysis revealed that prevalence of sleep disturbances decreased as the time since injury increased: 51%, 40% and 9% within 1 week, between 1 week and 1 month, and between 1 and 3 months, respectively, but increased to 21% after 3 months. The sleep symptom drowsiness followed a similar temporal pattern. Other sleep symptoms of hypersomnia (sleeping more than usual) and insomnia (trouble falling asleep and sleeping less than usual) remained stable over time. The prevalence of sleep disturbances in children with mTBI was higher than in the general population. Pre-injury sleep and older age at injury were related to worse sleep outcomes. CONCLUSIONS: Sleep disturbances are highly prevalent in the acute phase post-mTBI. Given that disturbed sleep can impact daily functioning and recovery, routine screening and management of sleep disturbances in children who sustain mTBI is important.