Persistent Sleep Disturbances Independently Predict Poorer Functional and Social Outcomes 1 Year After Mild Traumatic Brain Injury.
OBJECTIVE
To investigate the effect of sleep disturbances on functional and social outcomes after mild traumatic brain injury.


METHODS
Outpatient traumatic brain injury clinic in a tertiary trauma center.


METHODS
A total of 374 mild traumatic brain injury patients were assessed within 3 months of injury and followed up every 3 months for 1 year.


METHODS
Analysis of a historical cohort in a naturalistic clinical setting.


METHODS
At each visit, symptoms of concussion and psychological distress and indices of functional and social outcomes were measured with the Rivermead Postconcussion Questionnaire, 28-item General Health Questionnaire, and Rivermead Head Injury Follow-up Questionnaire, respectively. Changes in outcome scores over time were explored using repeated measures analysis of variance and compared between subjects with persistent (SD) and recovered (SR) sleep disturbances. Predictors of functional/social outcome were determined using linear regression.


RESULTS
The percentages of subjects reporting sleep disturbances at each time point were 71.9%, 57.2%, 55.1%, and 53.7%, respectively. For functional and social outcomes, significant effects of time (F3,315 = 9.54; P < .001), group (SD vs SR) F1,317 = 5.32; P = .022, and time X group interaction F3,315 = 4.14; P = .007 were found. Persistent sleep disturbance (P = 0.011) and higher symptom burden at 6 months postinjury (P < .0001) were independent predictors of poorer outcome.


CONCLUSIONS
Sleep disturbance, independent of psychological distress, is an important prognostic factor of functional and social outcomes after mild traumatic brain injury.
Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada (Dr Chan), and, Department of Psychological Medicine, Tan Tock Seng Hospital, Jalan Tan Tock Seng, Singapore (Dr Chan); and Department of Psychiatry, University of Toronto and Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada (Dr Feinstein).
Lai Gwen
LG
Chan
Anthony
A
Feinstein
D000203:Activities of Daily Living; D000328:Adult; D000553:Ambulatory Care / Q000379:methods; D001930:Brain Injuries / Q000523:psychology* / Q000534:rehabilitation*; D016022:Case-Control Studies; D002908:Chronic Disease; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D007398:Interpersonal Relations; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D017286:Polysomnography / Q000379:methods*; D011237:Predictive Value of Tests; D011379:Prognosis; D018570:Risk Assessment; D012720:Severity of Illness Index; D012893:Sleep Wake Disorders / Q000209:etiology* / Q000503:physiopathology; D062606:Tertiary Care Centers; D014193:Trauma Centers; D016896:Treatment Outcome; D055815:Young Adult