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SEATTLE -- Children suffering traumatic brain injuries had more disturbed sleep patterns and more daytime sleepiness months later than their peers without such injuries, researchers reported here.

Children with brain injury after falls, car wrecks, or other accidents posted a mean score of 8.1 on the Epworth Sleepiness Scale on the basis of parental report at least a month post injury, compared with a mean score of 4.9 in a matched control group (P=0.03), said assistant professor of nursing at the Center for Narcolepsy, Sleep and Health Research at the University of Illinois-Chicago. "The children with traumatic brain injury had significantly more daytime sleepiness," she said.

And in the Child Sleep Wake Scale, children with traumatic brain injury scored a mean of 3.58 compared with a mean of 4.61 among the control group (P=0.0012), she reported in her poster presentation at , the annual meeting of the Associated Professional Sleep Societies.

The children with traumatic brain injury also scored more poorly on the PedsQL 4.0 Generic Core Scales, showing a mean 62.12 score compared with a mean score of 87.75 in the control group (P<0.0001), Allen told MedPage Today.

Higher scores are associated with better sleep quality in the Child Sleep Wake Scale and the PedsQL; lower scores indicated less daytime sleepiness in the Epworth scale.

"These findings are not surprising," said director of the Pediatric Sleep and Research Center at SSM Cardinal Glennon Children's Medical Center in St. Louis. "But, there is [little] research in this group of patients. We have theories that brain injuries affect sleep, but until we actually do the study we don't know that is true. We suspect that traumatic brain injury would affect sleep, and that is what these researchers have shown."

Paruthi, also assistant professor of pediatrics at the University of St. Louis, told MedPage Today, "This was a very small study, almost like a pilot study with just 15 children with traumatic brain injury and 15 healthy children. I think it would be really great if we had a larger study so we could really say 'yes.' However, this study is helpful. The more we learn about what the problems are with these patients, the more we can focus their therapy."

For the study, Allen and colleagues enrolled parents of children ages 3 to 16 in the study. The mean age of the children was 11.3. The children had to have been at least 1 month post-traumatic brain injury to 36 months after the insult. Mean time since injury was about 18 months.

The researchers also enrolled 15 healthy, normally developing children to act as controls. Maternal demographic data including race, maternal education, age, and household size were collected: they were not significantly different between the injured children and the healthy matched controls.

The majority of the children with traumatic brain injury -- caused by direct trauma from an external force, a penetrating injury, or a jolt to the head -- were hospitalized for at least a week, required rehabilitation, and needed assistance in school.

"All these reports are from parents, and we did not ask parents how the child got the brain injury," Allen said. She said that she did not believe that these children were victims of in-home abuse that caused the injuries.

"As hypothesized, children with traumatic brain injury had increased daytime sleepiness, poorer sleep quality, and poorer functional status compared to healthy, typically developing matched controls based on parent report surveys," Allen said.

Traumatic brain injury is considered a chronic condition, she said. "There are persistent problems in adult patients with traumatic brain injury but we don't know very well what happens in pediatric patients." She said she believes the type of injury may have different effects on sleep, "but that is a completely different study."

"Clinicians treating children with traumatic brain injury may need to ask children or their parents about sleep quality and daytime sleepiness as these data suggest it is problematic for this sample," she said.

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