Update on Insomnia after Mild Traumatic Brain Injury

Zhou, Yi; Greenwald, Brian D.

doi:10.3390/brainsci8120223

Cited by 27 publications

(26 citation statements)

References 84 publications

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Section: Discussionmentioning

confidence: 99%

“…27 Nonpharmacological interventions (eg, sleep hygiene recommendations such as a regular sleep schedule, keeping the bedroom dark, limiting noise) are often built into the care plan of the patient exhibiting postconcussive symptoms and have shown effectiveness in promoting optimal sleep behavior after concussion. 28 Cognitive-behavioral therapy (CBT) has shown to be an effective treatment modality for improving school attendance and managing sleep symptoms after concussion. A study examining the effects of CBT on reduction of postconcussive symptoms in 31 patients aged 10 to 18 years revealed that 2 to 5 sessions of CBT improved persistent symptoms, including sleep symptoms, and thus school attendance in 97% of children following treatment.…”

Section: Discussionmentioning

confidence: 99%

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Sleep Symptoms Predict School Attendance After Pediatric Concussion

Saleem

Slomine

Suskauer

2020

Clin Pediatr (Phila)

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This study examined the relationship between postconcussive symptom domain and school attendance. Retrospective chart review was completed for 88 children aged 6 to 18 years who were evaluated within 30 days postinjury. Hierarchical multiple regression was used to assess the association of physical, cognitive, emotional, and sleep symptoms with extent of school attendance. A subgroup multiple regression analysis was conducted to evaluate whether age affected the relationship of symptoms to school attendance. After controlling for demographic variables and total number of symptoms, a higher number of postconcussive sleep symptoms strongly predicted less school attendance. Specifically, older children (≥14 years old) with more sleep symptoms demonstrated less school attendance. For children presenting for specialty care after concussion, sleep symptoms are unfavorably associated with return to school. Future work aimed at optimizing sleep regulation following concussion may assist with early reengagement in school as recommended by current concussion management guidelines.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Sleep Symptoms Predict School Attendance After Pediatric Concussion

Saleem

Slomine

Suskauer

2020

Clin Pediatr (Phila)

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“…Ten participants were excluded from the analysis as they were over 30 years of age at the time of the attack. Two additional participants were excluded as they sustained mild traumatic brain injury (TBI) during the attack, which is associated with an increased risk of insomnia (Zhou & Greenwald, 2018 ). Thus, 336 participants were included in the analysis of present study.…”

Section: Methodsmentioning

confidence: 99%

Insomnia in survivors 8.5 years after the Utøya Island terrorist attack: transition from late adolescence to early adulthood - the Utøya study

Porcheret

Stensland

Wentzel‐Larsen

et al. 2022

European Journal of Psychotraumatology

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Background Insomnia is a global health concern, associated with many mental and physical health conditions. Prevalence of insomnia is reported to increase during adolescence and early adulthood. High levels of insomnia are also reported in adolescents up to 2.5 years after a traumatic event. What is less well understood is the prevalence of insomnia in a trauma exposed population transitioning from adolescence to adulthood. Objective To assess insomnia in the survivors in the 2011 Utøya Island terrorist attack, 2.5 years and 8.5 years after the attack when the majority of survivors were transitioning from late adolescence to early adulthood. Method Participants were 336 survivors of the Utøya Island attack who completed the Utøya Study 2.5 years (T3) and 8.5 years (T4) after the attack. Participants completed a face-to-face interview including the Bergen Insomnia Scale (BIS), which was used to assess insomnia symptoms and prevalence of meeting diagnostic criteria for insomnia. Results Insomnia was indicated in 47.7% of survivors 8.5 years after the attack. Insomnia prevalence did not significantly change from 2.5 to 8.5 years after the attack, though insomnia symptoms (BIS sum score) were found to increase. Age was negatively associated with insomnia at T4, with older age being associated with less insomnia. No significant sex difference was found in insomnia prevalence at T4. Conclusion Almost a decade after the Utøya Island terrorist attack, nearly a half of the young survivors in our study reported insomnia and typical age- and sex-related differences in sleep were not always seen. This rate is almost double what is reported in the general population (20–30%) indicating a high level of unmet need in this population. The implications of such sleep disruption during a critical time for physical, mental, social and cognitive development are far reaching.

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“…VIP cells in the SCN receive light information from the retinohypothalamic tract and exert a powerful synchronizing effect on the rest of the SCN ( Hamnett et al, 2019 ). The coup-contrecoup injury associated with TBI may also affect the basal forebrain arousal area, damage the SCN, interrupt melatonin pathways, or disrupt thalamocortical connectivity, all of which have the potential to contribute to post-traumatic sleeping difficulties ( Zhou and Greenwald, 2018 ). Previous work has shown that the basal forebrain is involved in direct regulation of circadian rhythms in the SCN ( Yamakawa et al, 2016 ).…”

Section: Circadian Desynchrony and Tbi Symptomologymentioning

confidence: 99%

The interaction of the circadian and immune system: Desynchrony as a pathological outcome to traumatic brain injury

Yamakawa

Brady

Sun

et al. 2020

Neurobiology of Sleep and Circadian Rhythms

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Traumatic brain injury (TBI) is a complex and costly worldwide phenomenon that can lead to many negative health outcomes including disrupted circadian function. There is a bidirectional relationship between the immune system and the circadian system, with mammalian coordination of physiological activities being controlled by the primary circadian pacemaker in the suprachiasmatic nucleus (SCN) of the hypothalamus. The SCN receives light information from the external environment and in turn synchronizes rhythms throughout the brain and body. The SCN is capable of endogenous self-sustained oscillatory activity through an intricate clock gene negative feedback loop. Following TBI, the response of the immune system can become prolonged and pathophysiological. This detrimental response not only occurs in the brain, but also within the periphery, where a leaky blood brain barrier can permit further infiltration of immune and inflammatory factors. The prolonged and pathological immune response that follows TBI can have deleterious effects on clock gene cycling and circadian function not only in the SCN, but also in other rhythmic areas throughout the body. This could bring about a state of circadian desynchrony where different rhythmic structures are no longer working together to promote optimal physiological function. There are many parallels between the negative symptomology associated with circadian desynchrony and TBI. This review discusses the significant contributions of an immune-disrupted circadian system on the negative symptomology following TBI. The implications of TBI symptomology as a disorder of circadian desynchrony are discussed.

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Update on Insomnia after Mild Traumatic Brain Injury

Cited by 27 publications

References 84 publications

Sleep Symptoms Predict School Attendance After Pediatric Concussion

Sleep Symptoms Predict School Attendance After Pediatric Concussion

Insomnia in survivors 8.5 years after the Utøya Island terrorist attack: transition from late adolescence to early adulthood - the Utøya study

The interaction of the circadian and immune system: Desynchrony as a pathological outcome to traumatic brain injury

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