Abstract
Objective
To examine the relationship between an estimate of sleep–wake regulation derived from
actigraphy and determine whether it would be sensitive to neurocognitive dysfunction
associated with acquired brain injury (ABI) in a pediatric rehabilitation sample.
Design
Cross-sectional design.
Setting
Inpatient pediatric rehabilitation facility.
Participants
A sample (N=43) of 31 males (72.1%) and 12 females (27.9%) admitted to a pediatric
rehabilitation hospital wore an actigraph (wrist accelerometer) for 1 week. Participant
ages ranged from 8 to 17 years (mean, 13.1y; SD, 2.7y).
Interventions
Not applicable.
Main Outcome Measures
Raw actigraphy activity counts in 1-minute epochs were used to derive a rest-activity
ratio over each 24-hour period; a 5-day average value was calculated for Monday through
Friday. Brain injury status was derived through medical record review, resulting in
the formation of 3 groups: traumatic brain injury (n=14), nontraumatic brain injury
(n=16), and a non-ABI control group (n=13). Functional status was measured using FIM
for children (WeeFIM) Cognitive and Motor scores extracted from the medical records.
Results
Unadjusted models showed a significant main group effect for brain injury status (P=.012). Compared with controls, the rest-activity ratio was significantly lower in
both the traumatic brain injury (P=.005), and nontraumatic brain injury (P=.023) groups. However, the main group effect was no longer significant in an adjusted
model controlling for WeeFIM Cognitive and WeeFIM Motor scores at admission. In the
context of the adjusted model, there was a significant relationship between the rest-activity
ratio and WeeFIM Cognitive scores at admission.
Conclusions
Individuals with lower functional status at admission, especially in the cognitive
domain, had lower rest-activity ratios, suggesting poorer sleep–wake regulation. Similar
to findings in adults with ABI, this ratio may have utility in tracking sleep–wake
regulation in the pediatric rehabilitation setting. Future studies should investigate
sensitivity to change over the course of recovery and responsiveness to clinical interventions
to improve sleep.
Keywords
List of abbreviations:
ABI (acquired brain injury), TBI (traumatic brain injury), WeeFIM (FIM for children)To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Archives of Physical Medicine and RehabilitationAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Sleep disruptions and emotional insecurity are pathways of risk for children.J Child Psychol Psychiatry. 2007; 48: 88-96
- Sleepiness in children and adolescents: clinical implications.Sleep Med Rev. 2002; 6: 287-306
- Neurocognitive dysfunction and sleep in children: from human to rodent.Pediatr Clin North Am. 2004; 51: 187-202
- Sleep and psychiatric symptoms in school-age children.J Am Acad Child Adolesc Psychiatry. 2000; 39: 502-508
- Prospective longitudinal associations between persistent sleep problems in childhood and anxiety and depression disorders in adulthood.J Abnorm Child Psychol. 2005; 33: 157-163
- Sleep quality and noise: comparisons between hospital and home settings.Arch Dis Child. 2019; 104: 147-151
- Quality of sleep in a pediatric hospital: a descriptive study based on an assessment of interruptions, perceptions, and the environment.J Nurs Adm. 2019; 49: 273-279
- Nocturnal awakenings, sleep environment interruptions, and fatigue in hospitalized children with cancer.Oncol Nurs Forum. 2007; 34: 393-402
- Sleep-wake disturbances after traumatic brain injury: synthesis of human and animal studies.Sleep. 2017; 40 (zsx044)
- Long-term sleep disturbances in adolescents after minor head injury.Pediatr Neurol. 2001; 24: 129-134
- Pediatric sleep difficulties after moderate-severe traumatic brain injury.J Int Neuropsychol Soc. 2013; 19: 829-834
- Prevalence and risk of sleep disturbances in adolescents after minor head injury.Pediatr Neurol. 2003; 29: 131-135
- Construct validation of actigraphic sleep measures in hospitalized depressed patients.Behav Sleep Med. 2004; 2: 24-40
- Return of memory and sleep efficiency following moderate to severe closed head injury.Neurorehabil Neural Repair. 2009; 23: 320-326
- Reduced daytime activity in patients with acquired brain damage and apathy: a study with ambulatory actigraphy.Brain Inj. 2006; 20: 157-160
- Validity of accelerometry for measurement of activity in people with brain injury.Med Sci Sports Exerc. 2005; 37: 1474-1480
- Objective measures of sleep and wakefulness in patients with moderate to severe brain injury on an inpatient rehabilitation unit. Pearls and pitfalls of actigraph monitoring.NeuroRehabilitation. 2018; 43: 277-285
- Rest-activity cycle disturbances in the acute phase of moderate to severe traumatic brain injury.Neurorehabil Neural Repair. 2014; 28: 472-482
- Day-night activity in hospitalized children after major surgery: an analysis of 2271 hospital days.J Pediatr. 2019; 209: 190-197
- What wrist should you wear your actigraphy device on? Analysis of dominant vs. non-dominant wrist actigraphy for measuring sleep in healthy adults.Sleep Sci. 2017; 10: 132-135
- The role of actigraphy in the study of sleep and circadian rhythms.Sleep. 2003; 26: 342-392
- Item-specific functional recovery in children and youth with acquired brain injury.Pediatr Phys Ther. 2003; 15: 16-22
- Sleep benefits subsequent hippocampal functioning.Nat Neurosci. 2009; 12: 122-123
- Prevalence of sleep disturbance in closed head injury patients in a rehabilitation unit.Neurorehabil Neural Repair. 2008; 22: 341-347
- Subacute sleep disturbance in moderate to severe traumatic brain injury: a systematic review.Brain Inj. 2020; 34: 316-327
- The influence of sleep quality, sleep duration and sleepiness on school performance in children and adolescents: a meta-analytic review.Sleep Med Rev. 2010; 14: 179-189
- Sleep, cognition, and behavioral problems in school-age children: a century of research meta-analyzed.Psychol Bull. 2012; 138: 1109-1138
- The interplay of sleep disturbance, anxiety, and depression in children.J Pediatr Psychol. 2008; 33: 339-348
- Evolution of severe sleep-wake cycle disturbances following traumatic brain injury: a case study in both acute and subacute phases post-injury.BMC Neurol. 2016; 16: 186
Article info
Publication history
Published online: January 27, 2022
Accepted:
December 26,
2021
Received in revised form:
December 22,
2021
Received:
November 18,
2021
Footnotes
Supported by the Church & Dwight Employee Giving Fund for the purchase of study equipment (actigraphs).
Disclosures: none.
Identification
Copyright
© 2022 by the American Congress of Rehabilitation Medicine.
