Higher rates of sleep disturbances in youth following mild TBI

Children with mild traumatic brain injury (mTBI) are more likely to have sleep disturbances than typically developing children (TDC), according to a recent study published in JAMA Network Open.¹

Persistent physical, cognitive, and emotional symptoms present in approximately 30% of youth mTBI cases, often leading to brain structural changes such as decreased white matter volume and cortical thinning. Additionally, 53% to 92% of adults with mTBI have reported sleep disturbances, and posttraumatic sleep problems have been reported in 28% of children.²

“However, pediatric studies that examine sleep in association with other outcomes are rare, and most do not include control groups,” wrote investigators.¹

Comparing sleep outcomes

The cohort study was conducted to compare rates of sleep disturbance in children with mTBI vs TDC. Participants were enrolled when aged 9 to 10 years and underwent 2-year follow-up assessments, during which parents completed the Adolescent Brain and Cognitive Development (ABCD) Parent Ohio State Traumatic Brain Injury Screen–Short Modified.

An mTBI was determined by loss of consciousness, memory loss, or feeling dazed or confused following a suitable event such as a fall. Only children without a history of head injury at baseline were included in the mTBI group, with a new injury reported by their parents at the 1-year or 2-year follow-up.

These cases were matched 1:1 to TDC controls with no prior injury and orthopedic injury (OI) controls with broken bones during the same period. Patients were matched based on sex, age, race, study site, and total family income, which were also included as study covariates.

Outcome measures

The Sleep Disturbance Scale for Children (SDSC) was completed by parents to determine sleep problems in their children. SDSC has 6 subscales, as follows:

• Disorders of initiating and maintaining sleep
• Sleep breathing disorders
• Disorders of arousal
• Sleep-wake transition disorders
• Disorders of excessive somnolence
• Sleep hyperhidrosis

Clinically relevant sleep problems were determined by a total score of more than 39. Groups of children included “normal” for those with no sleep problems, “chronic” for those with persistent sleep problems, “improving” for those with sleep problems at baseline but not follow-up, and “new onset” for those with no problems at baseline but at follow-up.

The Child Behavior Checklist was used to assess behavioral problems, while the National Institutes of Health Toolbox was used to assess cognitive function. The ABCD study team performed MRI according to standardized protocols.

Higher rates of sleep problems in youth with mTBI

There were 191 cases with mTBI aged a mean 12.03 years included in the analysis, matched to an equal number of TDC and OI patients for 573 total participants. New-onset clinical sleep problems were more common in the former group vs the latter 2 groups, with rates of 15.2%, 11.5%, and 9.9%, respectively.

Chronic sleep disturbance rates in mTBI cases, TDC, and OI controls were 21.5%, 13.1%, and 13.1%, respectively, highlighting an increase among mTBI patients. Fewer improving cases were reported in OI patients, which investigators hypothesized was linked to fewer baseline sleep problems.

No differences in continuous sleep disturbance scores were reported between control groups. Children with mTBI had greater continuous sleep disturbance scores vs the TDC group, but not the OI group, with scores of β = −0.27 and β = −0.12, respectively.

Impact on behavior and cortical thickness

White matter microstructure and cognitive performance did not differ between groups. However, mTBI patients had increased behavior problems vs the TDC group and lower cortical thickness vs the OI group.

These differences were linked to sleep problems in the mTBI group. Overall, the data highlighted an increase in sleep problems following mTBI in youth.

“These findings highlight postinjury sleep as a modifiable risk factor and suggest that early identification and targeted intervention may offer a practical opportunity to mitigate long-term socioemotional difficulties in children following mTBI,” wrote investigators.

References

1. Betz AK, MacLaren HSR, Villagran Asiares AG, Schuhmacher LS, Koerte IK. Sleep disturbances and cognition, behavior, and brain structure in children with mTBI. JAMA Netw Open. 2026;9(3):e260229. doi:10.1001/jamanetworkopen.2026.0229
2. Pillar G, Averbooch E, Katz N, Peled N, Kaufman Y, Shahar E. Prevalence and risk of sleep disturbances in adolescents after minor head injury. Pediatr Neurol. 2003;29(2):131-135. doi:10.1016/S0887-8994(03)00149-8