Post-Concussion Sleep Disturbance: Impact on Brain Healing and Recovery Outcomes in Children and Adolescents

Abstract

Sleep disturbance is one of the most prevalent and persistent complaints reported after a concussion. Until recently, screening for sleep disturbance in children and adolescents was largely neglected in the overarching management of concussion. This thesis aimed to characterise sleep disturbance in paediatric concussion, investigate the implications of sleep disturbance to concussion recovery outcomes, and determine the therapeutic utility of melatonin supplementation for the treatment of sleep disturbance after head trauma. Three original studies and a scoping review were conducted to fulfil the aims of this thesis. Study 1 was conducted in 554 children and adolescents with concussion and revealed the significant association between sleep disturbance, exacerbated symptom severity, and worsened neurocognitive functioning. Study 2 described post-concussion insomnia in 164 children and adolescents and demonstrated that insomnia was a notable driver of symptom burden and prolonged recovery. Further investigation into post-concussion insomnia within an exclusive sample of 20 children with persistent post-concussion symptoms is presented in Study 3, which conveyed that sleep disturbance clustered with mood disruption and was a major component of delayed recovery time in this population. As endogenous melatonin production is observed to be impaired in traumatic brain injury, Study 4 utilised a scoping review to demonstrate the positive therapeutic utility of melatonin administration for treating sleep disturbance in 8 out of 9 studies reviewed. Taken together, the findings from this thesis provide evidence of the adverse implications post-concussion sleep disturbance has to recovery outcomes in children and adolescents. Sleep should be considered a core domain in concussion assessment and management. Melatonin may be beneficial as a short-term treatment to facilitate sleep in individuals with sleep and mood disturbance after injury.