Association of daytime somnolence with executive functioning in the first 6 months after adolescent traumatic brain injury

Marisa B Osorio, Brad G Kurowski, Dean Beebe, H Gerry Taylor, Tanya M Brown, Michael W Kirkwood, Shari L Wade
PM & R: the Journal of Injury, Function, and Rehabilitation 2013, 5 (7): 554-62

OBJECTIVE: To determine the relationship between severity of injury and self-reports and parent reports of daytime somnolence in adolescents after traumatic brain injury (TBI), and to determine the relationship between daytime somnolence and self-report and parent report of executive functioning in daily life.

DESIGN: Cross-sectional study conducted within the first 6 months (mean ± standard deviation 14.97 ± 7.51 weeks) after injury. Partial correlation controlling for injury severity was used to examine the associations of TBI severity with daytime somnolence and the association of daytime somnolence with executive functioning.

SETTING: Outpatient visits at 3 children's hospitals and 2 general hospitals with pediatric trauma commitment.

PARTICIPANTS: A total of 102 adolescents, 12-18 years old, who sustained moderate-to-severe TBI (n = 60) or complicated mild TBI (n = 42).

MAIN OUTCOME MEASUREMENTS: Parent-report Sleepiness Scale, Epworth Sleepiness Scale (youth report), Behavior Rating Inventory of Executive Function (BRIEF) (self-report and maternal report).

RESULTS: Adolescents who sustained moderate-to-severe TBI had increased daytime somnolence compared with those with complicated mild injuries in the parent report but not in the youth report. Based on the parent report, 51% of adolescents with moderate-to-severe TBI showed significant daytime somnolence compared with 22% of those with complicated mild TBI. The parent report of daytime somnolence was associated with executive dysfunction on both the BRIEF self-report and parent report; however, the youth report of daytime somnolence was associated only with the BRIEF self-report.

CONCLUSIONS: The parent report of daytime somnolence correlated with TBI severity and predicted executive functioning difficulties of the teens in everyday circumstances. Although a correlation between daytime somnolence and executive dysfunction were also apparent on self-report, this did not differ based on injury severity. Teens tended to report fewer difficulties with executive function, which suggests that the teens have decreased awareness of their impairments.

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