BACKGROUND Sleep disturbance is common after a mild traumatic brain injury (mTBI) in children, yet its biology is poorly understood. We aimed to explore sleep-related problems (SRPs), sleep-activity patterns, and endogenous melatonin production in children with different recovery trajectories following mTBI. We hypothesized that children with delayed recovery would have more SRPs and abnormal sleep-activity patterns, which would correlate with lower overnight melatonin production. METHODS In this prospective controlled cohort study, we enrolled 83 children with persistent symptoms, 26 children who had clinically recovered following mTBI, and 25 healthy controls. SRPs were evaluated using the sleep subscale of the Post-Concussion Symptom Inventory. Sleep actigraphy was performed for five to seven days at 37 (S.D. 7) days post-injury. Health-related quality of life and mood disturbance was assessed using the Child Health Questionnaire and the Behavior Assessment System for Children, respectively. Endogenous melatonin production was assessed using overnight urine collection. RESULTS The groups were similar in age (13.9 [S.D. 2.6] years) and sex (52% female). Regression analysis demonstrated increased SRP in the symptomatic group (9.0; 95% confidence interval: 7.6, 11.1) compared with the recovered group (1.6; 95% confidence interval: 1.0, 2.4) and controls (2.0; 95% confidence intervals: 1.2, 3.2). Actigraphy parameters and urinary melatonin levels were not significantly different between groups. Neither SRPs nor actigraphy parameters correlated with anxiety and depression scores. CONCLUSIONS Although children with persistent post-concussion symptoms reported more SRPs, this was not related to actigraphy sleep parameters or melatonin production. Further research is warranted to understand the pathophysiology of post-traumatic sleep disturbance.

中文翻译：

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持续性脑震荡后患儿的睡眠参数和通宵尿中褪黑激素的产生。

背景技术睡眠障碍在儿童发生轻度脑外伤（mTBI）之后很常见，但对其生物学的了解却很少。我们旨在探讨mTBI后具有不同恢复轨迹的儿童的睡眠相关问题（SRP），睡眠活动模式和内源性褪黑激素产生。我们假设恢复迟缓的孩子会有更多的SRP和异常的睡眠活动模式，这与较低的通宵褪黑激素产生有关。方法在这项前瞻性对照队列研究中，我们招募了83例持续症状的儿童，26例mTBI后临床康复的儿童和25例健康对照。使用脑震荡后症状量表的睡眠子量表评估SRP。在受伤后第37天（标准差7天）进行了5到7天的睡眠活动记录。使用儿童健康调查表和儿童行为评估系统分别评估与健康相关的生活质量和情绪障碍。使用过夜尿液收集来评估内源性褪黑激素的产生。结果两组的年龄（13.9 [SD 2.6]岁）和性别（52％的女性）相似。回归分析表明，与康复组（1.6; 95％置信区间：1.0、2.4）和对照组（2.0; 95％置信区间：1.2，）相比，有症状组（9.0; 95％置信区间：7.6，​​11.1）的SRP增加。 3.2）。两组之间的活动参数和尿中褪黑激素水平无显着差异。SRP和书法参数均与焦虑和抑郁评分无关。结论尽管脑震荡后症状持续的儿童报告了更多的SRP，这与活动记录睡眠参数或褪黑激素的产生无关。有必要做进一步的研究来了解创伤后睡眠障碍的病理生理。