Sleep After Adolescent Concussion
Condition: Brain Concussion
MeSH terms: Brain Concussion
Study type: Interventional

Summary: 
      The purpose of this research study is to learn more about how sleep changes as teens recover
      from concussions. We also want to learn if we can improve sleep in teens who have
      concussions.
    

Detailed description: 
      Mild traumatic brain injuries (mTBI), also called concussions, affect millions of individuals
      and cost over $17 billion in the US annually. Despite the term "mild," mTBI symptoms in
      children and adolescents (e.g., poor concentration, headache, emotional lability, slow
      thinking) seriously disrupt all aspects of a patient's functioning and impair quality of
      life. Although many youth recover quickly from mTBI, 30-60% remain symptomatic a month later.
      A biopsychosocial model was developed to account for protracted recoveries. In this model,
      acute symptoms result from a rapid cascade of injury-related neurometabolic and
      micro-structural aberrations. Since the vast majority of these abate within 1-3 weeks
      post-injury, persistent symptoms become increasingly difficult to explain physiologically,
      and psychosocial circumstances and patient behaviors become increasingly prominent
      contributors to impairment. There is reason to believe that, after mTBI, sleep is an
      underappreciated, modifiable behavior that drives impairment for youth with protracted
      recoveries. Care recommendations often mention sleep, but the field lacks
      empirically-supported guidelines and interventions for sleep after pediatric mTBI. Studies of
      mTBI in youth have used crude, unvalidated sleep measures. Also, there is no systematic
      research on non-injury contributors to poor sleep after mTBI, nor the nature and sources of
      advice that families receive. Lacking such data, one cannot develop empirically-based sleep
      recommendations. Finally, while there is reason to believe that a brief sleep intervention
      can alleviate mTBI symptoms in many youth who are recovering slowly, this needs to be tested
      in a well-powered clinical trial. The investigators are positioning to undertake such a
      trial, but must first document feasibility and acceptability of a sleep intervention after
      mTBI. To address these research gaps, the investigators are conducting a novel observational
      study and pilot clinical trial with these Aims:

      Aim 1: Establish more detailed and definitive links between protracted mTBI recovery and
      sleep in 12-18-year-olds. The investigators are undertaking a prospective, observational
      study, objectively tracking sleep and assessing recovery 3-4 weeks post-mTBI. The study team
      will also explore potential contributors to inadequate sleep, including sleep-related
      behaviors and detail the nature and sources of information on sleep post mTBI.

      Aim 2: Pilot-test a brief sleep intervention in the subset of youth who are slow to recover
      from mTBI and show short sleep. The study team will document feasibility and acceptability,
      and test its success in extending sleep duration.
    

Intervention name(s): Sleep Intervention
Intervention type(s): Behavioral
Intervention description(s): The study therapist will outline the biopsychosocial model of mTBI recovery, highlighting the shift from biological injury to behavior (especially sleep behavior) as key driver of symptoms. The intervention will then apply well-established strategies from the pediatric psychology and insomnia literatures, encouraging conjoint problem-solving by parent and youth with the shared goal of maximizing nocturnal sleep. These include: pre-planning, problem-solving, development of a positive routine, commitment to sleep-promoting behaviors, self-monitoring, and positive reinforcement. The therapist will also teach a brief, self-guided pre-sleep relaxation exercise that has been used in insomnia treatment to maximize the benefit of additional sleep opportunity.
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: Note that the intervention portion of the study involves only a subset of participants. The larger bulk (planned n=108) will undergo only initial observation of sleep and concussion symptoms. The investigators plan to have 24 (those still symptomatic at 4 weeks post-concussion who do not get recommended sleep) undergo a pilot trial of a sleep intervention.
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment
Keywords: Adolescence, Sleep