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Advanced Neurologyurology
Advanced Ne Sleep and lifestyle factors in young adults with childhood TBI

health, and sleep [3,4] . Sleep disturbances such as insomnia lifestyle factors, individuals may adopt late night behaviors,
(i.e., prolonged sleep onset and sleep maintenance increase the use of alcohol, caffeine, and tobacco/cigarette,
problems) and daytime sleepiness (i.e., increased and use sleep and psychotropic medications (stimulants
[22]
propensity to fall asleep during the day) are common and antidepressants) .
in survivors of childhood TBI . The presence of these The relationship between sleep and lifestyle factors
[3]
sleep disturbances in young TBI survivors is problematic is yet to be investigated in survivors of childhood TBI;
considering the important role of sleep in memory however, some studies involving adult survivors of TBI
consolidation and learning, behavior regulation, mental have reported significant associations between poor sleep
health, and well-being [5-7] , and its essence for body and and these lifestyle factors [23,24] , with studies in healthy
brain recovery following potentially devastating incidents adults reporting similar outcomes [25-28] . Considering
such as TBI . Proposed origins of these sleep disturbances the vulnerability of the brain to stress and related
[8]
include the impact of TBI on sleep-wake contingent consequences following brain injuries [9,10] , survivors of
brain areas and neural mechanisms [9,10] , and secondary childhood brain injury may be at a greater risk of these
sleep-related factors such as pain, fatigue, anxiety, and lifestyle-related impacts on sleep. In previous publications
depression. In addition to these proposed causes, studies involving the current sample, subjective sleep problems in
in typically developing individuals show that sleep can the young adults with TBI were associated with increased
be affected by lifestyle factors such as screentime, having symptoms of anxiety and pain , fatigue, depression,
[20]
young children, smoking, and use of caffeine and certain and poorer general health ; all of which may have been
[29]
medications [11-13] , but the relationships between sleep related to lifestyle choices. Identifying lifestyle factors that
disturbances and lifestyle factors have not been explored impact on sleep in the long-term following childhood TBI
in survivors of childhood TBI. can further knowledge regarding factors impacting sleep
Studies have reported that sleep disturbances can after childhood brain injury and provide insights into
persist several years following childhood TBI [3,14,15] and are modifiable risk factors that can be targeted to improve this
associated with injury severity, age at injury (older age for critical biological phenomenon that facilitates our mental
mild TBI , younger age for moderate-severe TBI) [17-19] health and well-being.
[16]
sex, anxiety, depression, pain, and fatigue in children The aim of the present study is to explore the
and adolescents with TBI [3,17] , although reports on some relationships between sleep and lifestyle factors in young
associations are inconsistent (e.g., male vs. female sex). We adults who sustained TBI in childhood. The following
recently extended these findings in a cross-sectional study lifestyle factors were explored based on their known impact
that showed a higher rate of subjective sleep disturbance on sleep in studies involving individuals who sustained
in young adults who sustained TBI in childhood TBI in adulthood [23,24] and studies of healthy adults [25-28] :
(39%) , compared to controls (15%), and to rates reported Parenting status; nap duration; screen time, chronotype;
[20]
in typically developing young adults (10 – 35%) . use of tobacco, alcohol, caffeine, and medication.
[21]
Consistent with evidence from the broader sleep literature
Young adulthood is a developmental period typically
associated with increased professional, social, and family about the relationship of these lifestyle factors and sleep
, we predict that significant associations
outcomes
[12,25-28,30]
commitments, all of which can impact sleep and well- would be identified between sleep and these lifestyle
being. During this developmental stage, there may be an factors.
adaptation of lifestyles and related coping mechanisms
(e.g., parenting, caffeine use, screen time, work and 2. Materials and methods
social patterns, and medications), which may contribute
to alterations in sleep patterns and increase risk of sleep 2.1. Study design and ethics
disturbance even in healthy young people . Some may This study was approved by the Human Research Ethics
[21]
engage in late night social activities, or work for long hours Committee of The Royal Children’s Hospital (RCH –
on computer screens, and therefore adopt an evening HREC Ref No: 30064), Melbourne, Australia. It forms part
chronotype (i.e., delayed bedtime and extended wake-up of a longitudinal, prospective study of long-term outcomes
time) to meet work and social expectations. In typically of childhood TBI and reports cross-sectional outcomes
[31]
developing adults, high levels of screentime on mobile at 20-year post-injury.
phones have been associated with increased risk of sleep
problems and depression , while cigarette smoking has a 2.2. Participants
[11]
2-fold risk for mental health disorders . To help manage Participants for this 20-year follow-up included young
[13]
the sleep and mental health problems associated with these adults with a history of childhood TBI recruited from

Volume 2 Issue 3 (2023) 2 https://doi.org/10.36922/an.0876