Association of Daytime Somnolence With Executive Functioning in the First 6 Months After Adolescent Traumatic Brain Injury

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 TB I 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.