Quality of sleep and psychosocial functioning in pediatric-onset spinal cord injury over time.
January A, Zebracki K, Chlan K, Vogel L
Shriners Hospitals for Children-Chicago, Chicago, IL, USA
Objectives: To examine change in sleep quality over time for adults with pediatric-onset spinal cord injury (SCI) and to identify clinical and demographic characteristics associated with sleep-related difficulties.
Methods: The study included 151 adults who sustained a SCI prior to age 19 (M=13.4, SD=4.7; 0-18). Participants had been injured for an average of 18.9 years (SD=7.8; Range 2-41). Average age at baseline was 32.8 (SD=6.8; Range 19-48). Participants completed interviews on an approximately annual basis, for a total of 580 interviews (range 2-7). Interviews included questions on demographic information, injury characteristics, and health problems experienced within the previous year. Participants also completed standardized measures of sleep quality, depression, anxiety, life satisfaction, and perceived mental and physical health. Analyses were conducted utilizing mixed effect models to explore sleep quality across time.
Results: Participants tended to have complete injuries (AIS A, 72%) and tetraplegia (58%), and were predominantly male (66%) and Caucasian (82%). Average sleep scores at initial status were above the cutoff for “poor” sleep quality (M=6.25, SD=3.75) and scores increased significantly over time (p=.012). Several factors emerged as significant predictors of poor sleep quality including tetraplegia (p=.01), age (p<.01), presence of another chronic medical condition (p<.01), and unemployment (p=.04). Additionally, within individuals, as depression and anxiety symptoms increased sleep scores worsened (p<.01). Similarly, increases in perceived physical health (p<.01), perceived mental health (p<.01), and life satisfaction (p<.01) resulted in improved sleep scores for individuals.
Conclusion: Overall, the results from the current study suggest that average sleep quality gets worse over time for individuals with pediatric-onset SCI. Further, decreases in psychosocial functioning and well-being is associated with decreasing sleep quality. These findings underscore the importance of understanding the longitudinal course of sleep after pediatric SCI and highlight the need for future research exploring strategies to foster positive mental health and well-being.
Support: Shriners Hospitals for Children®-Chicago Grant #84202; Craig H. Neilsen Foundation #324671
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