Quantifying Risk Factors for Long-Term Sleep Problems After Burn Injury in Young Adults

Abstract

Restorative sleep is an important component of quality of life. Disturbances in sleep after burn injury were reported but all based on uncontrolled or nonstandardized data. The occurrence and the effect of long-term sleep problems in young adult burn survivors have not been well defined. This 5-year (2003-2008) prospective multicenter longitudinal study included adults with burn injuries ages 19 to 30 years who completed the Young Adult Burn Outcome Questionnaire (YABOQ) up to 36 months after injury. The items measured 15 patient-reported outcomes including physical, psychological, and social statuses and symptoms such as itch and pain. Scores of these 15 YABOQ outcome domains were standardized to a mean of 50 and a SD of 10 based on an age-matched nonburned reference group of young adults. Sleep quality was assessed using the item 'How satisfied are you now with your sleep,' rated by a 5-point Likert scale. Patients responding with very and somewhat dissatisfied were classified as having sleep dissatisfaction and the remaining as less or not dissatisfied. The associations between sleep dissatisfaction (yes/no) and YABOQ outcome domains were analyzed longitudinally using mixed-effect generalized linear models, adjusted for %TBSA burned, age, gender, and race. Generalized estimating equations were used to take into account correlated error resulting from repeated surveys on each patient over time. One hundred and fifty-two burn survivors participated in the YABOQ survey at baseline and during the follow-up who had at least one survey with a response to the sleep item. Among them, sleep dissatisfaction was twice as prevalent (76/152, 50%) when compared with the nonburned reference group (29/112, 26%). The likelihood of a burn survivor being dissatisfied with sleep was reduced over time after the burn injury. Sleep dissatisfaction following burns was significantly associated, in a dose-dependent manner, with increasing burn size (P = .001). Better sleep was associated with better outcomes in all domains (P < .05) except Fine Motor Function, and this association was significantly more apparent in the longer term compared with the shorter term with the same domains (P < .05). Dissatisfaction with sleep is highly prevalent following burn injuries in young adults. Lower satisfaction with sleep is associated with poorer scores in nearly all quality of life measures. Satisfaction with sleep should be addressed during the long-term clinical follow-up of young adults with burn injuries. Further research should be undertaken to understand the components of sleep quality that are important to burn survivors and which ones might be modified and tested in future intervention studies.

Figure 1.

Recovery curves for the odds ratio (OR) of sleep dissatisfaction over time by changes in Young Adult Burn Outcome Questionnaire (YABOQ) domain scores. The impact of improvements in domain scores by 0.5, 1, 1.5, or 2 SD on the OR of sleep dissatisfaction is depicted. These curves show that the risk of sleep dissatisfaction decreases over time from burn, that improvements in all domain scores are associated with decreased risk of sleep dissatisfaction except fine motor function, and that the association of improvement in domain score with decreased risk of sleep dissatisfaction becomes more apparent with time.

Figure 1.

Recovery curves for the odds ratio (OR) of sleep dissatisfaction over time by changes in Young Adult Burn Outcome Questionnaire (YABOQ) domain scores. The impact of improvements in domain scores by 0.5, 1, 1.5, or 2 SD on the OR of sleep dissatisfaction is depicted. These curves show that the risk of sleep dissatisfaction decreases over time from burn, that improvements in all domain scores are associated with decreased risk of sleep dissatisfaction except fine motor function, and that the association of improvement in domain score with decreased risk of sleep dissatisfaction becomes more apparent with time.