ADOLESCENTS REPORT SLEEP QUALITY IMPAIRMENTS ACUTELY POST-CONCUSSION

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Background:Recently, the association between concussion and sleep has been explored. Few studies have used validated patient-reported outcome measures to examine how sleep quality differs between adolescents who have recently sustained a concussion compared to healthy adolescents.Hypothesis/Purpose:Our purpose was to evaluate the effect of acute concussion on sleep quality using the Pittsburgh Sleep Quality Index (PSQI). We hypothesized that adolescents with acute concussion symptoms would report worse sleep quality compared to healthy adolescent athletes undergoing a pre-participation evaluation.Methods:Patients seen for initial evaluation at a sports medicine clinic within 14 days of sustaining a concussion were matched with healthy control subjects undergoing a pre-participation evaluation based on age, sex and concussion history at a 3:1 control:concussion subject ratio. Controls with history of concussion were included if fully recovered at their evaluation. Both groups completed the PSQI and Post-Concussion Symptom Inventory (PCSI). Those with concussion reported sleep quality since their injury, while controls reported sleep quality over the past month. The primary outcome was global PSQI score, where higher scores indicate worse sleep quality. We compared sleep quality ratings between groups using independent samples t-test, and proportion of poor sleep ratings using Chi-square analysis. We then constructed a multivariable regression model to assess the effect of acute concussion on global PSQI scores while adjusting for sex, age and concussion history.Results:We evaluated 17 patients with concussion (mean 8±3 days post-injury) who were matched with 51 controls. Demographic variables did not differ significantly between concussion and control groups (Table 1). The concussion group reported higher PCSI symptom rating (Table 1), and worse overall sleep quality (Table 2). Specifically, the concussion group reported longer time to fall asleep, later morning awakening, longer sleep duration and longer time in bed, compared to controls. The concussion group was also less likely to rate their sleep as “very good” compared to controls (Table 2). After adjusting for the independent effect of sex, age, and concussion history, concussion was significantly associated with higher PSQI scores (β=2.01, 95% CI= 0.35, 3.68; p= 0.019).Conclusion:Adolescents assessed within 14 days of concussion reported worse overall sleep quality, longer sleep duration, and decreased sleep efficiency compared to healthy adolescents. These results, obtained utilizing a validated measure, highlight the negative impact of acute concussion on sleep quality and provide additional support that assessment of sleep characteristics is an important component of acute concussion management.Table 1.Group characteristics between concussion and control groups. Data are presented as mean (sd) or n (%).VariableConcussion Group(n=17)Control Group(n=51)P valueFemale Sex11 (65%)33 (65%)1.00Age (years)16.0 (1.4)16.0 (1.3)0.94Post-Injury Evaluation Time (days)7.6 (3.7)--Past history of concussion7 (41%)14 (27%)0.37Current PCSI Score57.2 (30.8)5.4 (8.5)< 0.001Table 2.Sleep characteristics from the PSQI for both participant groups. Data are presented as mean (standard deviation) or n (%).VariableConcussion GroupControl GroupP valueGlobal PSQI score6.77 (3.47)4.30 (2.64)0.007Poor sleep quality (PSQI score > 5)9 (69%)23 (45%)0.14Usual bed time10:01 PM (0:35)10:19 PM (0:56)0.42Usual wakeup time7:39 AM (1:39)6:15 AM (0:42)0.004Time to fall asleep (minutes)34.5 (40.8)18.3 (14.9)0.02Sleep per night (hours)8.6 (2.8)7.4 (1.0)0.009Time in bed per night (hours)10.1 (2.6)7.9 (1.1)< 0.001Self-rated overall sleep qualityVery good: 1 (6%)Fairly good: 12 (71%)Fairly bad: 3 (18%)Very bad: 1 (6%)Very good: 14 (28%)Fairly good: 33 (66%)Fairly bad: 3 (6%)Very bad: 0 (0%)0.04