Association Between Sleep Quality and Symptoms Following a Sports-Related Concussion in the Pediatric Population

Abstract

PURPOSE: To determine if there is an association between reported sleep quality and concussion symptoms in pediatric athletes. METHODS: A review of prospectively collected data from subjects diagnosed with a sports-related concussion between October 2015 and June 2017, and enrolled in the North Texas Concussion Network Prospective Registry (Con-Tex), was performed. Subjects were treated at one of four outpatient clinics, in North Texas, specializing in concussions. Records were reviewed for sleep quality, indicated by composite scores on the Pittsburgh Sleep Quality Index (PSQI). According to PSQI guidelines, good sleep quality (GOOD SLEEP group) is indicated by a composite score of <5 (possible total=21), and poor sleep quality (POOR SLEEP group) by a score of >5. Demographics, symptoms, and total symptom score, as assessed by the Sports Concussion Assessment Tool 3 (SCAT3) at initial visit and 3-month follow-up, were compared between groups. RESULTS: Of 356 eligible subjects, 180 (50.6%) were girls and 176 (49.4%) were boys, with a mean age of 14.38 years (7-18). 261 subjects had a PSQI composite score of <5 at their initial visit (GOOD SLEEP), while 95 had scores >5 (POOR SLEEP). At initial visit, the POOR SLEEP group had a higher mean PSQI composite score (8.7) and total symptom score on SCAT3 (39.2) compared to the GOOD SLEEP group (2.6 and 20.4, respectively, p<.0001). The POOR SLEEP group also had a higher mean PSQI composite score (5.7) and total symptom score (12.2) at 3 months compared to the GOOD SLEEP group (3.0 and 4.2, respectively, p<.0001), although both groups improved. Additionally, subjects in the POOR SLEEP group reported more fatigue, drowsiness, and trouble falling asleep on the SCAT3 at both the initial visit and 3-month follow-up when compared to the GOOD SLEEP group (p<.005). Gender was also significantly different between the two sleep groups with more girls included in the POOR SLEEP group than boys (61.1% vs 38.9%, respectively, p=.017). CONCLUSIONS: Poor sleep was strongly associated with increased symptom burden within pediatric athletes both at initial visit and 3-month follow-up post-concussion. Clinicians should include an evaluation of sleep quality in young athletes treated for a sports-related concussion.