Evaluating the Association of Sleep & Physical activity with Prolonged Concussion Symptoms

Abstract

IntroductionAdolescents with concussion will typically experience symptom resolution within 4‐weeks of injury; however, persistent post‐concussion symptoms (PPCS) may develop in approximately 30% of adolescents. Concussion management guidelines currently recommend a brief (24‐48 hour) rest period followed by sub‐symptom exercise to facilitate recovery. Additionally, poor sleep is associated with longer recovery, and early physical activity (PA) may accelerate symptom resolution. By understanding the individual association of both sleep and PA with symptom recovery, a basis can be provided for future recommendations on concussion intervention. Therefore, the purpose of this study was to determine whether sleep characteristics (duration, timing) and/or PA (steps/day, exercise frequency, duration, exercise intensity) in the first month after concussion are associated with PPCS.MethodsWe performed a prospective study of adolescent athletes who sustained a concussion and were evaluated within 14 days of injury. Participants received a Fitbit Charge 3TM to track PA and sleep parameters during recovery. The Post‐Concussion Symptom Inventory (PCSI) was used to determine symptom severity at the initial visit and the clearance visit. Participants were followed until symptom resolution, and the main outcome interest was development of PPCS (symptom duration ≥ 28 days). We then used a logistic regression model to examine associations between PA and sleep parameters with PPCS.ResultsOf the 49 patients included in the analysis, 47% (n=23, symptom resolution=57±23 days post‐injury) developed PPCS and 53% (n=26, symptom resolution=15±7 days post‐injury) did not. There was a significant difference between the PPCS and no PPCS groups in three different variables: steps/day (7526±2975 vs. 9803±3786; p=0.02), exercise days/week (2.5±2.2 vs. 4.4±2.1; p=0.005), and time in bed awake (1.2±0.3 hours/night vs. 0.8±0.3 hours/night; p=0.03). In our multivariable model, the risk of developing PPCS decreased by 1.6x with each additional exercise session/week (adjusted odds ratio=0.616, 95% confidence interval=0.389, 0.974, p=0.038).ConclusionsThe results suggest that participating in multiple exercise sessions per week during concussion recovery is associated with a lower risk of developing PPCS. Furthermore, taking more steps/day and spending less time awake in bed are associated with a shorter recovery period. Counseling patients on optimizing sleep and PA during concussion recovery may be one method for clinicians to promote recovery for their patients.