Impact of Diagnosed Sleep Disorder on Baseline Concussion Assessments in Collegiate Athletes

Abstract

Research suggests at least 27% of college students are at risk for at least one sleep disorder. Adolescents with sleep-related symptoms and reduced sleep duration perform worse on baseline neurocognitive testing, although this effect size is small and samples have not included older or collegiate-level athletes. Previous research has not taken into consideration the effects of previously diagnosed sleep disorders on performance of preinjury baseline assessment. PURPOSE: The purpose of the current study was to compare athletes with and without a history of diagnosed sleep disorders on commonly used baseline concussion assessments. METHODS: All participants completed baseline testing including: the Balance Error Scoring System (BESS), Brief Symptom Inventory (BSI), Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT), Post-Concussion Symptom Score (PCSS), Standardized Assessment of Concussion (SAC) and Vestibular/Ocular Motor Screening (VOMS). A total of 632 NCAA student-athletes participated in the study including 316 with previously diagnosed sleep disorders and 316 with no history of sleep disorder, matched for age, sex, sport, concussion history and race. Both groups were 19.87 years old (SD = 1.36), consisted of 176 males (55.7%), with 119 athletes (37.7%) previously having sustained a concussion, and represented a multitude of sports. RESULTS: A series of one-way ANOVAs with Bonferroni corrections revealed significant differences between groups on BESS (F(1, 535) = 4.02, p = .045), BSI somatization (F(1,623) = 11.41, p < .01), BSI depression (F(1, 623) = 13.59, p < .01), BSI anxiety (F(1, 623) = 20.97, p < .01), BSI global severity index (F(1, 623), p < .01) and PCSS (F(1, 396) = 22.86, p < .01). Specifically, the diagnosed sleep disorder group scored worse on the BESS and reported higher BSI and PCSS symptoms. No differences were noted between groups on VOMS, ImPACT neurocognitive measures, and SAC. CONCLUSION: Collegiate student-athletes with sleep disorders may have elevated affective and concussion symptoms at baseline that could affect interpretation of post-injury impairment and symptoms. Clinicians should assess diagnosed sleep disorders during pre-participation sport physicals and consider them when interpreting post-injury assessments.