Post-concussion Dizziness, Sleep Quality, And Postural Stability In Young Athletes

Abstract

PURPOSE: Dizziness is a common post-concussion symptom. We examined associations among dizziness, sleep quality, and postural stability for pediatric athletes with concussion. METHODS: We evaluated patients ages 10-18 years within 14 days of concussion (n = 58, 15.2 + 1.8 years; 50% female; 7.1 + 3.1 days post-injury) and compared them to healthy controls (n = 73; 15.8 + 1.3 years; 42% female). Patients completed ratings of pre-injury and current dizziness (Post-Concussion Symptom Inventory [PCSI]) and current sleep quality (Pittsburgh Sleep Quality Index [PSQI]). Trained research assistants administered postural stability assessments (single/dual-task tandem gait [TG] and modified Balance Error Scoring System [mBESS]). We grouped concussion patients based on the difference between their current and pre-injury dizziness ratings: difference > 3 = dizzy (n = 21); difference < 2 = not dizzy (n = 37). RESULTS: The dizzy group reported significantly worse sleep quality than the not dizzy and control groups. However, the not dizzy group still reported significantly worse sleep ratings than healthy controls (mean = 9.6 + 3.7 vs 7.2 + 3.5 vs 4.3 + 2.6; p < 0.001). Similarly, the dizzy group performed the slowest on single and dual-task TG, followed by the not dizzy group, then the control group (single-task TG: mean = 27.2 + 11.7 sec vs 21.2 + 6.3 vs 14.7 + 3.6; p < 0.001); (dual-task TG: mean = 38.4 + 16.2 sec vs 29.9 + 7.2 vs 21.6 + 7.5; p < 0.001). The dizzy group demonstrated more mBESS errors than the other two groups, while the not dizzy group demonstrated more errors than the control group (mean = 9.8 + 5.1 vs 6.9 + 5.8 vs 3.8 + 3.5; p < 0.001). Differences in mBESS scores between concussion groups were not significant (p = 0.055). CONCLUSION: Worsening dizziness post-concussion was associated with impaired sleep quality and TG. Sleep quality and TG measures differed between dizzy and not-dizzy concussion groups, while mBESS scores did not. Thus, when evaluating patients with post-concussion dizziness, measures of sleep quality and postural control, specifically TG, may provide clinicians with clinically useful information. Although limited, our data suggest that worsened dizziness post-concussion may play a role in the sleep and postural stability impairments identified in the concussion literature.