Abstract
Sleep-wake disturbance (SWD) results from sport-related concussion (SRC) and may increase risk of protracted post-injury symptoms. However, methodological limitations in the extant literature limit our understanding of the role of SWD in SRC. This study examined the association between acute/subacute SRC and two sleep behaviors—sleep duration and efficiency—as measured by self-report and commercially available actigraphy (CA) in a sample of football players enrolled in a larger prospective longitudinal study of concussion. Fifty-seven high school and Division 3 male football players with SRC (mean [M] age = 18.00 years, standard deviation [SD] = 1.44) and 26 male teammate controls (M age = 18.54 years, SD = 2.21) were enrolled in this prospective pilot study. Sleep duration and sleep efficiency were recorded nightly for 2 weeks (starting 24–48 h post-injury in the SRC group) via CA and survey delivered via mobile application. There was no significant relationship between SRC and objectively recorded sleep measures, a null finding. However, the SRC group reported a brief (3-day) reduction in sleep efficiency after injury (M SRC = 82.18, SD = 12.24; M control = 89.2, SD = 4.25; p = 0.013; Cohen's d = 0.77), with no change in sleep duration. Self-reported and actigraph-assessed hours of sleep were weakly and insignificantly correlated in the SRC group (r = −0.21, p = 0.145), whereas they were robustly correlated in the non-injured control group (r = 0.65, p = 0.004). SWD post-SRC was not observed in objectively measured sleep duration or sleep efficiency and was modest and time-limited based on self-reported sleep efficiency. The weak correlation between self-reported and objective sleep behavior measures implies that subjective experience of SWD post-SRC may be due to factors other than actual changes in these observable sleep behaviors. Clinically, SWD in the early-subacute stages of recovery from SRC may not be adequately measurable via current CA. Subjective SWD may require alternative methods of evaluation (e.g., clinical actigraph or sleep study).
Highlights
Sleep-wake disturbance (SWD) results from sport-related concussion (SRC) and may increase risk of protracted post-injury symptoms
Detailed day-by-day descriptive statistics and group comparisons between SRC versus control group metrics are found in Supplementary Table S1
Because of the minimal relationship identified between commercially available actigraphy (CA) or mobile survey (MS) sleep and acute concussion, we explored the possibility that concussion might be associated with increased variability in sleep duration or efficiency over the acute post-concussive period, as opposed to the mean difference investigated by the aforementioned analyses
Summary
Sleep-wake disturbance (SWD) results from sport-related concussion (SRC) and may increase risk of protracted post-injury symptoms. Mild traumatic brain injury (mTBI) accounts for the mTBI, and one population-based longitudinal study idenvast majority of medically treated TBIs (85+%).[1,2] Sleep- tified a rise from 10% incidence pre-injury to a 2-week This Null Hypothesis article is published as part of a collaborative effort between Cohen Veterans Bioscience, the Center for Biomedical Research Transparency (CMBRT), and Mary Ann Liebert, inc., publishers to promote open science through publication of high-quality studies, including those with negative, inconclusive, and confirmatory results. Sleep disturbance may cause or intensify a variety of concussion-related comorbidities such as mood problems, fatigue, cognitive deficits, pain, and functional impairments that compromise recovery.[6,7] Current literature suggests that SWD is a common sequelae of concussion but, once present, may independently contribute to other symptoms common to concussion (e.g., pain, depression, fatigue, cognitive dysfunction), thereby acting as a perpetuating factor.[3,8]
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