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Objective: To examine the association between sleep quality during the chronic stage of concussion and post-concussion outcomes. Literature Survey: Literature searches were performed during July 1st to August 1st, 2019 in selected databases along with searching grey literature. Out of the 733 results, 702 references were reviewed after duplicate removal. Methodology: Three reviewers independently reviewed and consented on abstracts meeting eligibility criteria (n=35). The full-text articles were assessed independently by two reviewers. Consensus was achieved, leaving four articles. Relevant data from each study was extracted using a standard data-extraction table. Quality appraisal was conducted to assess potential bias and the quality of articles. Synthesis: One study included children (18-60 months) and three studies included adolescents and/or adults (ranging 12 years to 35). The association between sleep and cognition (two studies), physical activity (one study), and emotion symptoms (one study) was examined. Sleep quality was associated with decreased cognition and emotional symptoms, but not with meeting physical activity guidelines 6 months post-concussion injury. Conclusions: The heterogeneity in age of participants and outcomes across studies and limited number of included studies made interpretations difficult. Future studies may consider if addressing sleep quality following concussion will improve outcomes.

Background Recovery from a concussion varies based on a multitude of factors. One such factor is sleep disturbances. In our prior review, it was observed that in the acute phase, sleep disturbances are predictive of poor outcomes following a concussion. The literature gap remains on how sleep in the chronic phase of recovery affects outcomes. Objective To examine the association between sleep quality during the chronic stage of concussion and post-concussion outcomes. Literature Survey: Literature searches were performed during 1 July to 1 August 2019 in selected databases along with searching grey literature. Out of the 733 results, 702 references were reviewed after duplicate removal. Methods Three reviewers independently reviewed and consented on abstracts meeting eligibility criteria ( n = 35). The full-text articles were assessed independently by two reviewers. Consensus was achieved, leaving four articles. Relevant data from each study was extracted using a standard data-extraction table. Quality appraisal was conducted to assess potential bias and the quality of articles. Results One study included children (18–60 months) and three studies included adolescents and/or adults (ranging 12–35 years). The association between sleep and cognition (two studies), physical activity (one study), and emotion symptoms (one study) was examined. Sleep quality was associated with decreased cognition and emotional symptoms, but not with meeting physical activity guidelines six months post-concussion injury. Conclusions The heterogeneity in age of participants and outcomes across studies and limited number of included studies made interpretations difficult. Future studies may consider if addressing sleep quality following concussion will improve outcomes.

Background. Over 50% of individuals with multiple sclerosis (MS) have moderate or severe sleep disturbances, insomnia being the most common. In-person cognitive behavioral therapy for insomnia (F2F-CBTi) is currently the first-line treatment for insomnia. However, given potential limitations to access including mobility difficulty, fatigue, or living in a rural area, telehealth-delivered CBT-I (tele-CBTi) has been considered as an alternative treatment. The purpose of this study was to assess the feasibility and treatment effect of tele-CBTi in people with MS and compare it to outcomes from a F2F-CBTi study in individuals with MS. Methods. 11 individuals with MS and symptoms of insomnia participated in 6 weekly CBT-I sessions with a trained CBT-I provider via live video. Insomnia severity (ISI), sleep quality (PSQI), and fatigue severity (FSS and MFIS) were assessed pre- and posttreatment as primary outcomes. Sleep onset latency (SOL), sleep efficiency (SE) and total sleep time (TST) from the PSQI, depression (PHQ-9), anxiety (GAD-7), sleep self-efficacy (SSES), and quality of life (MSIS-29) were also assessed pre- and posttreatment as secondary outcomes. Results. Participants resided in 9 different states. Retention and adherence rates were 100%. There were significant improvements in ISI, PSQI, MFIS, FSS, SOL, SSES, PHQ-9, and MSIS-29, but not SE, TST, or GAD-7. There were no significant differences between the F2F-CBTi group and tele-CBTi group for magnitude of change in the primary outcomes (ISI, PSQI, MFIS, and FSS) or the secondary outcomes (SOL, SE, TST, SSES, PHQ-9, GAD-7, and MSIS-29). Conclusions. Tele-CBTi is feasible and has outcome measures that are similar to that of in-person CBT-I treatment. Tele-CBTi may increase access to insomnia treatment in individuals with MS.