Our results indicate that athletes sleeping fewer than 7 hours before baseline testing perform worse on 3 of 4 ImPACT scores and report more symptoms. Because SRC management and RTP decisions hinge on the comparison with a reliable baseline evaluation, clinicians should consider sleep duration before baseline neurocognitive testing as a potential factor in the assessment of athletes' recovery.
Sleep disturbances are among the most common nonmotor complaints of patients with Parkinson’s disease (PD), and can have a great impact on quality of life. These disturbances manifest in a variety of ways; for instance, insomnia, sleep fragmentation, and excessive daytime sleepiness. Sleep-related movement disorders such as restless legs syndrome and periodic leg movements may share a common pathophysiology, and occurrence of rapid eye movement behavior disorder may predate the onset of PD or other synucleinopathies by several years. Medications for PD can have a significant impact on sleep, representing a great challenge to the treating physician. Awareness of the complex relationship between PD and sleep disorders, as well as the varied way in which sleep disturbances appear, is imperative for successful long-term management.
Background: Sleep disorders are common following traumatic brain injury (TBI). Methods: We review the literature regarding sleep disturbances in the acute and chronic phase following TBI in both the adult and pediatric population. Results: Acute and chronic disruption of sleep commonly follows TBI and contributes to morbidity commonly seen post-injury in both adults and children. This includes the direct effect of TBI leading to sleep disruption, as well as sleep disorders resulting from TBI itself. Pre-TBI neurocognitive testing is important to determine a baseline prior to injury, while disrupted sleep can also prolong recovery after TBI. Early recognition of sleep disturbances post-injury can lead to earlier treatment and limit the sequelae of TBI, as well as assist in recovery. Conclusion: We suggest that evaluation for sleep disturbances following TBI is a critical component of post-TBI assessment and management.
Objectives:When managing sport-related concussions (SRC), sports medicine physicians utilize serial neurocognitive assessments and self-reported symptom inventories when evaluating athlete recovery and safety for returning to play (RTP). Since post-concussive RTP goals include symptom resolution and return to neurocognitive baseline, clinical decisions rest on an understanding of modifiers of baseline performance. Several studies have reported the influence of age, gender and sport on baseline neurocognitive performance, but few have assessed the potential effect of sleep. We hypothesized that: 1) athletes receiving less sleep prior to baseline testing would perform worse on neurocognitive metrics; and 2) decreased sleep would have no association with the quantity of reported symptoms.Methods:We retrospectively reviewed 3,704 non-concussed athletes, 2,385 male, 3,321 high school and 383 college-aged, with baseline symptom and neurocognitive scores on Immediate Post-concussion Assessment and Cognitive Testing (ImPACT). Subjects were stratified into three groups based on self-reported sleep duration the night prior to testing; 1) short < 7 hrs, 2) intermediate 7−9 hrs; and 3) long ≥ 9 hrs). Multivariate analysis assessed the influence of categorical sleep duration on the baseline number of reported symptoms and ImPACT performance, with alpha level of 0.05.Results:When controlling for age, gender and sport as covariates, the multivariate analysis of covariances showed a significant association between shorter sleep duration and poorer verbal memory scores (p=0.019), visual memory scores (p=0.035), and reaction time scores (p=0.044), but not for visual-motor scores. Significance was found between shorter sleep duration and increased number of reported symptoms (P < 0.0001). Subsequent pairwise comparisons revealed these associations to be most significant when specifically comparing the short and intermediate sleep groups.Conclusion:Our results indicate that athletes sleeping less than 7 hours prior to testing perform worse on 3 out of 4 neurocognitive ImPACT scores and endorse more symptoms. Because concussion management and RTP decisions hinge on the comparison to a reliable baseline evaluation, sports medicine physicians should strongly consider amount of sleep prior to neurocognitive testing in the assessment of athletes’ recovery.
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