Sleep Disturbance Following Concussion Is a Risk Factor for a Prolonged Recovery

Bramley, Harry; Henson, Alyssa; Lewis, Mechelle M.; Kong, Lan; Stetter, Christy; Silvis, Matthew

doi:10.1177/0009922816681603

Cited by 68 publications

(61 citation statements)

References 43 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Although grey matter and intra-regional connectivity values did not indicate gender-specific associations, the negative association between inter-regional FC and sleep disturbances was driven by females. This association, along with the fact that females reported higher levels of sleep-related symptoms compared to males, is in line with the suggestion that concussed females are more sensitive to sleep difficulties and have protracted recovery patterns 8,51 .…”

Section: Discussionsupporting

confidence: 87%

Default mode network anatomy and function is linked to pediatric concussion recovery

Iyer

Zalesky

Barlow

et al. 2019

Preprint

View full text Add to dashboard Cite

Objective:To determine whether anatomical and functional brain features relate to key persistent post-concussion symptoms (PPCS) in children recovering from mild traumatic brain injuries (mTBI), and whether such brain indices can predict individual recovery from PPCS.Methods: 110 children with mixed recovery following mTBI were seen at the concussion clinic at Neurology department Alberta Children's Hospital. The primary outcome was the Post-Concussion Symptom Inventory (PCSI, parent proxy). Sleep disturbance scores (PCSI sub-domain) and the Neurocognition Index (CNS Vital Signs) were also measured longitudinally. PPCS was assessed at 4 weeks post-injury and 8-10 weeks post-injury. Grey matter volumes were assessed using magnetic resonance imaging (MRI) and voxel-based morphometry. Functional connectivity was estimated using resting-state MRI. Two complementary machine learning methods were used to assess if the combination of grey matter and functional connectivity indices carried meaningful prognostic information.Results: Higher scores on a composite index of sleep disturbance, including fatigue, were associated with converging decreases in grey matter volume and local functional connectivity in two key nodes of the default mode network: the posterior cingulate cortex and the medial prefrontal cortex. Sleep-related disturbances also significantly correlated with reductions in functional connectivity between these brain regions. The combination of structural and functional brain indices associated to individual variations in the default mode network accurately predicted clinical outcomes at follow-up (area under the curve = 0.86). Interpretation:These results highlight that the function-structure profile of core default mode regions underpins sleep-related problems following mTBI and carries meaningful prognostic information for pediatric concussion recovery.

show abstract

Section: Discussionsupporting

confidence: 87%

Default mode network anatomy and function is linked to pediatric concussion recovery

Iyer

Zalesky

Barlow

et al. 2019

Preprint

View full text Add to dashboard Cite

show abstract

“…Additionally, we also found evidence that greater insomnia symptoms after concussion were associated with more severe postconcussive symptoms at 3 months, extending findings from retrospective studies. Retrospective studies have shown that insomnia may be associated with poorer outcomes (41,42). In a study of over 400 adolescents after concussion, Bramley and colleagues found that sleep disturbance was associated with a 3-to 4-fold increase in recovery time (41).…”

Section: Discussionmentioning

confidence: 99%

“…Retrospective studies have shown that insomnia may be associated with poorer outcomes (41,42). In a study of over 400 adolescents after concussion, Bramley and colleagues found that sleep disturbance was associated with a 3-to 4-fold increase in recovery time (41). Similarly, using a national high school sports injury surveillance database Kerr and colleagues found that insomnia symptoms were associated with a 2.79 increase in odds of post-concussive symptoms (42).…”

Section: Discussionmentioning

confidence: 99%

The role of sleep deficiency in the trajectory of postconcussive symptoms in adolescents

2019

View full text Add to dashboard Cite

Objective: To investigate the trajectory of sleep deficiency after concussion and examine its role as a predictor of postconcussive symptoms (PCS) over 3 weeks and at 3 months post-concussion. Design: This was a prospective pilot study of 29 adolescents recruited from a pediatric Emergency Department (69% female, mean age = 14.0 years, SD = 1.8) following a concussion. Methods: Adolescents completed questionnaire assessments at baseline, Weeks 1, 2, and 3 on PCS and sleep patterns. Concurrently, adolescents also completed a daily diary and wore an actigraph continuously to monitor sleep activity. At 3 months post-concussion, adolescents repeated questionnaire measures. Results: At enrollment, 53.6% reported severe PCS, and 12% maintained severe symptoms at 3 months. Over the first three weeks, sleep duration and daytime sleepiness gradually declined; however, insomnia symptoms remained unchanged. After accounting for age, sex and time since concussion, greater insomnia symptoms at enrollment were associated with more severe PCS at 3 weeks and 3 months (β = 1.17, p < .001). In contrast, sleep duration, efficiency and waketime after sleep onset were not predictors. Conclusions: Study findings suggest that insomnia symptoms after concussion may provide a target for early intervention to reduce prolonged severity and duration of PCS.

show abstract

“…Each ConTex clinic collects a core set of measures: the Concussion Symptom Log (a subset of the Sport Concussion Assessment Tool or SCAT5/ChildSCAT5, depending on subject age) to record symptoms,14 the Generalised Anxiety Disorder 7-item Scale to assess anxiety symptoms,15 16 Patient Health Questionnaire-8 (PHQ-8) to assess depressive symptoms17 and the Pittsburgh Sleep Quality Index to assess sleep quality over the past month18 because sleep disturbance is common following concussion 19. Approximately 92% of participants have completed all core measures.…”

Section: Introductionmentioning

confidence: 99%

The North Texas Concussion Registry (ConTex)

et al. 2020

View full text Add to dashboard Cite

PurposeThe North Texas Concussion Registry (ConTex) was established in 2015 as a multi-institutional collaboration intended to study risk factors, recovery patterns and clinical outcomes associated with concussion across the lifespan, with a particular emphasis on sport-related concussion.ParticipantsProspective enrolment of individuals who sustained a concussion within the past 6 months who were seen at one of four North Texas ConTex concussion clinics which employ common diagnostic criteria and assessment metrics to evaluate effects of a concussion as well as longitudinal tracking of recovery.Findings to dateThe ConTex database and multidisciplinary oversight team has been established, and over 1700 participants aged 5–88 years have been enrolled. A majority of concussions were sport-related (60%), with a mean age of 17.5 years and similar numbers of males and females. Three-month follow-up compliance has been excellent (86%), with a majority of subjects reporting good recovery by that time. ConTex has provided a rich data source for multiple research projects focused on concussion characteristics, risk factors and outcomes, and led to the development of a statewide youth concussion registry.Future plansConTex data are being analysed to add to the body of knowledge regarding concussion mechanisms, factors related to recovery and improving outcomes for concussion patients. ConTex will serve as a platform for future treatment studies and may serve as a model for other concussion surveillance programmes.

show abstract

Sleep Disturbance Following Concussion Is a Risk Factor for a Prolonged Recovery

Cited by 68 publications

References 43 publications

Default mode network anatomy and function is linked to pediatric concussion recovery

Default mode network anatomy and function is linked to pediatric concussion recovery

The role of sleep deficiency in the trajectory of postconcussive symptoms in adolescents

The North Texas Concussion Registry (ConTex)

Contact Info

Product

Resources

About