Sleep Disturbances in the Acute Stage of Concussion are Associated With Poorer Long‐Term Recovery: A Systematic Review

Abstract

Objective: To examine the association between sleep during the acute stage of concussion and long-term outcomes. Literature Survey: Literature searches were performed 1 July 2018 to 1 August 2018 in Ovid MEDLINE, CINAHL, and Web of Science, along with hand searching for gray literature and cited references. Of the 610 search results, 359 unique references were reviewed after duplicates were removed. Methodology: Two reviewers independently reviewed and came to consensus on which titles/abstracts met inclusion/exclusion criteria (n = 23). The 23 full-text articles were assessed independently by the same two reviewers for eligibility. Consensus was achieved, leaving four articles for quality assessment and data extraction. One person extracted relevant data from each study using a standard data-extraction table. The data extraction table was reviewed by two reviewers and consensus was achieved for completeness and accuracy. Quality appraisal was conducted to assess the risk for potential bias and quality of included articles. Synthesis: Two of the articles included children younger than 16 years old and two included a wide age range. In general, poorer sleep was associated with poorer outcomes following concussion at reassessments across any age population. In addition, poorer sleep in the acute stage of concussion was associated with poorer long-term outcomes and recovery. Conclusions: The variability in sleep assessments used, symptoms assessed, length of time to reassessments, and comparator group included made data synthesis challenging. The use of standard valid and reliable sleep assessments is recommended. Future studies may consider if addressing sleep disturbances early following concussion will improve longer-term outcomes.

Sleep quality in the chronic stage of concussion is associated with poorer recovery: A systematic review

“…The copyright holder for this preprint this version posted September 7, 2020. ; https://doi.org/10.1101/2020.09.04.20188425 doi: medRxiv preprint 4 learning disabilities, migraines, previous concussions, psychiatric conditions, female gender, lower cognitive reserve, lower socioeconomic status, substance abuse, and premorbid sleep disturbance. [16][17][18][19][20] Concussion-specific risk factors for prolonged symptoms consist of loss of consciousness, injuries to other areas of the body, lower (<15) Glasgow Coma score, and a higher velocity mechanism of injury. 16,17 Post-injury anxiety, depression, post-traumatic stress disorder, migraine, sleep disturbances, fogginess, difficulty concentrating, vestibular dysfunction, and ocular motor dysfunction post-injury have also been associated with prolonged symptom recovery.…”

“…[16][17][18][19][20] Concussion-specific risk factors for prolonged symptoms consist of loss of consciousness, injuries to other areas of the body, lower (<15) Glasgow Coma score, and a higher velocity mechanism of injury. 16,17 Post-injury anxiety, depression, post-traumatic stress disorder, migraine, sleep disturbances, fogginess, difficulty concentrating, vestibular dysfunction, and ocular motor dysfunction post-injury have also been associated with prolonged symptom recovery. 13,14,21 Variability in length of recovery following a concussion is likely due to multiple reasons, including fluctuation of cellular effects, extent of axonal injury, location of impact, and the number and severity of symptoms following a concussion.…”

“…28 Our recently published systematic review found that sleep disturbances in the acute phase have been shown to be predictive of prolonged symptom recovery following a concussion. 17 Short sleep duration and poor quality during the acute and subacute stage of concussion are associated with a range of prolonged post-concussion symptoms including poorer cognitive function, reduced productivity at work or school, decreased social engagement, increased pain, daytime sleepiness, depression, and anxiety. 17,29,30 The association between sleep and post-concussion symptoms in the acute and sub-acute stages has been well documented.…”

“…17 Short sleep duration and poor quality during the acute and subacute stage of concussion are associated with a range of prolonged post-concussion symptoms including poorer cognitive function, reduced productivity at work or school, decreased social engagement, increased pain, daytime sleepiness, depression, and anxiety. 17,29,30 The association between sleep and post-concussion symptoms in the acute and sub-acute stages has been well documented. 19,[31][32][33][34][35][36] There remains a gap in the literature assessing the All rights reserved.…”

“…Short sleep duration and poor quality during the acute and subacute stage of concussion are associated with a range of prolonged post-concussion symptoms including poorer cognitive function, reduced productivity at work or school, decreased social engagement, increased pain, daytime sleepiness, depression, and anxiety. 17,29,30…”