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

Abstract

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.

Brain Injury Screening Tool (BIST): test–retest reliability in a community adult sample

“…Fatigue and sleep have previously been found to be common problems in the general population with up to 28.6% of the population reporting sleeping problems and 35% reporting fatigue 15. While this may suggest these symptoms may not be specific in identifying concussion, poor sleep whether directly related to the mTBI or not, has been found to be a significant predictor of longer term persistent symptoms 23. Consequently, it is important to assess sleep quality in the acute period post-mTBI as a risk factor for poorer longer term recovery 24.…”

“…15 While this may suggest these symptoms may not be specific in identifying concussion, poor sleep whether directly related to the mTBI or not, has been found to be a significant predictor of longer term persistent symptoms. 23 Consequently, it is important to assess sleep quality in the acute period post-mTBI as a risk factor for poorer longer term recovery. 24 Inclusion of people with diagnosed comorbidities did not appear to have had a meaningful impact on the test-retest reliability of the BIST in itself, as the presence of comorbidities were not notably associated with the BIST symptom score.…”

Poor sleep quality is associated with greater negative consequences for cognitive control function and psychological health after mild traumatic brain injury than after orthopedic injury.

“…The presence of an mTBI and concurrent sleep disturbances has been hypothesized to have a combined negative effect on patient outcome. Disturbed sleep may act as an impediment for neurocognitive and psychological recovery and outcome after mTBI (Lowe et al, 2020; Ludwig, D’Silva, et al, 2020; Ludwig, Nelson, et al, 2020). Extant studies indicate that poor sleep quality after mTBI is associated with poorer neurocognitive performance and higher levels of psychological distress (Dean & Sterr, 2013; Kalmbach et al, 2018; Theadom et al, 2015).…”

“…Neurocognitive tests that require continuous performance and place high demands on processing speed that are particularly sensitive to the effects of mTBI (Rabinowitz et al, 2015), sleep loss in healthy participants (Massar et al, 2019; Saksvik-Lehouillier et al, 2020), poor sleep quality in individuals with insomnia (Altena et al, 2008; Edinger et al, 1997), and poor sleep quality after mTBI (Dean & Sterr, 2013). There is, however, a need for more studies investigating the associations between sleep and outcome after mTBI both in the acute phase (the first 2 weeks after injury; Ludwig, D’Silva, et al, 2020) and in the chronic stage (≥3 months after injury; Ludwig, Nelson, et al, 2020). Additionally, including control groups with orthopedic injuries are essential for ensuring that general injury-related factors are controlled, such that factors specific to the mTBI itself can be evaluated (Ludwig, D’Silva, et al, 2020; Saksvik et al, 2020).…”