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

Abstract

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.

Assessing Cognitive Behavioral Therapy for Insomnia to Improve Sleep Outcomes in Individuals With a Concussion: Protocol for a Delayed Randomized Controlled Trial

“…Sleep dysregulation is a risk factor for prolonged recovery. One recent systematic review found that poor sleep was predictive of poor long-term outcomes in the acute phase of concussion recovery [ 6 ], while another systematic review found that poor sleep in the chronic phase of recovery was associated with poor cognitive functioning (executive function and working memory) and emotional regulation [ 7 ]. Currently, it is unknown if treatment for sleep disturbances in individuals with a concussion could impact recovery.…”

Cognitive Behavioral Therapy for Insomnia Improves Sleep Outcomes in Individuals With Concussion: A Preliminary Randomized Wait-List Control Study

“…Poor sleep in the acute phase of a concussion is associated with prolonged recovery including more postconcussion symptoms with higher severity 4. Poor sleep in the chronic phase of concussion is associated with decreased cognitive functioning (executive function and working memory) and decreased emotional regulation 5…”

“…Poor sleep is associated with prolonged recovery following concussion,4,5 and insomnia is the most commonly reported sleep disturbance in the concussion population 3. CBT-I may assist in the recovery process by improving sleep and potentially improving postconcussion symptoms.…”

“…4 Poor sleep in the chronic phase of concussion is associated with decreased cognitive functioning (executive function and working memory) and decreased emotional regulation. 5 Insomnia is the most commonly reported sleep disturbance in individuals with a concussion. 3 Insomnia is characterized by difficulty of falling asleep and/or staying asleep and is associated with impairments in daytime functioning.…”