Sleep Quantity and Quality during Acute Concussion: A Pilot Study

Abstract

Study Objectives: A number of subjective and objective studies provide compelling evidence of chronic post-concussion changes in sleep, yet very little is known about the acute effects of concussion on sleep quality and quantity. Therefore, the purpose of this prospective pilot study was to use actigraphy to examine the changes in sleep quality and quantity acutely following concussion at home rather than in a hospital or sleep laboratory. Methods: Seventeen young adults (7 with acute concussion, 10 controls) were recruited for this study. All participants completed two 5-day testing sessions separated by 30 days from intake (controls) or day of injury (concussion). Participants wore actigraphs and kept a sleep journal. Sleep parameter outcomes included nighttime total sleep time (nTST), 24-h total sleep time (TST), wake after sleep onset (WASO), and sleep efficiency (SE). The coefficient of variation (CV) for each sleep parameter was computed for each session. Results: nTST and TST CV was significantly greater in the concussion group. There is the additional indication that individuals with a concussion may require and obtain more sleep shortly after injury and subsequently have a shorter duration of sleep at 1 mo post-injury. This pattern was not seen in the measures of sleep quality (WASO, SE). Conclusions: Individuals with a concussion demonstrated increased nighttime sleep duration variability. This increase persisted at 1 mo post-injury and may be associated with previously documented self-reports of poor sleep quality lasting months and years after a concussion. Additionally, this increase may predispose individuals to numerous negative health outcomes if left untreated.

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

“…Depression, anxiety, feelings of isolation, sex, age, learning disorders, family history, and history of migraine headaches are some factors that can contribute to the perpetuation of concussion symptoms . Evidence suggests that sleep disturbances before and immediately following the concussion may contribute to the perpetuation of concussion symptoms …”

A review of sleep disturbances following traumatic brain injury

“…A recent prospective study (n = 17) used actigraphy to demonstrate that an increased sleep need might be seen in the acute period following (Raikes and Schaefer 2016). A larger prospective study (n = 748) showed that these changes persist up to one month, but may resolve by one year following TBI; however, increased sleep need was assessed via survey rather than actigraphy (Watson et al 2007).…”

“…Increased sleep need is a significant issue in the acute period following TBI (Baumann et al 2007;Sommerauer et al 2013;Raikes and Schaefer 2016). A prospective study of 96 patients with TBI demonstrated that 22% experienced hypersomnia following TBI, defined as a sleep need of equal to or greater than 2 h when compared to pre-TBI sleep need (Baumann et al 2007).…”

“…However, there is no current consensus on what constitutes these time frames as it relates to the emergence of sleep disturbances following TBI. The acute phase for sleep disruption has been described as occurring anywhere from 1 week up to one year post-injury, while the chronic phase has been felt to begin six months to a year following TBI (Wickwire et al 2016;Nakase-Richardson et al 2013;Chan and Feinstein 2015;Pillar et al 2003;Baumann et al 2007;Sommerauer et al 2013;Raikes and Schaefer 2016;Watson et al 2007;Imbach et al 2015). In this review, we designate the acute phase up to six months post-injury, with the chronic phase six months or greater.…”

“…Those who sustain TBI may suffer from hypersomnia and insomnia in the acute period post-injury (Wickwire et al 2016;Baumann et al 2007;Sommerauer et al 2013;Raikes and Schaefer 2016;Watson et al 2007;Imbach et al 2015). Furthermore, central nervous system symptoms occurring as a result of TBI also may cause disruption of sleep (Pillar et al 2003;Lavigne et al 2015;Chaput et al 2009;Minen et al 2016;Hou et al 2013;Jaramillo et al 2016;Farrell-Carnahan et al 2015;Bryan 2013;Holster et al 2017).…”