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

Abstract

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.

Sleep Moderating the Relationship Between Pain and Health Care Use in Youth With Sickle Cell Disease

“…Weekday and weekend nights were included in our actigraph calculations, which may have altered the findings given that youth tend to differ in their weekday and weekend sleep patterns. [42] However, it is consistent with previous pediatric research [26][27][28][29] and does allow for a more comprehensive estimate of the amount of sleep deprivation and disruption experienced throughout the week. Also, the current study assessed HCU using retrospective guardian report, which may be influenced by response bias.…”

“…This takes into account variability in sleep during the week that may be important for understanding the general level of sleep deprivation and disruption experienced by youth with SCD, and is consistent with previous pediatric research studies. [26][27][28][29] Sleep actigraphy has been validated in comparison to polysomnography, with agreement rates for sleep and wake identification higher than 90%. [30]…”

Pediatric Sports-Related Concussion: An Approach to Care

“…Two studies evaluating sleep after pediatric concussion found poor sleep quality to be strongly associated with greater concussion symptom severity and longer recovery times following SRC. 38,42 Similarly, a study looking at collegiate athletes found daytime sleepiness and insomnia to be a risk factor for SRC, 43 further highlighting the need for sleep to be assessed and incorporated into treatment recommendations to ensure safe return to sport participation. Emphasizing the importance of proper sleep hygiene can improve these sleep disturbances.…”

Assessment and Treatment of Concussion in the Pediatric Population

“…Over the first 3 weeks, sleep duration and daytime sleepiness gradually declined; however, insomnia symptoms remain unchanged. 71 Piantino et al proposed a model where changes in the lymphatic function caused by TBI and posttraumatic sleep disruption may impair the clearance of neuropeptides involved in the pathogenesis of posttraumatic headaches and posttraumatic sleep. 72 Not only are sleep disturbances associated with fatigue and reduced quality of life in the acute phase, but they may hinder recovery from other concussion symptoms, 73,74 often with exacerbation of problems such as headache and cognitive deficits.…”