The Effect of Preinjury Sleep Difficulties on Neurocognitive Impairment and Symptoms After Sport-Related Concussion. (April 2015)

• Record Type: Journal Article
• Authors: Sufrinko, Alicia; Pearce, Kelly; Elbin, R.J.; Covassin, Tracey; Johnson, Eric; Collins, Michael; Kontos, Anthony P.
• Is Part Of: American journal of sports medicine. Volume 43:Number 4(2015:Apr.)
• Page Start: 830
• Page End: 838
• Publication Date: 2015-04
• Subjects: concussion -- sleep problems -- injury; Sports medicine -- Periodicals; Sports injuries -- Periodicals; Orthopedic surgery -- Periodicals; 617.102705
• DOI: 10.1177/0363546514566193
• Languages: English
• ISSNs: 0363-5465

Abstract

Background: Researchers have reported that sleep duration is positively related to baseline neurocognitive performance. However, researchers have yet to examine the effect of preinjury sleep difficulties on postconcussion impairments. Purpose: To compare neurocognitive impairment and symptoms of athletes with preinjury sleep difficulties to those without after a sport-related concussion (SRC). Study Design: Cohort study; Level of evidence, 3. Methods: The sample included 348 adolescent and adult athletes (age, mean ± SD, 17.43 ± 2.34 years) with a diagnosed SRC. The sample was divided into 2 groups: (1) 34 (10%) participants with preinjury sleep difficulties (sleeping less as well as having trouble falling asleep; SLEEP SX) and (2) 231 (66%) participants without preinjury sleep difficulties (CONTROL). The remaining 84 (24%) participants with minimal sleep difficulties (1 symptom) were excluded. Participants completed the Immediate Postconcussion Assessment and Cognitive Test (ImPACT) and Postconcussion Symptom Scale (PCSS) at baseline and 3 postinjury intervals (2, 5-7, and 10-14 days after injury). A series of repeated-measures analyses of covariance with Bonferroni correction, controlling for baseline non–sleep-related symptoms, were conducted to compare postinjury neurocognitive performance between groups. Follow-up exploratory t tests examined between-group differences at each time interval. A series of analyses of variance were used to examine total PCSS score, sleep-related, and non–sleep-related symptoms across time intervals between groups. Results: Groups differed significantly in PCSS scores across postinjury intervals for reaction time ( P < .001), with the preinjury SLEEP SX group performing worse than controls at 5-7 days (mean ± SD, 0.70 ± 0.32 [SLEEP SX], 0.60 ± 0.14 [CONTROL]) and 10-14 days (0.61 ± 0.17 [SLEEP SX]; 0.57 ± 0.10 [CONTROL]) after injury. Groups also differed significantly on verbal memory performance ( P = .04), with the SLEEP SX (68.21 ± 18.64) group performing worse than the CONTROL group (76.76 ± 14.50) 2 days after injury. The SLEEP SX group reported higher total symptom ( P = .02) and sleep-related symptom ( P = .02) scores across postinjury time intervals. Conclusion: Preinjury sleep difficulties may exacerbate neurocognitive impairment and symptoms after concussion. The findings may help clinicians identify athletes who are at risk for worse impairments after a concussion due to preinjury sleep difficulties.