Sleep Problems Following Concussion are Associated with Worse Balance and More Severe Symptoms in Youth Athletes

• Published in: Orthopaedic journal of sports medicine 2022-05, Vol.10 (5_suppl2)
• Main Authors: Magliato, Samantha N., Seehusen, Corrine N., Wingerson, Mathew J., Smulligan, Katherine L., Wilson, Julie C., Howell, David R.
• Format: Article
• Language: English
• Subjects: Concussion; Orthopedics; Posture; Sleep; Sports medicine
• ISSN: 2325-9671; 2325-9671
• DOI: 10.1177/2325967121S00425

Background: Sleep disturbances are common following concussion and may affect symptom severity and recovery timing. Whether post-concussion sleep problems are associated with functional outcomes, such as postural stability, remains unexplored. Hypothesis/Purpose: We examined the association of self-reported sleep problems with clinical measures of postural stability, persistent post-concussion symptoms (PPCS), and symptom severity following pediatric concussion. We hypothesized that patients reporting post-concussion sleep problems would demonstrate worse postural stability, more severe symptoms at their initial clinical visit, and slower symptom recovery times than those without sleep problems. Methods: We retrospectively examined data from patients (6-18 years) evaluated by a sports medicine physician ≤21 days post-concussion. Patients performed the modified Balance Error Scoring System (mBESS) and single- and dual-task tandem gait (TG). They also reported initial concussion symptom severity they recalled within the first 24 hours post-injury and current symptoms at the first clinical visit using the Health and Behavior Inventory (HBI). Symptom duration was the number of days post-injury until the patient reported a return to baseline status. PPCS was defined as a symptom duration >28 days post-injury. We stratified patients based on those that self-reported sleep problems since injury (n=97, 14.32.9 years; 49% female; initial visit 10.25.8 days post-injury) compared to those who did not (n=110, 14.32.4 years; 46% female; initial visit 9.35.4 days post-injury) assessed with a yes/no question. Groups were compared using independent sample t-tests, Mann Whitney U tests, or Chi square analyses evaluated at a significance level of p=0.05. We examined PPCS development between groups using a logistic regression analysis adjusted for time of initial visit. Symptom severity was analyzed using a 2x2 repeated measures ANOVA with pairwise follow-up using an adjusted significance level of p=0.025. Results: Patients reporting sleep problems post-concussion had significantly more mBESS errors than those without (Table 1). We observed no between-group differences for single- or dual-task TG time or dual-task cognitive performance. Sleep problems post-concussion were associated with more severe symptoms during the first clinical visit despite similar day-of-injury symptoms (Figure 1), and a 2x greater odds of developing PPCS (adjusted odds ratio=2.02, 95% confidence int