Association Between Sleep Quality and Recovery Following a Sport-Related Concussion in the Pediatric Population

Purpose: To determine if there is an association between sleep quality and symptom severity and recovery following sport-related concussion (SRC) in pediatric athletes. Methods: A review of prospectively collected data from subjects seen between October 2015 and June 2017, and enrolled in the North Texas Concussion Network Prospective Registry (Con-Tex), was performed. Subjects were treated at one of four outpatient clinics, in North Texas, specializing in concussions. Subjects were included in this analysis if they were diagnosed with an SRC and < 19 years old at enrollment. Records were reviewed for sleep quality, indicated by composite scores on the Pittsburgh Sleep Quality Index (PSQI). According to PSQI guidelines, good sleep quality (GS group) is indicated by a composite score of <6 (possible total=21), and poor sleep quality (PS group) by a score of >5. Demographics, symptoms, as assessed by the Sports Concussion Assessment Tool 3 (SCAT3), and days to symptom resolution (0-14 days, 15-30 days, >30 days, still experiencing symptoms) at initial and 3-month visits were compared between groups. Results: Of 356 eligible subjects, 180 (50.6%) were girls and 176 (49.4%) were boys, with a mean age of 14.38 years (7-18). 261 (73.3%) subjects had a PSQI composite score of <6 at their initial visit (GS), while 95 (26.7%) had scores >5 (PS). At initial visit, the PS group had a higher mean PSQI composite score (8.7) and total symptom score on SCAT3 (39.2) compared to the GS group (2.6 and 20.4, respectively, p<0.0001). The PS group also had a higher mean PSQI composite score (5.7) and total symptom score (12.2) at 3 months compared to the GS group (3.0 and 4.2, respectively, p<0.0001), although both groups improved. The GS group was more likely to have symptoms resolve within 0-14 days compared to the PS group, who was more likely to have symptoms resolve in >30 days (p<0.0001). Additionally, subjects in the PS group reported more fatigue, drowsiness, and trouble falling asleep on the SCAT3 at both the initial visit and 3-month follow-up when compared to the GS group (p<0.01). Gender was also significantly different between the two sleep groups, with more girls (61.1%) in the PS group than boys (38.9%, p=0.02). Conclusion: Poor sleep was strongly associated with greater symptom severity and days to symptom resolution following sport-related concussion in the pediatric population. Early recognition of concussed pediatric athletes with poor sleep quality at initial clinic visit may help clinicians predict prolonged recovery. Future research should focus on the effect of sleep quality intervention on recovery following sport-related concussion.