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 3 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.

KEYWORDS:

• Postconcussive symptoms
• sleep
• adolescents
• insomnia
• actigraphy

Acknowledgments

The authors are grateful to the study participants.

This work was funded by Seattle Children’s Research Institute Child Health Behavior and Development Mentored Scholars Award.

Conflict of interest statement

The authors have no conflicts of interest related to this work.

Additional information

Funding

This work was supported by the Seattle Children’s Research Institute Center for Child Health Behavior and Development .