Poor sleep predicts subacute postconcussion symptoms following mild traumatic brain injury

ABSTRACT

The primary objective was to determine if poor sleep predicts postconcussion symptoms in the subacute period after mild traumatic brain injury (TBI). The impact of poor sleep pre- and post-injury was examined. The research design was cross-sectional. After screening to detect response invalidity, 61 individuals with a self-reported history of mild TBI 1-to-6 months prior answered an online fixed order battery of standardized questionnaires assessing their sleep (current and preinjury) and persistent postconcussion symptoms (Neurobehavioral Symptom Inventory, minus sleep, and fatigue items). The sleep measures were the Insomnia Severity Index, Epworth Sleepiness Scale, a single Likert-scale pre-injury sleep quality rating, and two PROMIS™ measures (sleep-related impairment and sleep disturbance). After controlling for the effects of preinjury sleep quality and demographics, the combination of the sleep measures made a significant contribution to the outcome (F[8,58] = 4.013, p = .001, ). Only current sleep-related impairment (ß = .60, p < .05) made a significant and unique contribution to neurobehavioral symptoms. Preinjury sleep was not a predictor (ß = −.19, p > .05), although it contributed 3% of the variance in NSI scores after controlling for demographics. Sleep-related impairment is a modifiable factor. As a significant contributor to neurobehavioral symptoms, treatment for post-injury sleep-related impairment warrants further attention.

KEYWORDS:

• Concussion
• insomnia
• mild traumatic brain injury
• postconcussion symptoms
• sleep

Acknowledgments

The authors acknowledge Ms. Lina Karlsson who collected and entered the data for this research. The Queensland University of Technology (QUT) Human Research Ethics Committee approved this research (HREC Ref no. 1300000224). This research was conducted in accordance with an approved occupational health and safety risk assessment.

Declaration of interest

The authors declare no conflict of interest in relation to the content of this report.

Notes

¹Participants were asked how often their sleep is disturbed by physical pain or discomfort at night. Responses were on a 5-point scale, from 1 (every night/almost every night) to 5 (never). When analysed instead of the pain rating, there was no difference in the pattern of results.

²We did not exclude participants on the basis of an affirmative response to this question. When we ran the analyses with and without the affirmative group included, it did not change the pattern of the results. There was no significant relationship between mental health treatment in the previous 12 months (yes = 1; no = 2) and scores on the PROMISb, ESS, or the ISI (p > .05), but a modest negative correlation with PROMIS a (r = −.23, p < .05).