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  • 6.2 Sleep disturbance following concussion is associated with greater initial symptom burden and poorer sleep hygiene: a cross-sectional study from a paediatric tertiary referral concussion clinic

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6) Persistent Symptoms
6.2 Sleep disturbance following concussion is associated with greater initial symptom burden and poorer sleep hygiene: a cross-sectional study from a paediatric tertiary referral concussion clinic
  1. Maree Cassimatis1,
  2. Rhonda Orr1,2,
  3. Andrew Fyffe1,2,
  4. Gary Browne2,3
  1. 1Discipline of Exercise and Sports Science, Faculty of Medicine and Health, Sydney School of Health Sciences, The University of Sydney, Sydney, New South Wales, Australia, Sydney, Australia
  2. 2Sydney Children’s Hospital Network, Children’s Hospital Institute of Sports Medicine, Children’s Hospital Westmead, Sydney, New South Wales, Australia, Sydney, Australia
  3. 3Discipline of Child and Adolescent Health, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia, Sydney, Australia

Abstract

Objective To determine the prevalence of sleep disturbance in paediatric concussion and ascertain what clinical characteristics are associated with post-concussion sleep disturbance.

Design Retrospective cross-sectional study.

Setting Tertiary referral concussion clinic.

Participants Ninety children (aged <18 years) diagnosed with concussion.

Interventions (or Assessment of Risk Factors) The Insomnia Severity Index (ISI) was used to measure sleep following concussion, with a score >7 identifying participants with sleep disturbance. Clinical characteristics of symptom burden, neurocognition, exercise tolerance and sleep hygiene were assessed via the Post-Concussion Symptom Scale (PCSS), Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT), graded exercise testing and Sleep Hygiene Index, respectively.

Outcome Measures Clinical characteristics of participants with and without sleep disturbance were compared. A subgroup analysis of recovered participants was conducted to determine whether sleep disturbance influenced recovery duration (days).

Main Results Of the 108 initial assessments conducted between January 2021 to April 2022, 90 participants (mean age: 14 ± 2 years, 66% male) were eligible. Over one-third (37%) of participants had post-concussion sleep disturbance. Initial symptom burden was three times greater in participants with sleep disturbance compared to participants without sleep disturbance (mean(95%CIs) PCSS score: 39(31–47) versus 13(9–17), p<0.001). Sleep hygiene was significantly poorer in participants with sleep disturbance (p<0.001). Demographic characteristics, neurocognition and exercise tolerance were similar between groups. The subgroup analysis of recovered participants (n=38, mean(95%CIs) recovery time: 55(30–80) days) conveyed no significant differences in recovery duration between groups (p=0.91).

Conclusions Sleep disturbance contributed to a large portion of children presenting to a specialist concussion clinic, and was associated with exacerbated symptomatology and poor sleep hygiene.

https://doi.org/10.1136/bjsports-2023-concussion.280

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