Good sleep quality encourages better recovery after sport-related concussion

November 02, 2018

ORLANDO, Fla. - A new study found that young athletes who have good sleep quality after sustaining a concussion are more likely to recover within two weeks. Those who don't have good sleep quality often take longer to recover, sometimes greater than 30 days.

The study abstract, "Association Between Sleep Quality and Recovery Following a Sport-Related Concussion in the Pediatric Population," will be presented at the American Academy of Pediatrics 2018 National Conference & Exhibition, in Orlando, Fla. Researchers at Texas Scottish Rite Hospital for Children examined data from four outpatient clinics in north Texas that specialize in treating concussions, analyzing records from 356 athletes younger than 19 who were diagnosed with a sport-related concussion between October 2015 and June 2017.

Researchers looked at overall sleep quality for these young athletes by asking them to complete a commonly used sleep questionnaire. Those athletes who reported a score of five or fewer were considered to have good sleep quality and generally had their concussion symptoms resolve within two weeks. Those athletes who reported a score of six or more were considered to have poor sleep quality and experienced symptoms for a longer period of time, often times greater than one month.

"The importance of good sleep quality is often underestimated in young athletes," said Jane S. Chung, MD, FAAP, the primary author of the abstract and a sports medicine physician at Texas Scottish Rite Hospital for Children. "Sleep is not only important for physical, mental, and cognitive well-being, but also seems to play a pivotal role in the recovery of the brain following a sport-related concussion."

Survey results showed that 73 percent of athletes had good sleep quality at their initial clinic visit, while 27 percent exhibited poor sleep quality. Girls were more likely to have poor sleep quality post-concussion than boys. Athletes with poor sleep quality reported two (2) times greater symptom severity at their initial clinic visit and three (3) times greater symptom severity at their 3-month follow-up compared to those with good sleep quality, although both groups improved over time.

The authors hope that this information encourages clinicians to ask about sleep quality post-concussion and use that information to encourage good sleep habits as well as identify athletes that may be at risk for a longer recovery period.

"Pediatricians and health care providers involved in the care of young athletes should educate and emphasize the importance of good sleep quality and sleep hygiene for optimal overall health, performance, and recovery," Dr. Chung said. "Parents can take small steps to help improve their child's sleep quality by establishing a regular sleep schedule, avoiding electronics at least one hour prior to bedtime, and encouraging them to get at least 8-10 hours of sleep each night."

Dr. Chung will present the study abstract, included below, at 11 a.m. ET, Saturday, Nov. 3, in the Regency Ballroom U at the Orange County Convention Center in Orlando, Fla.

Please note: only the abstract is being presented at the meeting. In some cases, the researcher may have more data available to share with media or may be preparing a longer article for submission to a journal.
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The American Academy of Pediatrics is an organization of 67,000 primary care pediatricians, pediatric medical subspecialists and pediatric surgical specialists dedicated to the health, safety and well-being of infants, children, adolescents and young adults. For more information, visit http://www.aap.org. Reporters can access the meeting program and other relevant meeting information through the AAP meeting website at http://www.aapexperience.org/

Editor's Note: The abstract below contains changes that were made after submission, making this version different from the one appearing in the National Conference program.

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

Jane Chung

Dallas, TX, United States

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 participants seen between October 2015 and June 2017 and enrolled in the North Texas Concussion Network Prospective Registry (Con-Tex), was performed. Participants were treated at one of four outpatient clinics, in North Texas, specializing in concussions. Participants were included in this analysis if they were diagnosed with an SRC and less than 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 <5 (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 clinic visit and 3-month follow-up were compared between groups. Results: Of 356 eligible participants, 180 (50.6%) were girls and 176 (49.4%) were boys, with a mean age of 14.38 years (7-18). 261 (73.3%) participants had a PSQI composite score of <5 at their initial clinic visit (gs), while 95 (26.7%) had scores>5 (PS). At initial clinic 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 group's symptoms 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, participants in the PS group reported more fatigue, drowsiness, and trouble falling asleep on the SCAT3 at both the initial clinic visit and 3-month follow-up when compared to the GS group (p<0.01). Sex 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.

American Academy of Pediatrics

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