Neurotrauma Reports (Apr 2021)
Relationship between Sport-Related Concussion and Sleep Based on Self-Report and Commercial Actigraph Measurement
Abstract
Sleep-wake disturbance (SWD) results from sport-related concussion (SRC) and may increase risk of protracted post-injury symptoms. However, methodological limitations in the extant literature limit our understanding of the role of SWD in SRC. This study examined the association between acute/subacute SRC and two sleep behaviors?sleep duration and efficiency?as measured by self-report and commercially available actigraphy (CA) in a sample of football players enrolled in a larger prospective longitudinal study of concussion. Fifty-seven high school and Division 3 male football players with SRC (mean [M] age?=?18.00 years, standard deviation [SD]?=?1.44) and 26 male teammate controls (M age?=?18.54 years, SD?=?2.21) were enrolled in this prospective pilot study. Sleep duration and sleep efficiency were recorded nightly for 2 weeks (starting 24?48?h post-injury in the SRC group) via CA and survey delivered via mobile application. There was no significant relationship between SRC and objectively recorded sleep measures, a null finding. However, the SRC group reported a brief (3-day) reduction in sleep efficiency after injury (M SRC?=?82.18, SD?=?12.24; M control?=?89.2, SD?=?4.25; p?=?0.013; Cohen's d?=?0.77), with no change in sleep duration. Self-reported and actigraph-assessed hours of sleep were weakly and insignificantly correlated in the SRC group (r?=??0.21, p?=?0.145), whereas they were robustly correlated in the non-injured control group (r?=?0.65, p?=?0.004). SWD post-SRC was not observed in objectively measured sleep duration or sleep efficiency and was modest and time-limited based on self-reported sleep efficiency. The weak correlation between self-reported and objective sleep behavior measures implies that subjective experience of SWD post-SRC may be due to factors other than actual changes in these observable sleep behaviors. Clinically, SWD in the early-subacute stages of recovery from SRC may not be adequately measurable via current CA. Subjective SWD may require alternative methods of evaluation (e.g., clinical actigraph or sleep study).
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