Poor sleep after concussion signals longer recovery

Children who suffer poor sleep quality after a sports-related concussion take almost twice as long to recover than such patients whose sleep is considered good, results from a new study suggest.

For patients whose quality of sleep was poor, symptoms were also more severe, both at initial presentation and at 3-month follow-up, compared to their counterparts…

"For clinicians, recognizing those athletes with poor sleep quality at the initial visit may help them predict those at risk for a more prolonged recovery," she said here at the American Academy of Pediatrics (AAP) 2018 National Conference…

Girls and boys were equally represented in the study, with 180 girls (50.6%) and 176 boys (49.4%). The mean age of the participants was 14 years (range, 7 to 18 years).

Most of the participants (n = 261, 73.3%) had good sleep quality, with a PSQI composite score ≤5 at their initial clinic visit, but 95 participants (26.7%) had scores >5, indicating poor sleep quality.

The poor-sleep group also had a higher total symptom score, as measured by the Sport Concussion Assessment Tool 3 (SCAT3)…

Participants in the poor-sleep group also experienced more fatigue, drowsiness, and trouble falling asleep, as indicated on the SCAT3, at both the initial visit and the 3-month follow-up when compared with the good-sleep group (P <.01).

More girls (61%) had poor sleep than boys (38.9%, P = .02).

"This study alerts clinicians to the fact that sleep symptoms are common among young athletes with concussion and that it is definitely a topic they should discuss with their patients when they come in for concussion evaluation," said Cynthia LaBella, MD, from Northwestern University's Feinberg School of Medicine and the Institute for Sports Medicine, Ann amd Robert H. Lurie Children's Hospital of Chicago, in Illinois.

Some people are excessively sleepy and sleep more than usual, whereas others have a hard time falling asleep at night or wake up frequently during the night and then wake up tired, she said. They are then "completely wiped out after school and take a 4-hour nap, which just compounds the problem about falling asleep at night, as it shifts their sleep cycle."

Adolescents are particularly prone to such disruptions because their circadian rhythm is different, she explained. "Their cortisol levels peak at a different time, and this is unique to adolescents. That's why teenagers are night owls naturally. They stay up later and sleep in later, and it's all biological."

These are the majority of youth who experienced concussions in this study, "and in my experience, it seems they are almost set up for having sleep issues disrupt their rhythm and their daily routine," she added.

LaBella advised that youth who experience concussions avoid using screens or electronics 30 to 60 minutes before bed and that they avoid doing homework, talking on the telephone, or engaging in other activities in bed besides sleep. However, "it's OK to read a chapter of a book, because there is something different about reading words on a page rather than on a screen," she said.

She also suggests limiting caffeine intake, especially after noon, and going to bed at the same time every night.

Children should be encouraged to take it easy during the school day, she added, and naps should be limited to no more than 30 minutes, because sleeping excessively during the day can upset sleep patterns at night.

"They don't necessarily have to sleep," she told Medscape Medical News. "They could go to a quiet place and just relax, and that can help limit the need for that big long nap."

In the end, good sleep quality is important for recovery, regardless of the injury.

American Academy of Pediatrics (AAP) 2018. Presented November 3, 2018.

https://www.medscape.com/viewarticle/904391