Sports Medicine Research: In the Lab & In the Field: A Good Night’s Sleep Could Go A Long Way with Neurocognitive Performance (Sports Med Res)
Monday, May 11, 2015

A Good Night’s Sleep Could Go A Long Way with Neurocognitive Performance

The effect of preinjury sleep difficulties on neurocognitive impairment and symptoms after sport-related concussion

Sufrinko A, Pearce K, Elbin RJ, Covassin T, Johnson E, Collins M, Kontos AP. Am J Sports Med. 2015;43:830-840.

Take Home Message: Athletes who reported sleeping difficulties during preseason neurocognitive testing performed worse on neurocognitive exams after a concussion and reported more symptoms following a concussion compared with those who reported no difficulties sleeping.

Clinicians often use neurocognitive testing in a concussion-assessment protocol to compare baseline and post-injury scores for diagnosis and determining readiness to return to play. Neurocognitive testing can be influenced by many variables such as amount of sleep prior to baseline testing. It remains unclear if an individual’s sleep difficulties could also influence post-injury neurocognitive testing results. Therefore, the authors compared neurocognitive impairment and concussion-related symptoms between groups of athletes with and without self-reported sleep difficulties on a baseline Post-concussion Symptom Scale (PCSS). The authors prospectively collected information on 670 athletes and identified 348 adolescent and adult athletes with a diagnosed sports-related concussion and a valid baseline neurocognitive exam. Based on baseline (preseason) symptoms, researchers placed the athletes into either the sleeping difficulties group (reporting difficulty falling asleep and sleeping less than usual; 34 athletes) or no sleep difficulties (control) group (reporting no sleep symptom items; 231 athletes). Eighty-four athletes were excluded because they only reported minimal sleep difficulties. In addition to the baseline test, the athletes completed neurocognitive testing 2 days, 5-7 days, and 10-14 days post injury. There were no differences in neurocognitive scores between groups at baseline. The sleep difficulty group scored worse on verbal memory at 2 days post-injury, but not 5-7 or 10-14 days compared with controls. The sleep difficulty group also had worse reaction times at both 5-7 days and 10-14 days after injury compared with the controls. Lastly, athletes reporting sleeping difficulties at baseline also had more post-concussion symptoms at all 3 time points compared with controls.

This study illustrates the influence of preexisting sleep difficulties on neurocognitive outcome scores following a sports-related concussion. The authors found that athletes with preinjury sleep difficulties demonstrated decreased post-concussion neurocognitive functioning and increased post-concussion symptoms compared with those reporting no sleep difficulties. Additionally, reaction time scores were worse for up to 10-14 days post injury compared with controls. Concussion consensus reports state that most athletes recover within 10 days. However, athletes with preinjury sleeping difficulties in this study were still reporting more symptoms and slower reaction times for over 10 days post injury. Based on previous studies and this new study medical professionals need to be aware that sleeping difficulties may influence baseline neurocognitive testing and be a risk factor for worse outcomes following a concussion. Clinicians should ask patients about sleeping difficulties before neurocognitive testing and emphasize the importance of a good night’s sleep.

Questions for Discussion: Do you think your athletes understand the importance of sleep and brain function? Do many of your athletes report sleep difficulties at baseline?

Written by: Jane McDevitt, PhD
Reviewed by: Jeffrey Driban

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Sufrinko A, Pearce K, Elbin RJ, Covassin T, Johnson E, Collins M, & Kontos AP (2015). The effect of preinjury sleep difficulties on neurocognitive impairment and symptoms after sport-related concussion. The American Journal of Sports Medicine, 43 (4), 830-8 PMID: 25649087

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