The influence of sleep duration and sleep-related symptoms on baseline neurocognitive performance among male and female high school athletes.
Sufrinko A, Johnson EW, and Henry LC. Neuropsychology. 2015. [Epub Ahead of Print].
Take Home Message: Athletes who obtained less than 5 hours of sleep performed worse on ImPact computerized neurocognitive testing than those who slept more.
Computerized neurocognitive testing is the standard of care for assessing an athlete’s baseline neurocognitive abilities, and later to assess an athlete’s ability to return to participation following a concussion. There are many factors that can affect the validity of computerized neurocognitive tests. For example, sleep deprivation can lead to neurocognitive deficits; however, no one has determined their effect on computerized neurocognitive testing. Therefore, Sufrinko and colleagues completed a study to determine the effect of sleep deprivation and restriction on baseline computerized neurocognitive tests. The authors include 7,150 high school athletes (14-17 years old, 2,080 female) with no self-reported learning disabilities or ADHD and no history of psychotropic medications. All athletes underwent baseline computerized neurocognitive testing (ImPact) under the supervision of a certified athletic trainer. Researchers assessed an athlete’s sleep duration the night before testing using self-reported demographic information. Athletes were classified into 1 of 3 groups: sleep restriction ≤ 5 hours, typical sleep: 5.5 to 8.5 hours, and optimal sleep ≥ 9 hours). Overall, athletes slept an average of 7.8 hours. Only 22% of athletes reported optimal sleep of ≥ 9 hours and 4% reported sleep restriction. Male athletes slept more than female athletes. Athletes with sleep restriction had worse total symptoms, reaction time, visual motor speed, and verbal memory than those with typical sleep. The results comparing typical sleepers to optimal sleepers were mixed with typical sleepers performing worse on verbal memory and visual memory and better on visual motor speed and reaction time. While these findings were statistically significant the clinical relevance of these findings are unclear since the differences between groups were small.
Overall, this study presents some interesting findings regarding athlete’s sleep duration and performance on computerized neurocognitive tests. As expected, the researchers’ data supported the concept that athletes with restricted sleep the night prior to a computerized test performed worse than those that did not. Clinicians should encourage their athletes to get adequate sleep and may even be able to advise coaches and support staff to organize team schedules in a way that will allow the athletes to get enough sleep, but ultimately it is the athlete’s prerogative. Clinicians may also wish to provide coaches and athletes with educational information regarding the cognitive impact of sleep deprivation. If an athlete reports severe sleep restriction, then the clinician could consider postponing baseline testing until the athlete gets adequate sleep – although this may not be an option after a concussion. It is important to keep in mind that sleep seemed to have a small effect on test scores and the clinical relevance of this may be minor. However, clinicians need to keep track of factors that influence test scores because they may add up. A patient with a learning disability and poor sleep may have a lower score than if they had just one factor. When using a computerized neurocognitive test clinicians need to know their athletes’ demographic information, especially hours of sleep, and decide whether baseline testing is appropriate and how these factors may influence test results after a concussion.
Questions for Discussion: Do you currently educate your athletes regarding sleep deprivation? Is sleep duration a factor you have previously look at when assessing athletes’ computerized neurocognitive test results?
Written by: Kyle Harris
Reviewed by: Jeffrey Driban
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