Sports Medicine Research: In the Lab & In the Field: Not Catching Enough Zzzs Could Worsen Concussion Symptoms (Sports Med Res)


Monday, August 28, 2017

Not Catching Enough Zzzs Could Worsen Concussion Symptoms

Short Sleep and Adolescents’ Performance on a Concussion Assessment Battery: An Experimental Sleep Manipulation Study

Beebe DW, Powers SW, Slattery EW, Gubanich PJ. Clin J Sports Med. 2017; ahead of print.

Take Home Message: An athlete who sleeps 6.5 hours or less per night may report more concussion-related symptoms than when getting a good night’s rest.

The importance of sleep regarding cognitive abilities are well established. Poor sleeping habits and short sleep nights could complicate concussion neurocognitive evaluation and baseline testing, because students who report sleeping less often report more signs and symptoms and have worse cognitive performance. However, no well-designed study has been conducted to see the cause and effect relationship between short and normal sleep nights and reported signs and symptoms and cognitive performance. Therefore, the authors assessed 14 adolescents (~18 years of age; 46% female) following 5 nights of short sleep (6.5 hours/night in bed) and after 5 nights of healthy sleep (9.5 hours/night in bed) to compare cognitive function and subjective symptoms related to sleep time. Authors included participants if they had normal body mass index and IQs as well as no history of injury (including head injury), psychiatric disorders, or neurological illness. They also excluded participants if they drank more than one coffee or energy drink per day or drank more than 2 caffeinated soft drinks per day. Each adolescent underwent a one-week sleep stabilization (awaken at 8am, bedtime at their own choosing) to acclimate to early rising. Potential participants that could not rise on time were excluded. Then, adolescents either began the short sleep period, where their bed time was adjusted to allow for 6.5 hours/night in bed (Monday to Friday), or healthy sleep where they slept for 9.5 hours per night. Sleep time was monitored using a sleep watch and data was uploaded during the weekly office visit. Also during this office visit, adolescents completed the Immediate Post Concussion Assessment and Cognitive Testing (ImPACT). The authors found small differences within the verbal memory portion of ImPACT. Specifically, adolescents performed worse during the short sleep period compared to scores obtained following the healthy sleep period. Lastly, adolescents reported more headache, fatigue, irritability, sleeping less, and feeling slowed following short sleep period compared to healthy sleep period.

The authors of this novel study demonstrated people report more symptoms when lacking a full night of sleep. The symptoms reported are similar to those that concussed athletes report, and to a small extent cognitive abilities were affected. Following the short sleep period healthy adolescents that were not suffering from a concussion reported that their levels of irritability and fatigue tripled compare to after the healthy sleep period. Additionally, teens reported a broad range of symptoms (18 out of 21). It is interesting to note that even following the healthy sleep period adolescents reported signs and symptoms such as sleeping less, fatigue, and irritability, which suggests that students may need more than 9.5 hours. Future studies may want to consider prolonging the time in between the different sleeping patterns. Finally, though less sleep was expected to alter cognitive abilities it failed to elicit a clinically meaningful change, which could suggest that this study needs to be replicated in a larger cohort with longer experimental sleep periods, which would simulate more of a real behavior. Currently, medical professionals should consider sleep length during baseline assessments, post-concussion evaluations, and when making treatment decisions to fully grasp the reasons behind the symptoms students are reporting. Additionally, educating adolescents, parents, and coaches about the importance of sleep and the negative effects of poor sleeping habits would be beneficial and promote better sleeping habits for our athletes.

Question for Discussion: Do you educate your athletes on the importance of sleep, and the negative impact if they do not obtain enough? If so, how? Do you consider sleeping time during concussion baseline and evaluations?

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

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Lauren Krywy said...

Being an athletic training student, I've rarely, if at all have seen athletes being educated on sleep and the negative impacts of it. I do believe that this is something that should be educated to athletes regardless of their age and performance ability. One thing that would be interesting in terms of looking at athletes sleep and the signs and symptoms would be collegiate athletes. Being a former NCAA athlete myself, I found that my sleep schedule was hardly consistent and my days felt long and drawn out. I would get up early for lifting, hurry back to my room to get cleaned up for the day, run over to class and go about my academic life, go to practice in the afternoon, attend meetings and try and get my homework and studying done. I know there are many athletes that go through that schedule and have a constant "go go go" schedule. I think the results in this age group will be beneficial with the results found in the adolescents from this study. After reading this study, it's another tool and friendly reminder to implement myself when I go further on past the beginning education points.

Jane McDevitt said...

Thank you for your comment. I think you bring up some good points that sleep, especially in the NCAA population, may not be regular. We really do need to educate athletes on good sleep behaviors in general, and then when they get concussed discuss the benefits of good sleep. It seems that getting at least the minimum number of hours for a good night sleep (6.5--which is still pretty low) could decrease signs and symptoms. I would have liked to have seen a patient reported outcome measure implemented in this study to determine quality of life reports between groups.

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