neurocognitive testing in sports-related concussions: The importance of a prior
night’s sleep

J, Zuckerman SL, Kutscher SJ, Gregory AJ, Solomon GS. The American Journal of
Sports Medicine.2013; ahead of print.

Take Home Message:
Athletes who reported sleeping fewer than 7 hours the night before concussion
baseline testing performed worse on ImPACT and reported more symptoms.

have many demands on their time (e.g., school, work, socializing, sports),
which can result in fragmented sleeping patterns that may negatively affect
cognitive function. Athletes that do not get enough sleep before a baseline
test could perform poorly resulting in an invalid test and thus making it even
more difficult to determine safe return to play. However, no studies have investigated
if the amount of sleep is influences ImPACT testing. Therefore, the authors evaluated
if athletes who sleep less before baseline testing would perform worse on
neurocognitive modules and report more symptoms compared with athletes that sleep
more. Three thousand six hundred and eighty-six collegiate (10.3%) and high
school (89.7%) athletes who had no excluding factors (e.g., valid ImPACT, no
history of concussion, attention deficit disorder, attention deficit hyperactivity disorder, anxiety, depression,
or learning disability) were separated in 3 categories based on sleep duration:
short (less than 7 hours of sleep; 768 athletes), intermediate (7-9 hours of
sleep; 2189 athletes), and long (more than 9 hours of sleep; 819 athletes). Among
the three groups, athletes sleeping less than 7 hours performed worse on verbal
memory (total memory percent score), visual memory (match memory percent
score), and reaction time, but the authors found no differences with processing motor speed.
Athletes in the short sleep group reported more frequent somatic (e.g.,
headache, dizziness, nausea), cognitive (e.g., fatigue, drowsiness, sleeping
more), emotional (e.g., irritable, sadness, nervousness), and sleep (i.e., sleeping
less, trouble staying asleep, trouble falling asleep) symptoms compared with
the intermediate and long sleep groups. Intermediate sleep athletes also
reported more sleep symptoms than the long sleep group.

concussion signs and symptoms remains to be one of the most common ways to
assess the progress of a concussion injury. The authors suggest that the amount
of sleep can affect athletes’ baseline scores. Specifically, athletes sleeping
fewer than 7 hours performed worse on 3 out of the 4 ImPACT composite scores
and reported more symptoms at baseline. Though, it is not surprising that athletes
with little sleep reported more sleep symptoms, the number of symptoms reported
in the other 3 symptom categories are alarming. The authors suggest that sleep
duration may influence an athlete’s baseline ImPACT scores. Other ImPACT
modifying factors like depression, anxiety, and somatic pain may also be a
result of chronically reduced sleep. Medical professionals should be aware of
the amount of sleep that the athletes are reporting on their baseline
neurocognitive exams. This complicated clinical scenario further highlights the
importance of a multifaceted approach to monitoring athletes and making return
to play decisions following a concussion injury.

Questions for Discussion:
Prior to baseline testing do you tell your athlete to get a good night sleep?
Do you think athletes believe a good night sleep is 7-9 hours? Should a
self-reported sleep time of less than 7 hours indicate a possible invalid test?

by: Jane McDevitt, PhD
by: Jeffrey Driban


McClure DJ, Zuckerman SL, Kutscher SJ, Gregory AJ, & Solomon GS (2013). Baseline Neurocognitive Testing in Sports-Related Concussions: The Importance of a Prior Night’s Sleep. The American Journal of Sports Medicine PMID: 24256713