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

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.

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.

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
by: Jeffrey Driban


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