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.
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.
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
by: Jeff Driban
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