Insomnia in Adolescents with Slow Recovery from Concussion

Sleep disruption can occur after brain injury; however, insomnia prevalence and severity in adolescents with persistent post-concussion symptoms have not been investigated. This study examined: 1) some of the psychometric properties of the Insomnia Severity Index (ISI), 2) the prevalence and severity of insomnia symptoms, and 3) associations between insomnia symptoms and clinical measures of post-concussion symptoms, mental health symptoms, and cognitive tests in adolescents with slow recovery from concussion. Participants (N = 121) were adolescents 13-18 years of age (mean = 16.2; standard deviation [SD] = 1.2) and, on average, of 6.4 months (SD = 3.8) post-concussion. This sample rated insomnia (ISI), post-concussion symptoms, symptoms of depression and anxiety, and cognitive complaints, as well as completed cognitive testing. The ISI demonstrated good internal consistency (alpha = 0.87) and a single factor structure. The majority of the sample endorsed at least some insomnia, with 62% being over the clinical cutoff for experiencing clinically significant symptoms of insomnia. Higher insomnia severity was associated with a greater number of previous concussions, worse post-concussion symptoms, more anxiety, and higher depression. Insomnia was significantly associated with more cognitive complaints and higher rates of failure on performance validity tests, but not with actual objectively measured cognitive abilities. Insomnia is common in adolescents with slow recovery from concussion and is associated with worse post-concussion symptoms, anxiety, depression, cognitive complaints, and performance validity concerns. Investigating evidence-based treatments for insomnia should be a priority in this population.