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Updated: Jun 27, 2025

A Neuroscientific Approach to the Examination of Concussions in Student-Athletes
Published on: December 8, 2014
Associations of Nightmares and Sleep Disturbance With Neurobehavioral Symptoms Postconcussion
Afik Faerman1, Andrew Nabasny, Brittany Wright
1Department of Psychiatry and Behavioral Sciences, School of Medicine, Stanford University, Stanford, California (Dr Faerman); Departments of Applied Clinical Research (Mr Nabasny and Dr Wright) and Physical Medicine and Rehabilitation (Drs Wright and Juengst), University of Texas Southwestern Medical Center, Dallas; Brain Injury Research Center, TIRR Memorial Hermann, Houston, Texas (Dr Juengst); and Department of Physical Medicine and Rehabilitation, UT Health Sciences Center at Houston, Houston, Texas (Dr Juengst).
Objective:
This study investigates the association of nightmares beyond general sleep disturbance on neurobehavioral symptoms in adults with mild traumatic brain injury (mTBI).
Design:
Secondary analysis of a concussion cohort study.
Participants:
One hundred and eleven adults older than 20 years with mTBI were recruited from a specialized concussion treatment center.
Main Measures:
Behavioral Assessment Screening Tool, Pittsburgh Sleep Quality Index, and self-report of nightmare frequency in the past 2 weeks.
Results:
Among adults with mTBI, nightmares accounted for the greatest amount of variability in negative affect (β = .362, P < .001), anxiety (β = .332, P < .001), and impulsivity (β = .270, P < .001) after adjusting for age and sex. Overall sleep disturbance had the strongest association with depression (β = .493, P < .001), fatigue (β = .449, P < .001), self-reported executive dysfunction (β = .376, P < .001), and overall burden from concussive symptoms (β = .477, P < .001).
Conclusions:
Nightmares and sleep disturbance are differentially associated with variance in neurobehavioral symptoms. Nightmares were independently associated with neurobehavioral symptoms representing an excess of normal functioning (eg, anxiety, impulsivity), while general sleep disturbance was associated with neurobehavioral symptoms representing functioning below normal levels (eg, depression, fatigue, self-reported executive dysfunction). Clinical and research implications are discussed.
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