Does the presence of acute sleep initiation symptoms impact recovery from sport-related concussion?

Acute sleep disturbances after sport-related concussions (SRC) may affect recovery. This study assessed how sleep symptoms impact time to return-to-learn (RTL), symptom resolution (SR), and return-to-play (RTP).

A retrospective cohort study was conducted at a regional sports concussion center (11/2017-04/2022) with adolescents presenting within 3 days of SRC. Participants were dichotomized based on the presence or absence of 'trouble falling asleep' per the Post-Concussion Symptom Scale (PCSS). Mann-Whitney U tests compared outcomes, and multivariable regressions adjusted for PCSS, sex, age, and migraine or psychological history.

Among 116 athletes, 29 (25%) reported sleep initiation symptoms. Median RTL was 4 days (IQR = 3-10) in those with sleep symptoms versus 3 days (IQR = 2-4, p = 0.005) without. Median SR and RTP times were longer for the sleep initiation symptoms group: 15 days (IQR = 7-27) vs. 8 days (IQR = 3-20, p = 0.024) for SR, and 16 days (IQR = 11-29) vs. 13 days (IQR = 6-21, p = 0.048) for RTP. Sleep initiation symptoms were not independent predictors of recovery, but migraine history predicted longer RTL, and prior concussions predicted longer RTP.

Although not independent predictors, acute sleep initiation symptoms were linked to delayed recovery. Strategies to optimize sleep acutely post-concussion may help facilitate timely recovery and improve outcomes.