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Actigraphy-derived sleep patterns in children and adolescents with persistent post-concussion symptoms: An
Maree Cassimatis1,2, Rhonda Orr1, Matthew Ahmadi1,3
1Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.
Insights
Sleep disturbance significantly impacts children with persistent post-concussion symptoms (PPCS), worsening mental health and tripling recovery time. Addressing sleep issues is crucial for better concussion outcomes in adolescents.
Area of Science:
- Pediatric neurology
- Sleep medicine
- Clinical psychology
Background:
- Persistent post-concussion symptoms (PPCS) affect a significant portion of children and adolescents.
- Sleep disturbances are common in pediatric concussion patients.
Purpose of the Study:
- To characterize sleep patterns in children and adolescents experiencing PPCS.
- To investigate the impact of sleep disturbance on clinical concussion outcomes, including symptom burden, cognition, and recovery time.
Main Methods:
- A prospective longitudinal study involving 20 participants (aged 11-18) with PPCS.
- Utilized wrist actigraphy for objective sleep assessment and the Insomnia Severity Index (ISI) to identify post-concussion clinical insomnia (PCCI).
- Conducted comprehensive concussion assessments at baseline and 4-week follow-up.
Main Results:
- 45% of participants with PPCS also presented with PCCI.
- Objective sleep parameters included total sleep time (452.1 ± 53.8 min), sleep latency (32.2 ± 16.3 min), wake after sleep onset (76.9 ± 21.4 min), and sleep efficiency (85.9 ± 3.7%).
- Mood disturbance predicted sleep disturbance; PCCI tripled recovery time compared to those without PCCI.
Conclusions:
- Sleep disturbance is strongly linked to poorer mental health in pediatric concussion patients.
- Clinical insomnia and sleep disturbances significantly prolong recovery duration in children and adolescents with PPCS.
- Targeting sleep issues may be a critical component in managing pediatric concussion recovery.
Background:
Persistent post-concussion symptoms (PPCS) affect 35% of children and adolescents with concussion. This study aimed to characterise sleep patterns in children and adolescents with PPCS and explore the effect of sleep disturbance on clinical concussion outcomes.
Methods:
A prospective longitudinal study was conducted in participants with PPCS (n = 20, aged 11-18 years) presenting to a tertiary referral clinic. Participants completed a battery of concussion assessments at their initial consultation and at 4 weeks follow-up to assess and monitor symptom burden, cognition, balance, mental health, and exercise tolerance. The Insomnia Severity Index (ISI) was used to identify participants with post-concussion clinical insomnia (PCCI). Wrist actigraphy was used to objectively characterise sleep patterns, including total sleep time, sleep latency, wake after sleep onset and sleep efficiency, over a 14-day period. Participants were followed until they were recovered from concussion.
Results:
Forty-five percent of participants with PPCS also had PCCI. Objective mean ± SD sleep parameters of participants were: total sleep time 452.1 ± 53.8 min, sleep latency 32.2 ± 16.3 min, wake after sleep onset 76.9 ± 21.4 min, and sleep efficiency 85.9 ± 3.7%. Mood disturbance was a significant predictor of sleep disturbance at the 4-week follow-up (P = 0.01). Recovery time was three times greater for participants with PCCI than those with no PCCI (median (interquartile range): 150 (91-247) vs 47 (30-58) days, P = 0.04).
Conclusions:
Sleep disturbance is significantly associated with poorer mental health and prolonged recovery time in children and adolescents with PPCS.
