Association Between Sleep Changes and Symptom Recovery Following Pediatric Concussion

Concussions are one of the most common causes of neurological morbidities in children. In addition to physical, cognitive, and emotional symptoms, a common complaint after concussion is the presence of sleep disturbances, such as trouble falling asleep. The present study sought to longitudinally assess the nature of sleep changes and their association with symptom recovery following concussion in a pediatric sample. Secondary analyses were conducted on a prospective, longitudinal, multicenter cohort study involving 2,991 children and adolescents (5-17 years) who presented to an emergency department within 48 h of a head trauma and who met diagnostic criteria for concussion consistent with the consensus statement prevailing at the time of data collection. Ratings of post-concussive symptoms and sleep disturbances were obtained at 5 pre-defined time points following concussion (weeks 1, 2, 4, 8, and 12), using the Post-Concussion Symptom Inventory (PCSI) and the sleep item of the Pediatric Quality of Life Inventory, respectively. Linear mixed models were fitted separately for the PCSI total score and the physical, cognitive, and emotional symptom subscales, adjusting for random participant effects. Model predictors included sleep, time, and time x sleep interaction. The model accounted for age, sex, maximum duration of previous concussion symptoms for individuals who had a previous concussion, prior diagnosis of developmental disorder, depression, and anxiety, and prior diagnosis of sleep disorders, as they are known risk factors for prolonged recovery. There was significant improvement in both sleep quality ratings (mean values per time point: week 1 = 76.3, SD = 30.1; week 2 = 81.6, SD = 28; week 4 = 82.4, SD = 27.4; week 8 = 86.6, SD = 24.2; week 12 = 89, SD = 22.8) and post-concussive symptoms across time points (mean delta values per time point: week 1 = 0.40, SD = 0.77; week 2 = 0.39, SD = 0.76; week 4 = 0.38, SD = 0.76; week 8 = 0.38, SD = 0.76; week 12 = 0.38, SD = 0.76) (all p < 0.001). Significant sleep*time interactions showed that better sleep was significantly associated with reduced global (β = 0.003, p = 0.030, 95% CI [0.00003, 0.0006]) and physical post-concussion symptoms (β = 0.007, p = 0.035, 95% CI [0.0005, 0.01]) after the injury relative to pre-injury levels, especially in early phases of recovery. Better sleep, regardless of the recovery period, was associated with greater reductions in patient-reported cognitive (β = -0.26, p = 0.0001, 95% CI [-0.34, -0.18]) and emotional symptoms (β = -0.28, p = 0.0001, 95% CI [-0.35, -0.20]) after concussion. The present findings indicate that better sleep is linked to more favorable post-concussion recovery as reflected by different clusters of symptoms. These results highlight the importance of investigating whether safeguarding sleep in children and adolescents with concussion may facilitate recovery.