Association between sleep difficulty and baseline concussion-like symptom burden in NCAA Division I athletes
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Updated: Oct 30, 2026
A Neuroscientific Approach to the Examination of Concussions in Student-Athletes
Published on: December 8, 2014
Amin Mohammadi1, Joshua T Lawton1, Eric Schussler1
1Ellmer College of Health Sciences, Macon & Joan Brock Virginia Health Sciences at Old Dominion University, Norfolk, Virginia, USA.
Objectives:
To examine the association between sleep difficulty and baseline concussion-like symptom burden among NCAA Division I athletes and whether sleep difficulty is associated with neurocognitive performance.
Methods:
This cross-sectional analysis included 584 NCAA Division I student-athletes. Sleep difficulty was assessed using the Athlete Sleep Screening Questionnaire Sleep Difficulty Score (SDS), and symptom burden using the 24-item SCOAT6 Symptom Evaluation. Symptom number was analyzed with multivariable negative binomial regression and symptom severity with multivariable linear regression using HC3 robust standard errors. Models adjusted for age, sex, sport type, and head-injury history. Sensitivity analyses excluded overlapping sleep-related symptoms and examined individual symptoms, symptom domains, head-injury strata, and neurocognitive outcomes.
Results:
Each 1-point increase in SDS was associated with greater symptom number (n = 583; IRR = 1.127, 95% CI 1.086-1.169, P < .001) and severity (n = 584; B = 1.054, 95% CI 0.688-1.419, P < .001). Associations persisted after excluding sleep disturbance and after additionally excluding fatigue/low energy and drowsiness. Twenty-one of 24 symptoms remained associated with SDS after false-discovery-rate correction. Head-injury history did not modify associations with symptom number (P = .971) or severity (P = .846). SDS was not associated with memory (B = -0.012, P = .269), executive function (B = -0.017, P = .247), or psychomotor speed (B = 0.001, P = .939).
Conclusions:
Greater self-reported sleep difficulty was associated with greater baseline concussion-like symptom burden but not with assessed neurocognitive outcomes. Sleep difficulty should be considered a contextual factor when interpreting baseline concussion symptom reports.
