Post-Concussion Sleep Quality Association With Dual-Task Postural Stability, Cognition, And Reaction Time Among Adolescents

PURPOSE: Post-concussion sleep problems are associated with more severe symptoms and may relate to functional deficits, including impaired postural stability and slower reaction time (RT). Sleep quality is a useful and valid proxy measure for identifying sleep problems. The purpose of this study was to investigate the association between sleep quality and clinical measures of dual-task postural stability, cognition, balance, and RT among adolescents following recent concussion. METHODS: Within 18 days of concussion, participants completed the Pittsburgh Sleep Quality Index (PSQI), dual-task tandem gait (DTTG) testing, the modified Balance Error Scoring System (mBESS), Ruler Drop Test (RDT) RT testing, and simple finger tap (SFT) RT testing. Outcomes included overall PSQI rating, DTTG completion time, responses per minute and cognitive response accuracy during DTTG, number of mBESS errors, and RT (RDT and SFT). We calculated pairwise correlation coefficients (Pearson r) between PSQI and the outcomes of interest. We used a multivariate linear regression model, adjusting for age, sex, time since concussion, concussion history, history of anxiety/depression, and pre-injury ADHD, to further assess the relationship between PSQI and other post-concussion outcomes. Covariates were pre-specified. RESULTS: We enrolled and tested 109 participants (mean age = 15.4 ± 1.7 years, 57% female; mean time since concussion = 9.3 ± 3.8 days). In unadjusted analysis, there were significant, but weak, positive correlations between PSQI rating and DTTG completion time (r = .24; 95% CI = .06, .41; p = .011) and PSQI rating and mBESS errors (r = .25; 95% CI = .06, .42; p = .010). PSQI rating was not significantly associated with response rate, response accuracy, or RT (RDT and SFT). After covariate adjustment, PSQI rating was significantly associated with DTTG completion time (β = .77; 95% CI = .18, 1.36; p = .011), mBESS errors (β = .31; 95% CI = .06, .57; p = .016), and SFT RT (β = 9.78; 95% CI = .11, 19.45; p = .048). CONCLUSIONS: Adolescents with a recent concussion who reported worse sleep quality demonstrated slower DTTG completion times, more mBESS errors, and slower SFT RT compared to participants with better sleep quality. Focusing on sleep quality following concussion may help improve post-concussion functional deficits.