Clinical Cutoff Scores For The Pittsburgh Sleep Quality Index In Adolescents With Concussion

Sleep quality is critical for concussion recovery. The Pittsburgh Sleep Quality Index (PSQI) can identify individuals with poor sleep in both clinical and research settings. The PSQI consists of 19 items, with a global score ranging from 0-21. A cutoff score >5 has historically been used to indicate poor sleep quality, though this cutoff score has not been critically examined in adolescents with concussion. PURPOSE: To determine the diagnostic utility of the PSQI and establish a relevant PSQI clinical cutoff score for adolescents with a recent concussion. METHODS: Adolescents within 16 days of concussion and uninjured controls participants completed the PSQI, and a global score was calculated. We used independent samples t-tests to compare PSQI mean scores, and logistic regression to calculate odds ratios (outcome=group, predictors=PSQI, covariates). A receiver operator characteristic (ROC) curve was used to evaluate the area under the curve (AUC) and determine the optimal cutoff score to distinguish between adolescents with/without a concussion. RESULTS: 147 adolescents with a concussion (15.4±1.6 years; 53% female; 9.8±3.6 days since injury), and 129 uninjured controls (15.8±1.1 years; 86% female) were included for analysis. The concussion group had significantly worse PSQI scores than controls (6.0±3.9 vs. 2.3±2.2; p<0.001; Cohen’s d=1.2). Both the univariable model and multivariable model (controlling for age, sex, concussion history, and history of anxiety and/or depression), had good diagnostic accuracy (Fig 1). Within the univariable model, a cutoff score of 4 correctly classified 73% of participants as concussion/control (sensitivity=87%, specificity=57%). CONCLUSION: Our results suggest a PSQI cutoff score of 4 (rather than the historical cutoff of 5) may enhance accuracy to identify poor sleep quality following adolescent concussion. Character count: 1,607/2,000