Within Person Variability In Sleep And Concussion Symptom Reporting In A Pilot Study Of Health High School Student-athletes

Sleep is among one of the most important contributors to athletic performance, injury, and recovery, particularly concussion; motivating researchers to find appropriate measures to regularly monitor sleep across an athletic season. A standardized tool to determine habitual sleep patterns is the Consensus Sleep Diary (American Academy of Sleep Medicine). However, it has limited daily use in healthy athletic participants. Furthermore, sleep outcomes from the daily sleep diary need evaluation regarding associations with daily symptom reporting in healthy participants prior to applying these methods post-concussion. PURPOSE: To determine within-person variability in sleep outcomes and daily symptom reporting in 16 (8 male) healthy high school athletes (age:15-17) over two weeks. METHODS: Using an ecological momentary assessment (EMA) platform, participants responded daily to sleep diary prompts and symptom reports on the 22 symptoms (scored: none “0” to severe “6”) included on the Sport Concussion Assessment Tool (SCAT5) at random times via text messaging. We determine variability in sleep and symptom reporting using the coefficient of variation (CV, ratio of the standard deviation to the mean) separately for each participant; testing associations between CV of each sleep outcome and symptom severity with Pearson correlations (p < .05). A higher CV suggests greater within-person variability. RESULTS: Participants responded an average of 14.19+/-1.56 days (range:10-16). Daily within-person variability (CV) ranged from 0.35-0.70 for minutes in bed, 0.12-0.66 for total sleep time, 0.11-0.61 for sleep quality, 0.37-2.64 for awakenings, and 0.42-2.60 for symptom severity scores. There were no significant associations with CV of sleep outcomes and CV of symptom severity (p > .05). CONCLUSION: These results suggest participants respond to daily symptom and sleep assessments via text messaging, and within-person variability exists in daily sleep and symptom reporting even in healthy participants. There was no association between sleep and symptom variability; however, more research is needed in participants following concussion.