Acute Sleep Duration, Clinical Presentation, And Recovery After Sport-Related Concussion In Collegiate Athletes

Sport-related concussion (SRC) is known to affect sleep quality. Sleep is essential to physical and neurocognitive function, however, the impact of post-SRC sleep duration on acute clinical presentation and recovery is unclear. PURPOSE: To compare clinical presentation and recovery by levels of acute, post-SRC sleep duration. METHODS: SRC clinical and recovery data from 1763 National Collegiate Athletic Association civilian student-athletes (SAs) collected by the Concussion, Assessment, Research and Education Consortium between 2014-2021 were analyzed. SAs self-reported their sleep duration for the night before their acute (within 24-48 hours [hrs.]) post-SRC symptom, balance, and cognition evaluation. Sleep duration was categorized into three levels: < 6 -, 6-8 -[referent], > 8-hrs. Negative binomial regression models were used to examine the association between sleep duration and Sport Concussion Assessment Tool total symptom severity- (TSS), Balance Error Scoring System- (BESS), and Standardized Assessment of Concussion (SAC)-total score. Weibull accelerated failure time models were used to examine differential time to asymptomatic (ASYMP) and unrestricted return to play (URTP) time between sleep duration groups. All models were adjusted for covariate effects (sex, sport contact category, event type, concussion history, amnesia, loss of consciousness), and baseline TSS score was included in the recovery models. Effect estimates with 95% Confidence Intervals (95% CI) not including 1.0 were statistically significant. RESULTS: Roughly ~13% of SAs reported <6 hrs. of sleep, while ~56% of SAs reported 6-8 hrs. SAs who slept <6 hrs. reported higher TSS (Ratio 1.50; 95% CI 1.32-1.70), worse BESS (Ratio 1.09; 95% CI 1.01-1.18) and SAC scores (Ratio 0.96; 95% CI 0.93-0.99). Moreover, estimated time to ASYMP was ~29% longer, and estimated time to URTP was ~22% longer as compared with SAs who slept 6-8 hrs. No significant differences in total scores or recovery duration was observed in SAs with >8.0 hrs. as compared with SAs with 6-8 hrs. CONCLUSIONS: Sleep duration of <6 hrs. acutely post-SRC was associated with poorer clinical outcomes and longer recovery time. Elucidating the neuroinflammatory profile in these SAs could guide targeted interventions to mitigate adverse SRC outcomes. Supported by: Supported by NCAA and DoD Award# W81XWH-14-2-0151