Feasibility of at-Home Sleep Monitoring in Adolescents with and without Concussion

Catherine C Donahue,1,2 Katherine L Smulligan,1,2 Mathew J Wingerson,1,2 Joshua R Kniss,1,2 Stacey L Simon,3,4 Julie C Wilson,1,2,4 David R Howell1,2 1Department of Orthopedics, University of Colorado School of Medicine, Aurora, CO, USA; 2Sports Medicine Center, Children’s Hospital of Colorado, Aurora, CO, USA; 3Department of Pulmonary and Sleep Medicine, University of Colorado School of Medicine, Aurora, CO, USA; 4Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USACorrespondence: Catherine C Donahue, Sports Medicine Center, Children’s Hospital Colorado; Department of Orthopedics, University of Colorado School of Medicine, 13123 E. 16th Avenue, B060, Aurora, CO, 80045, USA, Email [email protected]: Poor sleep is associated with longer recovery following adolescent concussion, making the longitudinal assessment of sleep important for monitoring recovery and identifying sleep disruptions. An important consideration for successful monitoring of sleep following concussion is the feasibility and adherence of a given sleep monitoring tool when used in an at-home environment. Understanding the usability of different sleep monitoring tools is essential for determining their applicability for longitudinal assessment in an ecologically valid environment.Purpose: The purpose of this study was to: (1) report on the adherence and feasibility of at-home sleep monitoring in adolescents following concussion, and (2) compare outcomes of subjective and wearable measures of sleep between adolescents with and without a concussion.Patients and Methods: Participants included adolescents within 21 days of a concussion and uninjured controls that participated in four separate, prospective and longitudinal investigations of sleep following concussion. Sleep data was measured with: (1) Dreem Headband; (2) Philips Actiwatch; (3) Fitbit; and (4) subjective sleep diary. Sleep data was collected nightly, and adherence was defined as percentage of nights the participant used the sleep-monitoring tool over the study duration. Independent t-tests and effect sizes were calculated for the following sleep data outcomes as measured by each of the monitoring tools: duration, efficiency, latency, wake after sleep onset.Results: Sleep data for a total of 183 adolescents (104 with concussion, 79 uninjured controls) was assessed. Adherence rates across all devices ranged from 53% to 98%, with the subjective sleep diary showing the highest adherence rate for both groups (concussion: 91%, control: 94%). Across the four different monitoring tools, adolescents with a concussion demonstrated longer duration, latency, wake after sleep onset, and lower (worse) efficiency, with medium to large effect sizes.Conclusion: The results indicate that at-home sleep monitoring is a feasible approach for tracking sleep in adolescents following concussion.Keywords: sleep assessment, concussion, adolescent