The Dynamic Interaction Between Psychological Health and Sleep Symptoms Following Adolescent Concussion.

OBJECTIVE

To evaluate changes in psychological symptoms and sleep quality at 3 clinically relevant milestones following adolescent concussion: while symptomatic, at symptom resolution, and about 2 months after symptom resolution.

STUDY

DESIGN

We conducted a secondary analysis of a multisite, longitudinal investigation of adolescent concussion recovery. Participants enrolled < 21 days following concussion and completed self-report questionnaires (Patient-Reported Outcomes Measurement Information System [PROMIS] Pediatric Global 25 anxiety and depressive symptom domains and the Pittsburgh Sleep Quality Index [PSQI]) at 3 time points: visit 1 (symptomatic), visit 2 (< 14 days after symptom resolution), and visit 3 (2 months after symptom resolution).

RESULTS

We followed 72 participants (median age = 15.5, interquartile range: 14-17; 46% female; 79% sport-related concussion). Prevalence of poor sleep quality (PSQI > 4) was high at each visit (78% at visit 1, 57% at visit 2, and 41% at visit 3). There was significant (P < .0001) improvement in PROMIS anxiety/depression and PSQI between visits 1 and 2. PSQI was positively correlated with PROMIS anxiety (P = .0003) and depression (P = .0050). Correlations between PSQI and depression (P = .1103) and anxiety (P = .5276) domain scores did not differ significantly across the study visits. A subset of patients (22.2%) developed clinically relevant anxiety/depression symptoms at visit 3 despite reporting none at visit 2.

CONCLUSIONS

Poor sleep quality was highly prevalent and associated with worse psychological health symptoms. Incorporating routine assessments of sleep and psychological health, during and after recovery, may help clinicians provide interventions and reduce risk of psychological symptoms after concussion.