Postconcussion Clinical Insomnia is Associated With Heightened Symptom Severity and Delayed Recovery in Children and Adolescents.

BACKGROUND

There is limited evidence on the prevalence and implications of specific types of sleep disturbance in pediatric concussion. This study aimed to (1) identify the prevalence of postconcussion clinical insomnia (PCCI) in children, (2) determine the impact of PCCI on concussion recovery outcomes, and (3) ascertain clinical characteristics associated with PCCI.

METHODS

A cross-sectional study was conducted in patients (n = 164, aged 9-17 years) presenting to a pediatric tertiary referral concussion clinic from January 2021 to December 2022. PCCI was identified using the Insomnia Severity Index. Characteristics, including symptom severity, cognitive function, sleep hygiene behavior, and exercise tolerance, were compared between patients presenting with and without insomnia postinjury. A subgroup analysis of recovered patients was undertaken to determine the impact of PCCI on concussion recovery duration.

RESULTS

Over one third of patients (n = 59, 36%) presented with PCCI. Symptom severity was three times greater in patients with PCCI compared with patients without insomnia postconcussion (P < 0.001). Patients with PCCI had inferior cognitive function in verbal memory (P = 0.01) and visual memory (P = 0.02) cognitive test domains and poorer sleep hygiene behavior (P < 0.001). The subgroup analysis of recovered patients (n = 113) revealed that patients with PCCI had a significantly prolonged recovery duration, taking over one month longer to recover compared with patients without insomnia postinjury (mean recovery duration: 89 vs 57 days, P = 0.004).

CONCLUSIONS

PCCI is an important contributing factor of symptom burden and severity in pediatric concussion.