The relationship between multiple concussions and multidimensional sleep quality in collegiate-aged, active athletes

Abstract

Objectives: Determine the association of cumulative concussion and repetitive head impacts with self-reported sleep quality in healthy collegiate-aged athletes.

Methods: Collegiate-aged athletes (N = 212; mean age 21.00, 62.7% male) completed semistructured interviews for sport and concussion history and the Pittsburgh Sleep Quality Index (PSQI). Number of concussions was retrospectively determined based on the 1993 American Congress of Rehabilitation Medicine (ACRM) criteria; repetitive head impact was measured based on the cumulative years of contact sport exposure. Associations of number of concussions and repetitive head impact exposure with global PSQI score, overall poor (PSQI >5) vs. good sleep, and binarized subscale scores were tested. Secondary analyses were conducted using alternative concussion criteria and metrics of repetitive head impact.

Results: The number of prior concussions was associated with higher PSQI global scores (B(SE)= 0.50(0.13), p < .001). Participants with more concussions were more likely to be poor sleepers (OR=1.52, p < .001), report poorer sleep quality (OR=1.29, p = .037), longer sleep latency (OR=1.34, p = .005), more sleep disturbances (OR=1.56, p = .001), increased use of sleep medications or sleep aids (OR=1.35, p = .008), and more sleep-related daily dysfunction (OR=1.38, p = .002). Similar results were observed for alternative definitions of concussion. No metric of repetitive head impact was associated with any sleep quality metric.

Conclusions: More prior concussions, but not repetitive head impact exposure, are associated with worse self-reported sleep, with subscale analyses showing concussion history associated with multiple aspects of subjective sleep quality rather than sleep quantity. Sleep represents an important factor to consider for future research aimed at characterizing and ultimately preventing adverse long-term health outcomes associated with concussion history.

Keywords: Mild traumatic brain injury; Pittsburgh Sleep Quality Index; Sleep; Sport.

Figure 1:. Enrollment flow chart

Consort diagram for the study. Participants could have multiple reasons for exclusion at each step. Other* includes individuals not contacted by staff in error or to avoid cohort imbalance. Screen failures were due to disclosure of exclusionary factors during the study visit that were not disclosed initially. Neurodev. = neurodevelopment, neuroend. = neuroendocrine, mod. or sev. TBI = moderate or severe traumatic brain injury, Cn. <6 m; incom. Rec. = concussion within the last 6 months or incomplete recovery from prior concussion. Alc./subs. = alcohol/substance use, <12 m = less than 12 months.