The Association Of Pre-season Sleep And Emotional Complaints With Concussion Risk And Symptoms In Adolescents

PURPOSE:This study investigated the associations of baseline sleep and emotional complaints on concussion severity and symptomology in adolescents (10-18 years old). METHODS: Pre-season/baseline concussion assessments were prospectively collected in 626 adolescent participants (age = 15.5 ± 1.7 years). Part of this baseline assessment examined symptoms, including those related to sleep disturbances and emotional complaints. Participants who experienced physician-diagnosed concussion during the season underwent follow up concussions symptom assessments. Linear regressions determined associations between overall concussion symptom scores and 1) baseline drowsiness, 2) baseline emotional symptoms and 3) the combination of both baseline drowsiness and emotional symptoms. Logistic regressions determined associations between all concussion symptoms and baseline drowsiness (Model 1), baseline emotional symptoms (Model 2) and the combination of both baseline drowsiness and emotional symptoms (Model 3). Both the linear and logistic regressions adjusted for age, time from injury, number of previous concussions, loss of memory during most recent concussion and loss of consciousness during most recent concussion. RESULTS: From 292 (15.7 ± 1.7 years) concussions, 174 reported baseline drowsiness and 183 baseline emotional symptoms. Increased concussion symptom scores were associated with both baseline drowsiness and emotional symptoms (unstandardised b [B] > 4.6, p < 0.01, along with a 2.6 (95% CI = 1.9 to 3.6) and 2.8 (95% CI = 2.0 to 3.9) times greater odds of sustaining a concussion, respectively. Sleep and emotional complaints in adolescent athletes are associated with higher risk of adverse clinical outcomes from concussion. CONCLUSIONS: This study indicated sleep problems and emotional disturbances during pre-season can precipitate and exacerbate concussion. As both sleep and emotions are controlled by the limbic system, dysfunction of the limbic system may play an important role in concussion symptom severity. However future research is needed to explore this premise.