Sedentary Behavior, Sleep, And Depressive Symptoms After Sport-related Concussion

PURPOSE: Sleep disturbances are commonly reported following a sport-related concussion (SRC) and have been linked to poorer long-term recovery and increased risk for depression. The aims of this study were to (1) investigate the relationship between objectively measured sedentary behavior, sleep, and mood disturbances in athletes with a recent SRC; and (2) to compare objective and subjective measures of sleep quality and depressive symptoms between athletes with and without a recent SRC. METHODS: Athletes from NCAA Division III athletic teams with higher concussion rates (football, soccer, volleyball, and basketball) completed consent procedures at the beginning of the academic year. Athletic trainers informed the research team when a consenting athlete sustained an SRC, and a matched (by age, sex, sport, and BMI) control was identified. Within 4 days post-SRC, both concussed (n = 11) and control (n = 11) participants completed sleep and mood questionnaires, and a one-week sleep and physical activity (PA) monitoring period (daily sleep diaries and wrist actigraphy). Established wrist actigraphy cut points were used to categorize sedentary behavior. RESULTS: Athletes who sustained an SRC exhibited significantly longer objectively measured wake after sleep onset (WASO) durations (65.9 min vs. 41.2 min; t = 3.5, p = 0.003), significantly higher number of nighttime awakenings (t = 2.3, p = 0.03), significantly higher sleep fragmentation indices (33.5 vs. 26.6; t = 2.2, p = 0.04), and significantly higher depressive symptoms (t = 2.2, p = 0.04). In concussed athletes, higher durations of sedentary behavior were significantly associated with poorer sleep quality (r = 0.62, p = 0.04), and poorer self-reported sleep quality and higher WASO were associated with greater depressive symptoms (r = 0.7, p = 0.03; and r = 0.6, p = 0.05, respectively). CONCLUSIONS: Results suggest that athletes with an SRC exhibit significantly greater sleep and mood disturbances than non-concussed athletes, and sleep problems in concussed athletes are associated with increased depressive symptoms after an SRC. Interestingly, sedentary behavior after concussion seems to be associated with poorer sleep quality, suggesting a role for physical activity in reducing post-concussion sleep and mood problems.