Assessment of Sleep Parameters in Adults with Persistent Post-Concussive Symptoms

Objectives: The primary aim of this study was to characterize sleep in adults with persistent post-concussive symptoms (PPCS). Secondary aims explored relationships between sleep parameters, injury characteristics, and symptom questionnaires. Methods: This case-controlled, cross-sectional study recruited adults (18-65yrs) diagnosed with PPCS and age and sex-matched controls. Participants wore a wrist-worn actigraph for 3-7 nights and completed daily sleep diaries. Participants completed questionnaires examining daytime sleepiness, fatigue, anxiety/depressive symptoms, and sedentariness. Sleep parameters were compared between groups using Mann-Whitney U tests. Secondary analyses used two-way ANOVA and Spearman's rank correlations. Results: Fifty adults with PPCS (43.7 +/- 10.6yrs, 78 % female) and 50 controls (43.6 +/- 11.0yrs) were included in this study. Adults with PPCS had significantly longer sleep onset latency (PPCS 16.99 +/- 14.51min, Controls 8.87 +/- 6.44min, p < 0.001) and total sleep time (PPCS 8.3 +/- 1.0hrs, Control 7.6 +/- 0.9hrs, p = 0.030) compared to controls, but woke up later (PPCS 7:57:27 +/- 1:36:40, Control 7:17:16 +/- 0:50:08, p = 0.026) and had poorer sleep efficiency (PPCS 77.9 +/- 7.5 %, Control 80.8 +/- 6.0 %, p = 0.019) than controls. Adults with PPCS reported more daytime sleepiness (Epworth Sleepiness Scale: PPCS 8.70 +/- 4.61, Control 4.28 +/- 2.79, p < 0.001) and fatigue (Fatigue Severity Scale: PPCS 56.54 +/- 12.92, Control 21.90 +/- 10.38, p < 0.001). Injury characteristics did not significantly affect sleep parameters in adults with PPCS. Actigraphy parameters were not significantly correlated to questionnaire measures. Conclusion: Several actigraphy sleep parameters were significantly altered in adults with PPCS compared to controls, but did not correlate with sleep questionnaires, suggesting both are useful tools in characterizing sleep in PPCS. Further, this study provides potential treatment targets to improve sleep difficulties in adults with PPCS.