D. Jake McClure, BS, PO Box 32861, Charlotte, NC 28232.
Am J Sports Med. 2014 Feb;42(2):472-8. doi: 10.1177/0363546513510389. Epub 2013 Nov 20.
The management of sports-related concussions (SRCs) utilizes serial neurocognitive assessments and self-reported symptom inventories to assess recovery and safety for return to play (RTP). Because postconcussive RTP goals include symptom resolution and a return to neurocognitive baseline levels, clinical decisions rest in part on understanding modifiers of this baseline. Several studies have reported age and sex to influence baseline neurocognitive performance, but few have assessed the potential effect of sleep. We chose to investigate the effect of reported sleep duration on baseline Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) performance and the number of patient-reported symptoms.
We hypothesized that athletes receiving less sleep before baseline testing would perform worse on neurocognitive metrics and report more symptoms.
Cross-sectional study; Level of evidence, 3.
We retrospectively reviewed 3686 nonconcussed athletes (2371 male, 1315 female; 3305 high school, 381 college) with baseline symptom and ImPACT neurocognitive scores. Patients were stratified into 3 groups based on self-reported sleep duration the night before testing: (1) short, <7 hours; (2) intermediate, 7-9 hours; and (3) long, ≥9 hours. A multivariate analysis of covariance (MANCOVA) with an α level of .05 was used to assess the influence of sleep duration on baseline ImPACT performance. A univariate ANCOVA was performed to investigate the influence of sleep on total self-reported symptoms.
When controlling for age and sex as covariates, the MANCOVA revealed significant group differences on ImPACT reaction time, verbal memory, and visual memory scores but not visual-motor (processing) speed scores. An ANCOVA also revealed significant group differences in total reported symptoms. For baseline symptoms and ImPACT scores, subsequent pairwise comparisons revealed these associations to be most significant when comparing the short and intermediate sleep groups.
Our results indicate that athletes sleeping fewer than 7 hours before baseline testing perform worse on 3 of 4 ImPACT scores and report more symptoms. Because SRC management and RTP decisions hinge on the comparison with a reliable baseline evaluation, clinicians should consider sleep duration before baseline neurocognitive testing as a potential factor in the assessment of athletes' recovery.
运动相关性脑震荡（SRC）的管理利用连续的神经认知评估和自我报告的症状量表来评估恢复情况和重返赛场（RTP）的安全性。由于脑震荡后 RTP 的目标包括症状的缓解和恢复到神经认知的基线水平，因此临床决策部分依赖于对这种基线的影响因素的理解。有几项研究报告说年龄和性别会影响基线神经认知表现，但很少有研究评估睡眠的潜在影响。我们选择调查报告的睡眠时间对基线即时脑震荡后评估和认知测试（ImPACT）表现和患者报告症状数量的影响。
我们假设在基线测试前睡眠较少的运动员在神经认知指标上表现较差，并报告更多的症状。
横断面研究；证据水平，3 级。
我们回顾性分析了 3686 名非脑震荡运动员（2371 名男性，1315 名女性；3305 名高中生，381 名大学生）的基线症状和 ImPACT 神经认知评分。根据测试前一晚自我报告的睡眠时间，患者被分为 3 组：（1）短，<7 小时；（2）中，7-9 小时；（3）长，≥9 小时。采用 α 水平为.05 的多变量协方差分析（MANCOVA）来评估睡眠持续时间对基线 ImPACT 表现的影响。进行单变量方差分析（ANCOVA）以研究睡眠对总自我报告症状的影响。
当控制年龄和性别作为协变量时，MANCOVA 显示在 ImPACT 反应时间、言语记忆和视觉记忆得分上存在显著的组间差异，但在视觉运动（处理）速度得分上则没有。ANCOVA 还显示在总报告症状上存在显著的组间差异。对于基线症状和 ImPACT 评分，后续的两两比较表明，当比较短睡眠组和中睡眠组时，这些关联最为显著。
我们的结果表明，在基线测试前睡眠时间少于 7 小时的运动员在 4 项 ImPACT 评分中的 3 项得分较低，报告的症状较多。由于 SRC 管理和 RTP 决策取决于与可靠的基线评估的比较，因此临床医生应考虑在基线神经认知测试前的睡眠时间作为评估运动员恢复情况的潜在因素。
