School of Physical Therapy & Sports Sciences, Morsani College of Medicine, University of South Florida, Tampa, FL,USA.
School of Health & Human Performance, Georgia College, Milledgeville, GA,USA.
J Sport Rehabil. 2022 Apr 1;31(6):809-814. doi: 10.1123/jsr.2021-0277. Print 2022 Aug 1.
Concussions are often neglected injuries that affect children and adolescents. Two physiological responses to a concussion are an ionic flux and an increased indiscriminate release of glutamate, which leads to an increase of intracellular calcium and extracellular potassium. This can ultimately result in sleep dysfunction, which often occurs after concussion and has long been thought of as simply another concussion symptom.
Does the likelihood of prolonged postconcussion symptoms increase with reported sleep-related problems (SRPs) in young athletes (8-18 y) compared to concussed young athletes without SRPs and healthy controls?
Four cohort studies with level 2/3 evidence measured subjective and objective sleep dysregulations in concussed and healthy populations. Overall, there was a difference in subjective SRPs between concussed and healthy patients. This correlated with other studies where worse sleep scores during the acute phase of concussion and increased SRPs led to worse ImPACT scores in patients 3 to 12 months postconcussion and longer overall recovery. Objective sleep dysfunction measures were significantly worse in concussed patients than in healthy controls, but no significant difference existed in melatonin measures.
There is strong evidence that sleep dysfunction is both a symptom of concussion as well as a causal factor of prolonged postconcussion symptoms. These studies show that sleep dysregulation is not always evident in objective measurements, leading to the strong possibility of a functional dysregulation of the sleep-wake cycle that is evident solely from subjective reports.
While there are strong cohort studies researching the role of sleep in those with postconcussion symptoms, the nature of sleep studies prevents the production of strong, high-level evidence studies such as randomized control trials. Thus, there is level B evidence that the likelihood of prolonged postconcussion symptoms is increased by a higher amount of SRPs.
脑震荡是经常被忽视的影响儿童和青少年的损伤。脑震荡的两种生理反应是离子通量增加和谷氨酸无差别释放增加，这会导致细胞内钙增加和细胞外钾增加。这最终可能导致睡眠功能障碍，这种障碍在脑震荡后经常发生，长期以来被认为只是另一种脑震荡症状。
与没有睡眠相关问题（SRP）的脑震荡年轻运动员和健康对照组相比，报告有睡眠相关问题（SRP）的年轻运动员（8-18 岁）发生持续性脑震荡后症状的可能性是否增加？
四项队列研究，使用 2/3 级证据测量了脑震荡和健康人群的主观和客观睡眠失调。总体而言，脑震荡患者和健康患者之间存在主观 SRP 差异。这与其他研究一致，即脑震荡急性期睡眠评分较差和 SRP 增加导致患者在脑震荡后 3 至 12 个月的 ImPACT 评分更差，并且整体恢复时间更长。与健康对照组相比，脑震荡患者的客观睡眠功能障碍测量值明显更差，但褪黑素测量值无显著差异。
有强有力的证据表明，睡眠功能障碍既是脑震荡的症状，也是持续性脑震荡后症状的一个因果因素。这些研究表明，睡眠失调并不总是在客观测量中显现，导致睡眠-觉醒周期的功能失调很明显，而仅从主观报告中就可以看出。
虽然有强有力的队列研究研究了睡眠在脑震荡后症状患者中的作用，但睡眠研究的性质阻止了像随机对照试验这样的强有力的高级别证据研究的产生。因此，有 B 级证据表明，SRP 越多，发生持续性脑震荡后症状的可能性就越大。
