Discipline of Exercise and Sports Science, Faculty of Medicine and Health, Sydney School of Health Sciences (Ms Cassimatis, Dr Orr, and Mr Fyffe), and Discipline of Child and Adolescent Health, The Children's Hospital at Westmead Clinical School (Browne), The University of Sydney, Sydney, New South Wales, Australia; and Sydney Children's Hospital Network, Children's Hospital Institute of Sports Medicine, Children's Hospital Westmead, Sydney, New South Wales, Australia (Drs Orr and Browne and Mr Fyffe).
J Head Trauma Rehabil. 2023;38(3):231-239. doi: 10.1097/HTR.0000000000000804. Epub 2022 Jul 21.
To investigate the relationship between sleep disturbance, neurocognition, symptom severity, and recovery in children and adolescents with concussion. Sex-related comparisons were also examined.
Pediatric tertiary referral concussion clinic.
Children and adolescents (aged 6-18 years; n = 554) diagnosed with concussion.
Cross-sectional retrospective study.
Assessment data were obtained from Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) Applications. Sleep disturbance was quantified using the sleep-related domains of the Post-Concussion Symptom Scale (PCSS) and self-report sleep duration. Sleep duration was categorized as short (<7 hours), intermediate (7-9 hours), and long (≥9 hours). Outcome measures included neurocognition, measured via composite scores of ImPACT cognitive domains (verbal memory, visual memory, visual motor speed, reaction time); symptom severity, using the PCSS; and concussion recovery time (days).
Short sleep resulted in significantly poorer verbal memory ( P = .03), visual memory ( P = .02), and reaction time ( P = .01). Sleep disturbance was strongly associated with total symptom burden (ρ = 0.90, P < .001). Recovery time, median (interquartile range), was significantly prolonged with short sleep, 61 (30-136) days, compared with intermediate, 38 (21-72) days, and long, 34 (19-71) days, sleep ( P < .001). Overall, female participants demonstrated significantly longer recovery times than male participants (mean 91 ± 95 vs 58 ± 85 days, P < .001). Females exhibited similar concussion recovery times irrespective of reported sleep duration ( P = .95), whereas mean recovery time in males was significantly longer with short sleep (84 ± 82 days) than with intermediate (61 ± 106 days) and long (49 ± 62 days) sleep ( P < .001).
Sleep disturbance following concussion poses as a promising modifiable risk factor to alleviate postinjury impairments, including cognitive deficits and symptom burden. Female children were found to experience more severe concussion symptoms and protracted recovery times than their male counterparts. Investigations into the factors that may contribute to sex-related differences following concussion are warranted.
研究儿童和青少年脑震荡后睡眠障碍、神经认知、症状严重程度和康复之间的关系。还检查了与性别相关的比较。
儿科三级转诊脑震荡诊所。
诊断为脑震荡的儿童和青少年（6-18 岁；n=554）。
横断面回顾性研究。
使用即时脑震荡评估和认知测试（ImPACT）应用程序获取睡眠评估数据。使用脑震荡后症状量表（PCSS）的睡眠相关域和自我报告的睡眠时间来量化睡眠障碍。睡眠时间分为短（<7 小时）、中（7-9 小时）和长（≥9 小时）。结果测量包括神经认知，通过 ImPACT 认知域的综合分数（言语记忆、视觉记忆、视觉运动速度、反应时间）；使用 PCSS 测量症状严重程度；以及脑震荡康复时间（天）。
短睡眠导致言语记忆（P=.03）、视觉记忆（P=.02）和反应时间（P=.01）明显下降。睡眠障碍与总症状负担密切相关（ρ=0.90，P<.001）。与中睡眠（38[21-72]天）和长睡眠（34[19-71]天）相比，短睡眠的康复时间中位数（四分位距）明显延长，分别为 61（30-136）天（P<.001）。总体而言，女性参与者的康复时间明显长于男性参与者（平均 91±95 天与 58±85 天，P<.001）。女性无论报告的睡眠时间如何，脑震荡的康复时间相似（P=.95），而男性短睡眠的平均康复时间（84±82 天）明显长于中睡眠（61±106 天）和长睡眠（49±62 天）（P<.001）。
脑震荡后睡眠障碍是一种很有前途的可改变风险因素，可以减轻受伤后的损伤，包括认知缺陷和症状负担。与男性相比，女性儿童和青少年的脑震荡症状更严重，康复时间更长。有必要研究可能导致脑震荡后性别差异的因素。
