Hrabarchuk Eugene I, Kalagara Roshini, Ezzat Bahie, Rentzeperis Frederika, Leska Tomasina M, Schupper Alexander J, Rodriguez Benjamin, Ali Muhammad, Quinones Addison, McCarthy Lily, Carr Mathew T, Lehman Arielle B, Gometz Alex, Lovell Mark, Choudhri Tanvir F
1Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York.
2Department of Neurology, Columbia University, New York.
J Neurosurg Pediatr. 2024 May 3;34(2):121-128. doi: 10.3171/2024.2.PEDS23437. Print 2024 Aug 1.
The influence of sleep on baseline and postconcussion neurocognitive performance prior to Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) is poorly understood. Since ImPACT is widely used in youth sport to assess neurocognitive performance before and after head injury, it is important to delineate factors that affect testing performance. While some have reported correlations between fewer hours of sleep and lower scores on baseline tests, others have not observed any such associations. Therefore, the authors sought to compare the relationship between sleep and neurocognitive performance on ImPACT at both baseline and postinjury.
The authors queried a database of 25,815 ImPACT tests taken from 2009 to 2019 by athletes aged 12-22 years. There were 11,564 baseline concussion tests and 7446 postinjury concussion ImPACT tests used in the analysis. Linear regression was used to model the effect of sleep on baseline and postconcussion ImPACT scores adjusting for sex, age, learning disability, attention-deficit/hyperactivity disorder, number of prior concussions, number of games missed, and strenuous exercise before testing.
Mean composite scores expectedly were all significantly lower in the post-head injury group compared with the baseline group. In the multivariable analysis, at baseline, hours of sleep significantly affected symptom scores (β = -1.050, 95% CI -1.187 to -0.9138; p < 0.0001). In the postinjury multivariable analysis, verbal memory (β = 0.4595, 95% CI 0.2080-0.7110; p = 0.0003), visual memory (β = 0.3111, 95% CI 0.04463-0.5777; p = 0.0221), impulse control (β = -0.2321, 95% CI -0.3581 to -0.1062; p = 0.0003), and symptom scores (β = -0.9168, 95% CI -1.259 to -0.5750; p < 0.0001) were all affected by hours of sleep.
Hours of sleep did not alter neurocognitive metrics at baseline but did have an impact on post-head injury metrics. These findings suggest that individuals may be able to compensate for lack of sleep at baseline but not immediately after concussion. Concussions may reduce cognitive reserve or detract from the brain's resources, making sleep even more important for proper neurocognitive functioning postconcussion. Future work will analyze the effects of sleep on postconcussion test performance.
在进行即时脑震荡评估和认知测试（ImPACT）之前，睡眠对基线和脑震荡后神经认知表现的影响尚不清楚。由于ImPACT在青少年体育运动中被广泛用于评估头部受伤前后的神经认知表现，因此明确影响测试表现的因素很重要。虽然一些人报告了睡眠时间减少与基线测试得分较低之间的相关性，但其他人并未观察到此类关联。因此，作者试图比较睡眠与基线和受伤后ImPACT神经认知表现之间的关系。
作者查询了一个数据库，该数据库包含2009年至2019年12至22岁运动员进行的25,815次ImPACT测试。分析中使用了11,564次基线脑震荡测试和7,446次受伤后脑震荡ImPACT测试。采用线性回归模型来模拟睡眠对基线和脑震荡后ImPACT得分的影响，并对性别、年龄、学习障碍、注意力缺陷多动障碍、既往脑震荡次数、错过的比赛次数以及测试前的剧烈运动进行了调整。
与基线组相比，头部受伤后组的平均综合得分预期均显著更低。在多变量分析中，在基线时，睡眠时间显著影响症状得分（β = -1.050，95%可信区间 -1.187至 -0.9138；p < 0.0001）。在受伤后的多变量分析中，言语记忆（β = 0.4595，95%可信区间0.2080 - 0.7110；p = 0.0003）、视觉记忆（β = 0.3111，95%可信区间0.04463 - 0.5777；p = 0.0221）、冲动控制（β = -0.2321，95%可信区间 -0.3581至 -0.1062；p = 0.0003）和症状得分（β = -0.9168，95%可信区间 -1.259至 -0.5750；p < 0.0001）均受睡眠时间影响。
睡眠时间在基线时并未改变神经认知指标，但对头部受伤后的指标有影响。这些发现表明，个体在基线时可能能够弥补睡眠不足，但在脑震荡后则不能。脑震荡可能会降低认知储备或消耗大脑资源，这使得睡眠对于脑震荡后正常的神经认知功能更为重要。未来的工作将分析睡眠对脑震荡后测试表现的影响。
