Donahue Catherine C, Smulligan Katherine L, Wingerson Mathew J, Brna Madison L, Simon Stacey L, Wilson Julie C, Howell David R
Department of Orthopedics, University of Colorado School of Medicine, Aurora, Colorado, USA.
Sports Medicine Center, Children's Hospital Colorado, Aurora, Colorado, USA.
Orthop J Sports Med. 2025 Apr 18;13(4):23259671251330571. doi: 10.1177/23259671251330571. eCollection 2025 Apr.
Concussions can have negative implications for sleep quality. Self-report measures, such as the Pittsburgh Sleep Quality Index (PSQI), have been used in clinical and research settings to identify individuals with sleep impairments. However, the accuracy/applicability of historically established PSQI scoring criteria for differentiating good versus poor sleep quality has not been critically examined in adolescents with concussion.
To establish a relevant PSQI clinical cut point for adolescents with a recent concussion.
Cross-sectional study; Level of evidence, 3.
Adolescents within 16 days of concussion and uninjured controls completed the PSQI, and a global score of 0 to 21 was calculated. Independent-samples tests were used to compare PSQI global scores, and logistic regression was used to calculate odds ratios (outcome = group; predictors = PSQI, covariates). A receiver operating characteristic curve was used to evaluate the area under the curve (AUC) and determine the optimal cut point to distinguish between adolescents with and without a concussion.
A total of 110 adolescents with a concussion (mean age, 14.9 ± 1.6 years; 53% female; 9.8 ± 3.6 days since injury) and 129 uninjured controls (mean age, 15.6 ± 1.1 years; 86% female) were included for analysis. The concussion group had significantly worse (higher) PSQI scores than controls (mean, 7.41 ± 3.62 vs 2.26 ± 1.97; < .001; Cohen = 1.8). Both the univariable model and multivariable model (controlling for age, sex, concussion history, history of anxiety and/or depression, and self-reported use of sleep medication) had excellent diagnostic accuracy (univariable AUC, 0.90; multivariable AUC, 0.99). Within the multivariable model, a cut point of 4 correctly classified 81% of participants as concussed or control (sensitivity, 87%; specificity, 74%).
Adolescents with a concussion demonstrated worse sleep quality than uninjured controls. The results suggest that sleep quality, as measured by the PSQI, can distinguish between adolescents with and without a concussion, using a cut point of 4.
脑震荡会对睡眠质量产生负面影响。自我报告测量方法，如匹兹堡睡眠质量指数（PSQI），已在临床和研究环境中用于识别有睡眠障碍的个体。然而，对于有脑震荡的青少年，历史上确立的PSQI评分标准在区分睡眠质量好坏方面的准确性/适用性尚未得到严格检验。
为近期有脑震荡的青少年建立相关的PSQI临床切点。
横断面研究；证据等级，3级。
脑震荡后16天内的青少年和未受伤的对照组完成PSQI评估，并计算0至21的总分。采用独立样本t检验比较PSQI总分，并使用逻辑回归计算比值比（结果=组别；预测因素=PSQI，协变量）。使用受试者工作特征曲线评估曲线下面积（AUC），并确定区分有和无脑震荡青少年的最佳切点。
共纳入110名有脑震荡的青少年（平均年龄，14.9±1.6岁；53%为女性；受伤后9.8±3.6天）和129名未受伤的对照组（平均年龄，15.6±1.1岁；86%为女性）进行分析。脑震荡组的PSQI评分显著低于对照组（更高）（平均值，7.41±3.62对2.26±1.97；P<.001；Cohen d=1.8）。单变量模型和多变量模型（控制年龄、性别、脑震荡史、焦虑和/或抑郁史以及自我报告的睡眠药物使用情况）均具有出色的诊断准确性（单变量AUC，0.90；多变量AUC，0.99）。在多变量模型中，切点为4时可将81%的参与者正确分类为脑震荡或对照组（敏感性，87%；特异性，74%）。
有脑震荡的青少年睡眠质量比未受伤的对照组更差。结果表明，使用PSQI测量的睡眠质量可以通过切点4区分有和无脑震荡的青少年。
