Butterfield Lauren, Zemek Roger, Borghese Michael M, Bijelic Vid, Barrowman Nick, Sicard Veronik, Kuzik Nicholas, Tremblay Mark S, Yeates Keith Owen, Ledoux Andrée-Anne
Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada.
Department of Neuroscience, Carleton University, Ottawa, Canada.
JAMA Netw Open. 2025 Jun 2;8(6):e2516333. doi: 10.1001/jamanetworkopen.2025.16333.
Approximately half of all youths with concussions report sleep disturbance, including short and long sleep durations, in the first week of recovery. Limited longitudinal research exists regarding the association between sleep duration and symptom burden during acute pediatric concussion recovery.
To investigate the association between mean nightly sleep duration over 1 week (days 1 to 7) and 2 weeks (days 1 to 14) postinjury and subsequent symptom burden at 1, 2, and 4 weeks following pediatric concussion.
DESIGN, SETTING, AND PARTICIPANTS: This cohort study used data from a randomized clinical trial conducted in 3 emergency pediatric departments in Ontario, Canada, from March 2017 to December 2019 (with secondary analysis conducted between September 2022 and September 2024). Eligible participants were between ages 10 years and 18 years who received treatment for a concussion within 48 hours.
Sleep postinjury was measured with waist-worn accelerometers 24 hours per day for 2 weeks and daily sleep logs.
Symptom burden was measured with the Health and Behavior Inventory at 1 week, 2 weeks, and 4 weeks postconcussion. A nonlinear mixed-effects model was applied that estimated symptom burden at 1, 2, and 4 weeks from mean sleep duration over days 1 to 7 and days 1 to 14. Logistic regressions were performed to assess the odds of being reliably symptomatic at 2 and 4 weeks by mean sleep duration. Conservative (z ≥ 1.65) and liberal (z ≥ 1.28) definitions of reliable change in symptoms were evaluated. All models compared 10th vs 50th, 25th vs 75th, and 50th vs 90th percentile contrasts, and were adjusted for prognostic pre-injury demographic and baseline injury variables.
A total of 291 participants (median [IQR] age, 13.2 [11.6-14.9] years; 128 female [44.0%]) were included in the main analysis. Mean nightly sleep duration beyond 9.5 hours in the first week postconcussion was associated with higher symptom burden at 1 week (75th percentile [10.5 h] vs 25th percentile [9.5 h]: estimate, 1.3 [95% CI, 0.25-2.28]; 90th percentile [11.3 h] vs 50th percentile [10.0 h]: estimate, 2.9 [95% CI, 1.22-4.69]). Mean sleep duration beyond 9.9 hours in the first 2 weeks postconcussion was associated with higher symptom burden at 2 weeks (90th percentile [10.9 h] vs 50th percentile [9.9 h]: estimate, 2.2 [95% CI, 0.85-3.47]) and 4 weeks (estimate, 2.2 [95% CI, 0.85-3.47]), and increased odds of persisting symptoms at 4 weeks (conservative: odds ratio [OR], 1.73 [95% CI, 0.91-3.26]; liberal: OR, 1.93 [95% CI, 1.07-3.47]).
In this observational study of adolescents, average nightly sleep durations beyond 9.9 hours over the first 2 weeks of concussion recovery were associated with high symptom burden and persistent symptoms. Clinicians should monitor youths' sleep after concussions.
在所有脑震荡青少年中，约有一半报告在恢复的第一周出现睡眠障碍，包括睡眠时间短和长。关于急性小儿脑震荡恢复期间睡眠时间与症状负担之间的关联，纵向研究有限。
调查受伤后1周（第1至7天）和2周（第1至14天）的平均夜间睡眠时间与小儿脑震荡后1、2和4周的后续症状负担之间的关联。
设计、设置和参与者：这项队列研究使用了2017年3月至2019年12月在加拿大安大略省3个急诊儿科部门进行的一项随机临床试验的数据（2022年9月至2024年9月进行二次分析）。符合条件的参与者年龄在10岁至18岁之间，在48小时内接受了脑震荡治疗。
受伤后的睡眠通过佩戴在腰部的加速度计每天24小时测量2周，并结合每日睡眠日志进行记录。
在脑震荡后1周、2周和4周，使用健康与行为量表测量症状负担。应用非线性混合效应模型，根据第1至7天和第1至14天的平均睡眠时间估计1、2和4周时的症状负担。进行逻辑回归分析，以评估根据平均睡眠时间在2周和4周时出现可靠症状的几率。评估了症状可靠变化的保守（z≥1.65）和宽松（z≥1.28）定义。所有模型比较了第10百分位数与第50百分位数、第25百分位数与第75百分位数以及第50百分位数与第90百分位数的对比，并针对预后性损伤前人口统计学和基线损伤变量进行了调整。
共有291名参与者（年龄中位数[四分位间距]为13.2[11.6 - 14.9]岁；128名女性[44.0%]）纳入主要分析。脑震荡后第一周平均夜间睡眠时间超过9.5小时与1周时较高的症状负担相关（第75百分位数[10.5小时]与第25百分位数[9.5小时]：估计值为1.3[95%置信区间，0.25 - 2.28]；第90百分位数[11.3小时]与第50百分位数[10.0小时]：估计值为2.9[95%置信区间，1.22 - 4.69]）。脑震荡后前2周平均睡眠时间超过9.9小时与2周时较高的症状负担相关（第90百分位数[10.9小时]与第50百分位数[9.9小时]：估计值为2.2[95%置信区间，0.85 - 3.47]）以及4周时（估计值为2.2[95%置信区间，0.85 - 3.47]），并且4周时持续症状的几率增加（保守：比值比[OR]为1.73[95%置信区间，0.91 - 3.26]；宽松：OR为1.93[95%置信区间，1.07 - 3.47]）。
在这项针对青少年的观察性研究中，脑震荡恢复的前2周平均夜间睡眠时间超过9.9小时与高症状负担和持续症状相关。临床医生应在脑震荡后监测青少年的睡眠情况。
