Noordeen Suleyman, Wang Poh, Strazda Anna E, Arany Eszter Sara, Ergisi Mehmet, Yeo Linghui Janice, Popovic Rebeka, Mahendran Abinayan, Khawaja Mikail, Grover Kritika, Memon Mohammed, Hegde Saahil, Qiu Connor S, Oulton Charles, Yu Yizhou
International Sleep Charity, Shedfield, Southampton SO32 2HQ, UK.
School of Clinical Medicine, Cambridge Biomedical Campus, University of Cambridge, Box 111, Cambridge CB2 0SP, UK.
Clocks Sleep. 2025 Aug 29;7(3):46. doi: 10.3390/clockssleep7030046.
Concussions significantly impact sleep quality among adolescents. Despite increasing recognition of these effects, the complex relationship between adolescent concussions and sleep disturbances is still not fully understood and presents mixed findings. Here, we conducted a systematic review and meta-analysis to assess how concussions affect sleep-related symptoms in adolescents. We included papers presenting Pittsburgh Sleep Quality Index (PSQI) differences following concussion in high school and collegiate patients, with sleep measures recorded following concussion. Animal studies, research on participants with conditions other than concussion, non-English articles and papers failing to present PSQI data were excluded. We searched MEDLINE, Embase, CINAHL, Web of Science™, PsycINFO, Google Scholar, and Cochrane Central Register of Controlled Trials databases until 23 August 2024. In addition, we performed hand-searching of relevant reference lists and conference proceedings to identify further studies. Risk of bias was assessed using the Newcastle-Ottawa scale. In total, we considered 4477 studies, with nine meeting the inclusion criteria. Our analysis involved 796 participants, 340 of whom had experienced a concussion. Analysis was carried out using the meta and metafor packages in R (version 4.0.0). We showed a deterioration in sleep quality post-concussion, as evidenced by increased PSQI (standardised mean difference 0.84; 95% CI 0.53-1.16; < 0.0001). Subgroup and quality assessments confirmed the consistency of these findings. Since poor sleep quality impacts daytime activities, we analysed the relationship between concussion and daytime dysfunction. We showed that concussion is associated with a significant worsening of the daytime dysfunction score by 0.55 (95% CI 0.24-0.70; = 0.006). We conclude that concussions impair both sleep quality and daytime functioning in adolescents. Our research underscores the need for systematic inclusion of sleep quality assessments in post-concussion protocols and calls for targeted interventions to manage sleep disturbances post-concussion to mitigate their broader impacts on daily functioning.
脑震荡对青少年的睡眠质量有显著影响。尽管人们对这些影响的认识日益提高，但青少年脑震荡与睡眠障碍之间的复杂关系仍未得到充分理解，研究结果也参差不齐。在此，我们进行了一项系统综述和荟萃分析，以评估脑震荡如何影响青少年与睡眠相关的症状。我们纳入了呈现高中和大学患者脑震荡后匹兹堡睡眠质量指数（PSQI）差异的论文，且睡眠测量是在脑震荡后进行记录的。动物研究、对非脑震荡患者的研究、非英文文章以及未呈现PSQI数据的论文均被排除。我们检索了MEDLINE、Embase、CINAHL、Web of Science™、PsycINFO、谷歌学术以及Cochrane对照试验中心注册库等数据库，检索截至2024年8月23日。此外，我们还对手检相关参考文献列表和会议论文集以识别更多研究。使用纽卡斯尔-渥太华量表评估偏倚风险。我们总共考虑了4477项研究，其中9项符合纳入标准。我们的分析涉及796名参与者，其中340人经历过脑震荡。分析使用R（版本4.0.0）中的meta和metafor软件包进行。我们发现脑震荡后睡眠质量恶化，PSQI升高证明了这一点（标准化均值差0.84；95%置信区间0.53 - 1.16；<0.0001）。亚组分析和质量评估证实了这些结果的一致性。由于睡眠质量差会影响白天的活动，我们分析了脑震荡与白天功能障碍之间的关系。我们发现脑震荡与白天功能障碍评分显著恶化0.55相关（95%置信区间0.24 - 0.70；=0.006）。我们得出结论，脑震荡会损害青少年的睡眠质量和白天功能。我们的研究强调在脑震荡后方案中需要系统地纳入睡眠质量评估，并呼吁采取有针对性的干预措施来管理脑震荡后的睡眠障碍，以减轻其对日常功能的更广泛影响。
