What is the clinical evidence from this study?

Study design: Cross-Sectional. Population: Sport-related concussion (n=34). Intervention: Prolonged return to sport (≥ 28 days) vs. Regular return to sport (< 28 days) and healthy controls. Primary outcome: Nocturnal heart rate variability (RMSSD) post return to sport (r = 0.612, p=0.035).

What does this research mean for the field?

Athletes with prolonged return to sport after concussion exhibit significantly lower nocturnal parasympathetic activity compared to those with regular recovery, even after clinical symptom resolution. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

This study aims to evaluate nocturnal autonomic activity differences between athletes with regular and prolonged recovery from sport-related concussions.

March 28, 2026Open Access

Nocturnal autonomic activity in athletes with regular versus prolonged return to sport after sport-related concussion

Q: What are the key findings of this study?

Athletes with prolonged return to sport after concussion exhibited significantly lower nocturnal parasympathetic activity (RMSSD 51.77 ms vs 91.43 ms) compared to those with regular recovery.

Q: What does this research mean for the field?

Athletes with prolonged return to sport after concussion exhibit significantly lower nocturnal parasympathetic activity compared to those with regular recovery, even after clinical symptom resolution. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Q: What question did this study set out to answer?

This study aims to evaluate nocturnal autonomic activity differences between athletes with regular and prolonged recovery from sport-related concussions.

Key Result

Athletes with prolonged return to sport after concussion exhibited significantly lower nocturnal parasympathetic activity (RMSSD 51.77 ms vs 91.43 ms) compared to those with regular recovery.

Key Points

This study aims to evaluate nocturnal autonomic activity differences between athletes with regular and prolonged recovery from sport-related concussions.
Exploratory cross-sectional design comparing 17 SRC athletes to 17 matched control athletes.
Athletes categorized by return to sport: regular (< 28 days) and prolonged (≥ 28 days).
Nocturnal data collected post RTS using a wearable device for heart rate, heart rate variability, and electrodermal activity.
No significant differences in concussion symptoms, heart rate, or electrodermal activity during return to sport.
Prolonged RTS athletes exhibited lower nocturnal heart rate variability post RTS compared to regular RTS athletes and controls.
Prolonged RTS athletes showed fewer sleep storms than regular RTS athletes, indicating reduced nocturnal sympathetic activity.

Study Design

Type

Cross-Sectional (n=34)

Structured PICO

Does prolonged recovery after sport-related concussion correlate with altered nocturnal autonomic activity in adult elite athletes?

Population

Adult elite athletes diagnosed with sport-related concussion (SRC) and matched healthy controls

Intervention

Prolonged return to sport (≥ 28 days) after SRC

Comparator

Regular return to sport (< 28 days) after SRC and matched healthy controls

Outcome

Nocturnal autonomic activity (RMSSD and HR)surrogate

Prolonged recovery after sport-related concussion is associated with persistent reductions in nocturnal parasympathetic and phasic sympathetic activity even after clinical symptom resolution.

Main Result

Effect estimate: r = 0.612

Absolute Event Rate: 51.77% vs 91.43%

p-value: p=0.035

Limitations

Small sample size of elite athletes limits statistical power
Low number of female participants prevented assessment of sex-specific effects
Concussion symptoms were collected only once at study inclusion
Training during and post return to sport was not monitored
Time in bed was approximated using accelerometry rather than polysomnography

Abstract

Sport-related concussion (SRC) is a multifaceted brain injury linked to altered autonomic activity, which may persist and contribute to prolonged recovery and persisting post-concussion symptoms (PPCS). This exploratory cross-sectional study addressed whether athletes with prolonged recovery show altered nocturnal autonomic activity after SRC, offering potential insights into PPCS and biomarkers. Nocturnal autonomic activity and concussion symptoms were evaluated and compared between 17 SRC athletes and 17 matched control athletes. SRC athletes were classified by individual return to sport (RTS) into regular RTS ( 3 weeks) using a multimodal wearable device. Outcomes included heart rate (HR), HR variability (RMSSD), and electrodermal activity (EDA). No group differences in concussion symptoms, HR, RMSSD, and EDA were found during RTS. Post RTS, prolonged RTS athletes displayed significantly lower nocturnal RMSSD (p = 0.035, r = 0.612) than regular RTS athletes and controls. Additionally, prolonged RTS athletes exhibited fewer phasic EDA (sleep storms) compared to regular RTS athletes. Prolonged SRC recovery might be associated with reduced nocturnal parasympathetic (RMSSD) and phasic sympathetic (EDA) activity, after clinical symptom resolution. Further research is needed to explore whether this reflects insufficient physiological recovery or deconditioning.

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