Predictors of Post-Concussion Sleep Quality in Adolescents Throughout Recovery

Purpose Post-concussion sleep dysregulation is associated with greater symptom severity and slower recovery. In adolescents, post-injury sleep quality is associated with widespread decreased white matter integrity at 7+ days post-injury, but not before that, suggesting that a unique phenotype may emerge in early recovery. We hypothesized that anxiety-related variables would best predict sleep quality across the first two weeks post-injury due to sympathetic hyperarousal. Method One hundred and fifty-five participants (46% female) aged 11-18 (15.18 +/- 1.8) years were recruited from multiple specialty concussion clinics within 7 days (d) of injury. Participants completed demographics, medical history, injury characteristics, the PROMIS-Anxiety and PROMIS-Depression questionnaires, and the Adolescent Sleep-Wake Scale (ASWS) at the initial (<7d post-injury) and follow-up (10+ d) visits. Bivariate linear regressions identified predictors of ASWS total sleep at each visit, informing a multiple regression predicting Time 2 ASWS total sleep. Results Worse sleep quality at both Time 1 (4.68 + / - 3.40 d post-injury) and Time 2 (17.28 + / - 5.59 d post-injury) was predicted by mechanism of injury and higher initial symptoms of both anxiety and depression, and Time 2 sleep quality was also associated with personal and family history of anxiety (all p < 0.05). A combined model including all significant factors predicted 14% of the variance in sleep quality at the second visit via initial visit depression symptoms alone (F(1,35)=24.44, p < 0.01). Conclusions Global depression scores may help index the impact of concussion on sleep quality in adolescents, but may obscure intra-individual contributing factors pertinent to intervention. This suggests that an individualized approach to understanding contributors to sleep quality in early recovery may be important to assist in identifying modifiable factors.