Understanding discrepancies between self-reported and objective sleep in adolescents and young adults with subacute concussion

Abstract Study Objectives Conduct a multidimensional analysis of sleep perception, objective sleep, and neuropsychiatric wellbeing in individuals with subacute concussion compared to controls. Methods Thirty-one recently concussed individuals completed the Pittsburgh Sleep Quality Index, Insomnia Severity Index, and Patient-Report Outcomes Measurement Information System measures of depression, anxiety, stress, and cognitive function. Concussion symptom severity scores (Sports Concussion Assessment Tool) were obtained from participants’ health records. Sleep parameters were derived from at least 7 days of monitoring with the Emfit QS device (total sleep time TST, time in bed, sleep onset latency, sleep efficiency, wake after sleep onset). Data were compared to 19 controls using parametric or non-parametric tests for independence (α = 0.05). Pearson correlations and linear mixed models assessed relationships between data modalities. Results Concussed individuals reported worse sleep and had lower sleep efficiency, longer time in bed, and greater sleep onset latency than controls (p .05). Patient-Report Outcomes Measurement Information System symptom scores moderated these relationships at significant or near-significant levels. Controls demonstrated agreement between reported and measured sleep (for TST: r = 0.52; p = .023) and a positive relationship between sleep dissatisfaction and wake after sleep onset (p .05). These relationships were not observed in individuals with concussion. Moreover, individuals with greater discrepancy between reported and measured sleep scored higher on Sports Concussion Assessment Tool concussion symptom inventories (βTSTdisc = 9.5/h; pbeta = .007; pmodel = .022; Total R2 = 0.34). Conclusions Individuals with subacute concussion exhibited worse self-reported and objective sleep than controls, but showed discrepancy between reported and measured sleep characteristics that correlated with concussion severity at diagnosis. Future assessment of sleep discrepancy may improve understanding of post-concussive sleep disturbance. Statement of Significance Previous studies of sleep after concussion base findings primarily on self-reported sleep quality questionnaires. Few include objective data, or adjust for demographic and neuropsychiatric covariates, which limits our current understanding of post-concussive sleep. Furthermore, there is a paucity of knowledge about sleep during the subacute phase of concussion recovery, which can be a critical period for those experiencing protracted symptoms. To help fill this gap, we provide a characterization of sleep in adolescents and young adults with subacute concussion. Our study evaluates the agreement between self-reported and objectively measured sleep after concussion and is the first to identify sleep discrepancy as a potential correlate of injury severity in this population.