Insomnia and daytime sleepiness: risk factors for sports-related concussion

Sleep Med. 2019 Jun:58:66-74. doi: 10.1016/j.sleep.2019.03.008. Epub 2019 Mar 25.


Objective/background: Poor quality and inadequate sleep are associated with impaired cognitive, motor, and behavioral components of sport performance and increased injury risk. While prior work identifies sports-related concussions as predisposing factors for poor sleep, the role of sleep as a sports-related concussion risk factor is unknown. The purpose of this study was to quantify the effect of poor sleep quality and insomnia symptoms on future sports-related concussion risk.

Patients/methods: In this study, 190 NCAA Division-1 athletes completed a survey battery, including the Insomnia Severity Index (ISI) and National Health and Nutrition Examination Survey (NHANES) Sleep module. Univariate risk ratios for future sports-related concussions were computed with ISI and NHANES sleepiness scores as independent predictors. An additional multiple logistic regression model including sport, sports-related concussion history, and significant univariate predictors jointly assessed the odds of sustaining a concussion.

Results: Clinically moderate-to-severe insomnia severity (RR = 3.13, 95% CI: 1.320-7.424, p = 0.015) and excessive daytime sleepiness two or more times per month (RR = 2.856, 95% CI: 0.681-11.977, p = 0.037) increased concussion risk. These variables remained significant and comparable in magnitude in a multivariate model adjusted for sport participation.

Conclusion: Insomnia and daytime sleepiness are independently associated with increased sports-related concussion risk. More completely identifying bidirectional relationships between concussions and sleep requires further research. Clinicians and athletes should be cognizant of this relationship and take proactive measures - including assessing and treating sleep-disordered breathing, limiting insomnia risk factors, improving sleep hygiene, and developing daytime sleepiness management strategies - to reduce sports-related concussion risk and support overall athletic performance.

Keywords: College athletes; Daytime sleepiness; Insomnia severity index; Relative risk; Sleep quality; Sports-related concussion.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Athletes / statistics & numerical data
  • Athletic Injuries / complications*
  • Brain Concussion / epidemiology
  • Brain Concussion / etiology*
  • Brain Concussion / prevention & control
  • Disorders of Excessive Somnolence / complications
  • Disorders of Excessive Somnolence / prevention & control
  • Disorders of Excessive Somnolence / psychology
  • Female
  • Humans
  • Male
  • Risk Factors
  • Self Report / statistics & numerical data
  • Severity of Illness Index
  • Sleep Initiation and Maintenance Disorders / complications*
  • Sleep Initiation and Maintenance Disorders / epidemiology
  • Sleep Initiation and Maintenance Disorders / psychology
  • Sleepiness
  • Sports / statistics & numerical data
  • Surveys and Questionnaires
  • Young Adult