Relationship between Sport-Related Concussion and Sleep Based on Self-Report and Commercial Actigraph Measurement

Ciaran M Considine; Daniel L Huber; Anna Niemuth; Danny Thomas; Michael A McCrea; Lindsay D Nelson

doi:10.1089/neur.2021.0008

Relationship between Sport-Related Concussion and Sleep Based on Self-Report and Commercial Actigraph Measurement

Neurotrauma Rep. 2021 Apr 26;2(1):214-223. doi: 10.1089/neur.2021.0008. eCollection 2021.

Authors

Ciaran M Considine¹, Daniel L Huber², Anna Niemuth², Danny Thomas³, Michael A McCrea^{2

4}, Lindsay D Nelson^{2

4}

Affiliations

¹ Department of Neurology, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
² Department of Neurosurgery, Medical College of Wisconsin, Milwaukee Wisconsin, USA.
³ Department of Pediatrics, Medical College of Wisconsin, Milwaukee Wisconsin, USA.
⁴ Department of Neurology, Medical College of Wisconsin, Milwaukee Wisconsin, USA.

Abstract

Sleep-wake disturbance (SWD) results from sport-related concussion (SRC) and may increase risk of protracted post-injury symptoms. However, methodological limitations in the extant literature limit our understanding of the role of SWD in SRC. This study examined the association between acute/subacute SRC and two sleep behaviors-sleep duration and efficiency-as measured by self-report and commercially available actigraphy (CA) in a sample of football players enrolled in a larger prospective longitudinal study of concussion. Fifty-seven high school and Division 3 male football players with SRC (mean [M] age = 18.00 years, standard deviation [SD] = 1.44) and 26 male teammate controls (M age = 18.54 years, SD = 2.21) were enrolled in this prospective pilot study. Sleep duration and sleep efficiency were recorded nightly for 2 weeks (starting 24-48 h post-injury in the SRC group) via CA and survey delivered via mobile application. There was no significant relationship between SRC and objectively recorded sleep measures, a null finding. However, the SRC group reported a brief (3-day) reduction in sleep efficiency after injury (M SRC = 82.18, SD = 12.24; M control = 89.2, SD = 4.25; p = 0.013; Cohen's d = 0.77), with no change in sleep duration. Self-reported and actigraph-assessed hours of sleep were weakly and insignificantly correlated in the SRC group (r = -0.21, p = 0.145), whereas they were robustly correlated in the non-injured control group (r = 0.65, p = 0.004). SWD post-SRC was not observed in objectively measured sleep duration or sleep efficiency and was modest and time-limited based on self-reported sleep efficiency. The weak correlation between self-reported and objective sleep behavior measures implies that subjective experience of SWD post-SRC may be due to factors other than actual changes in these observable sleep behaviors. Clinically, SWD in the early-subacute stages of recovery from SRC may not be adequately measurable via current CA. Subjective SWD may require alternative methods of evaluation (e.g., clinical actigraph or sleep study).

Keywords: actigraphy; football; mHealth mobile health technology; sleep; sport-related concussion.