Effect of Sleep Duration on Neurocognitive Testing Symptoms: A Comparative Analysis of Baseline and Post-Injury States

Introduction: Cognitive behavioral computerized tests are critical for standardizing concussion diagnosis in adolescent athletes. However, the effect of certain factors, like sleep duration, on these tests has been understudied. This study aims to evaluate which symptoms may be the most useful in the diagnosis of concussion and subsequent return to play protocols, considering the influence of sleep duration.

Methods: A database of Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) tests containing athletes aged 12-22 from 2009-2019 was queried and a total of 11,563 baseline tests and 2,546 post-concussion tests were included. A multiple linear regression model was constructed, adjusting for sex, age, learning disability, ADD/ADHD, and number of previous concussions with GraphPad Prism.

Results: At baseline, hours of sleep was associated with headache (β=-0.062,95%CI:-0.099 to -0.023,p < 0.0001), nausea (β=-0.095,95%CI:-0.177 to -0.014,p=0.022), dizziness (β=0.10,95%CI:0.024 to 0.175,p= 0.0097), fatigue (β=-0.126,95%CI:-0.164 to -0.088,p < 0.0001), drowsiness (β=-0.096,95%CI:-0.139 to -0.052,p < 0.0001), and difficulty concentrating (β=-0.049,95%CI:-0.093 to -0.005,p=0.028). After concussion, the symptoms most associated with hours of sleep were headache (β=-0.067,95%CI:-0.129 to -0.004,p=0.036), sadness (β=-0.127,95%CI:-0.241 to -0.014,p=0.028), numbness (β=0.213,95%CI:0.083 to 0.344,p=0.001), and feeling slowed down (β=0.01,95%CI:0.009 to 0.191,p=0.032).

Conclusion : Although headache was associated with hours of sleep both at baseline and post-injury, sadness, numbness, and feeling slowed down are symptoms tested by the IMPACT test are uniquely significant in the post-injury state while nausea, dizziness, fatigue, drowsiness, and difficulty concentrating were were identified in the baseline state. These neuropsychiatric symptoms may comprise a valuable set of variables which could aid clinicians in distinguishing concussion symptoms from poor sleep.