Characterizing Sleep-Related Changes and Their Effect on Recovery Following Concussion in Collegiate Athletes

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Donahue, Catherine, Education - School of Education and Human Development, University of Virginia
Resch, Jacob, ED-KINE Department, University of Virginia

Sleep is an essential component following a concussion. A concussion can be defined as a traumatic brain injury induced by biomechanical forces to the head, neck, or spine. Management of a concussion consists of an evidence-based, multimodal approach consisting of clinical measures of neurocognitive function, balance, and self-reported symptoms. Although up to 80% of high school and collegiate athletes will experience a resolution of symptoms within 10 days, up to 20% may experience symptoms for several weeks or months. For this reason there is significant interest in the modifiable factors that contribute to the length of recovery following a concussion to lessen the risk of a prolonged recovery for you and adult athletes.
Collegiate athletes experience a variety of symptoms following a concussion which may include sleep symptoms such as excessive drowsiness, difficulty maintain sleep, or changes in the quality and/or quantity of sleep. Sleep symptoms are endorsed by nearly 70% of collegiate athletes, and research has shown these symptoms to be associated with greater number of days to report symptom free. While clinical studies of concussion have demonstrated sleep disturbances at various time points throughout recovery (i.e.- days to months), a detailed explanation of how sleep influences recovery has yet to be established, particularly in the acute phase (<72 hours) of the injury.
In the following studies, we utilized advanced statistical modeling to examine how the severity of sleep symptoms influences the severity of all other symptoms commonly experienced following a concussion. Research has indicated symptom severity (i.e.- the sum severity of all symptoms reported) to be the primary predictor of prolonged recovery, however, none has examined how disrupted sleep may predict a higher symptom severity. Following this, in a first of its kind study, we utilized non-invasive, sensor-derived measures of sleep to determine differences in stages of sleep to examine how sleep is affected immediately following a concussion and throughout recovery. Finally, we utilized advanced neuroimaging techniques to measure levels of neuroinflammation in anatomical regions of the brain that are involved in the regulation of sleep to determine an explanation as to why sleep disturbances occur following a concussion.
Our results demonstrated that following a concussion, sleep is an essential component of recovery. Sleep symptoms were shown to be the strongest predictor of overall symptom severity in the acute phase of injury. Athletes with a concussion also had significantly less time in the stage of Deep sleep in the acute phase, compared to athletes without a concussion. Moreover, following the resolution of symptoms, athletes with a concussion had higher levels of neuroinflammation the sleep-wake areas of the brain.
Overall, these studies address a critical gap in research and the initial step in demonstrating how systemic alteration in the sleep-wake cycle can influence recovery following a concussion. The innovative methodology utilized has produced the first-of-its-kind data to demonstrate how changes in sleep, as measured though wearable technology and advanced neuroimaging, may be leveraged to facilitate recovery from concussion.

PHD (Doctor of Philosophy)
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