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

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).

SUBMITTER: Considine CM

PROVIDER: S-EPMC8086521 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:ContextInterest in identifying the effects of physical and mental activity on recovery after sport-related concussion is growing. Clinical studies of concussed athletes' activities require well-validated methods for tracking their intensity and timing.ObjectiveTo develop and validate a novel multimodal approach to monitoring activity postconcussion using mobile (mHealth) technologies.DesignCohort study.SettingTranslational research unit.Patients or other participantsA total of 40 high school and collegiate football players were evaluated at preseason and followed longitudinally after either concussion (n = 25; age = 17.88 ± 1.74 years, height = 182.07 ± 8.08 cm, mass = 98.36 ± 21.70 kg) or selection as a nonconcussed control (n = 15; age = 18.27 ± 1.83 years, height = 180.01 ± 7.19 cm, mass = 93.83 ± 24.56 kg).Main outcome measure(s)Participants wore a commercial actigraph and completed a daily mobile survey for 2 weeks. Analyses focused on comparisons between groups for actigraph-based physical activity and self-reported physical and mental activity during the follow-up period.ResultsFor the first 2 days postinjury, objective measures showed fewer daily steps in concussed (6663 ± 2667 steps) than in control (11 148 ± 3381 steps) athletes (P < .001), and both objective and self-reported measures indicated less moderate to vigorous physical activity in concussed (27.6 ± 32.6 min/d and 25.0 ± 43.6 min/d, respectively) than in control (57.3 ± 38.6 min/d and 67.5 ± 40.1 min/d, respectively) athletes (both P values < .05). Correlations between objective and self-reported measures of moderate to vigorous physical activity were moderate across select 1-week and 2-week averages. We observed no group differences in self-reported mental activities.ConclusionsPhysical activity after sport-related concussion varied widely across athletes but on average was reduced during the acute and early subacute postinjury periods for both objective and self-reported measures. The lack of differences in mental activities between groups may reflect limited change in mental exertion postconcussion or difficulty accurately measuring mental activities. Assessing concussed athletes' activities using actigraphy and self-reported scales may help monitor their compliance with activity recommendations and be useful in studies aimed at better understanding the effects of physical activity on concussion recovery.

Project description:BACKGROUND:Inflammation is considered a hallmark of concussion pathophysiology in experimental models, yet is understudied in human injury. Despite the growing use of blood biomarkers in concussion, inflammatory biomarkers have not been well characterized. Furthermore, it is unclear if the systemic inflammatory response to concussion differs from that of musculoskeletal injury. The purpose of this paper was to characterize systemic inflammation after injury in athletes with sport-related concussion or musculoskeletal injury. METHODS:A prospective, observational cohort study was conducted employing 175 interuniversity athletes (sport-related concussion, n?=?43; musculoskeletal injury, n?=?30; healthy, n?=?102) from 12 sports at a sports medicine clinic at an academic institution. High-sensitivity immunoassay was used to evaluate 20 inflammatory biomarkers in the peripheral blood of athletes within 7?days of injury (subacute) and at medical clearance. Healthy athletes were sampled prior to the start of their competitive season. Partial least squares regression analyses were used to identify salient biomarker contributions to class separation between injured and healthy athletes, as well as to evaluate the relationship between biomarkers and days to recovery in injured athletes. RESULTS:In the subacute period after injury, compared to healthy athletes, athletes with sport-related concussion had higher levels of the chemokines' monocyte chemoattractant protein-4 (p?<?0.001) and macrophage inflammatory protein-1? (p?=?0.001); athletes with musculoskeletal injury had higher levels of thymus and activation-regulated chemokine (p?=?0.001). No significant differences in biomarker profiles were observed at medical clearance. Furthermore, concentrations of monocyte chemoattractant protein-1 (p?=?0.007) and monocyte chemoattractant protein-4 (p?<?0.001) at the subacute time point were positively correlated with days to recovery in athletes with sport-related concussion, while thymus and activation-regulated chemokine was (p?=?0.001) positively correlated with days to recovery in athletes with musculoskeletal injury. CONCLUSION:Sport-related concussion is associated with perturbations to systemic inflammatory chemokines that differ from those observed in athletes with a musculoskeletal injury. These results support inflammation as an important facet of secondary injury after sport-related concussion that can be measured systemically in a human model of injury.

Project description:BACKGROUND:Increasing evidence suggests inflammation is an important component of concussion pathophysiology. However, its etiology, restitution, and potential clinical repercussions remain unknown. The purpose of the current study was to compare the blood concentrations of interleukin (IL) -6, a prominent inflammatory cytokine, between healthy athletes and athletes with a sport-related concussion (SRC), while addressing the potential confounds of sex, recent physical activity, and the interacting effect of concussion history. METHOD:A prospective, observational cohort study was conducted on athletes at a single academic institute participating across 13 interuniversity sports. Follow-up of 96 athletes who agreed to provide a blood sample was completed: 41 athletes with a physician diagnosed SRC, and 55 healthy athletes. Ella™, the high sensitivity immunoassay system by ProteinSimple was used to measure peripheral plasma concentrations of IL-6 within the first week (median = 4 days, range = 2-7) following injury. A resampled ordinary least squares regression was used to evaluate the relationship between IL-6 concentrations and concussion status, while partial least squares regression was used to evaluate the relationship between IL-6 and both symptom burden and time to clinical recovery. RESULTS:Regression analysis identified a negative relationship between plasma IL-6 concentrations and the interaction between an acute SRC and a history of concussion (? = -0.29, p = 0.029). IL-6 did not differ between healthy athletes and those with an acute SRC independent of concussion history, and was not correlated with either recovery time or symptom burden in athletes with SRC. CONCLUSION:Perturbations to circulating IL-6 concentrations, a key inflammatory cytokine, may be more pronounced following SRC in athletes who have a history of concussion. These results add to a growing body of evidence supporting the involvement of inflammation at all phases of recovery following SRC, and potentially support a concomitant effect of prior concussion on acute SRC pathophysiology.

Project description:ImportanceIdentifying plasma biomarkers associated with the amount of time an athlete may need before they return to sport (RTS) following a sport-related concussion (SRC) is important because it may help to improve the health and safety of athletes.ObjectiveTo examine whether plasma biomarkers can differentiate collegiate athletes who RTS in less than 14 days or 14 days or more following SRC.Design, setting, and participantsThis multicenter prospective diagnostic study, conducted by the National Collegiate Athletics Association-Department of Defense Concussion Assessment, Research, and Education Consortium, included 127 male and female athletes who had sustained an SRC while enrolled at 6 Concussion Assessment, Research, and Education Consortium Advanced Research Core sites as well as 2 partial-Advanced Research Core military service academies. Data were collected between February 2015 and May 2018. Athletes with SRC completed clinical testing and blood collection at preseason (baseline), postinjury (0-21 hours), 24 to 48 hours postinjury, time of symptom resolution, and 7 days after unrestricted RTS.Main outcomes and measuresA total of 3 plasma biomarkers (ie, total tau protein, glial fibrillary acidic protein [GFAP], and neurofilament light chain protein [Nf-L]) were measured using an ultrasensitive single molecule array technology and were included in the final analysis. RTS was examined between athletes who took less than 14 days vs those who took 14 days or more to RTS following SRC. Linear mixed models were used to identify significant interactions between period by RTS group. Area under the receiver operating characteristic curve analyses were conducted to examine whether these plasma biomarkers could discriminate between RTS groups.ResultsThe 127 participants had a mean (SD) age of 18.9 (1.3) years, and 97 (76.4%) were men; 65 (51.2%) took less than 14 days to RTS, and 62 (48.8%) took 14 days or more to RTS. Linear mixed models identified significant associations for both mean (SE) plasma total tau (24-48 hours postinjury, <14 days RTS vs ≥14 days RTS: -0.65 [0.12] pg/mL vs -0.14 [0.14] pg/mL; P = .008) and GFAP (postinjury, 14 days RTS vs ≥14 days RTS: 4.72 [0.12] pg/mL vs 4.39 [0.11] pg/mL; P = .04). Total tau at the time of symptom resolution had acceptable discrimination power (area under the receiver operating characteristic curve, 0.75; 95% CI, 0.63-0.86; P < .001). We also examined a combined plasma biomarker panel that incorporated Nf-L, GFAP, and total tau at each period to discriminate RTS groups. Although the analyses did reach significance at each time period when combined, results indicated that they were poor at distinguishing the groups (area under the receiver operating characteristic curve, <0.7).Conclusions and relevanceThe findings of this study suggest that measures of total tau and GFAP may identify athletes who will require more time to RTS. However, further research is needed to improve our ability to determine recovery following an SRC.

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

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