Persistent Post-Concussive Symptoms Can Affect Sleep, Stress and Anxiety Levels
Fagan M, Lakin J, Mularoni M, D’Silva LJ.
Fagan M, Lakin J, Mularoni M, D’Silva LJ.
Institution(s): Rockhurst University Department of Physical Therapy, Kansas City, MO
Purpose/Hypothesis: It is estimated that there are between 1.6 and 3.8 million sports-related concussions in the US every year. Concussed individuals present with signs and symptoms like irritability, drowsiness, “fogginess”, and emotional lability. As young athletes pursue school and occupational activities, they may continue to have symptoms. The purpose of this study was to evaluate if sleep, emotional status, and balance continue to be affected at least one year after a concussion injury.
Subjects: Adults between 20-30 years of age were recruited in 2 groups: with a diagnosed concussion at least a year prior, and age and sex matched controls.
Methods/ Materials: Subjects were excluded if they had neurological, inner ear, or musculoskeletal impairments. The Epworth Sleepiness Scale, Insomnia Severity Scale, and Pittsburgh Sleep Quality Index (PSQI) examined sleep quality. Stress, anxiety, and depression were examined using the Perceived Stress Scale (PSS) and the Depression and Anxiety Stress Scale- 21 (DASS-21). The NeuroCom Balance Manager (™) was used to assess postural sway in 6 conditions where vision and support surface were modified. Individuals with concussion completed the post-concussion symptom scale (PCSS) and history of the frequency of concussions. T--tests were utilized to compare differences between the 2 groups on all outcome measures.
Results: 12 participants, 6 with concussion (mean age 25 ± 3.3) and 6 controls (mean age 23.2 ± 1.8) completed the study. Participants with concussion injury had between 1-5 diagnosed concussions with PCSS scores ranging from 0-61. The PSQI total score was not significant (p=0.13), however, sleep latency (p=0.09) and sleep efficiency (p=0.08) and the Epworth Sleepiness Scale (p=0.08) scores were different between the 2 groups. The DASS-21 total score was trending toward significance (p=0.07), while the stress component (p=0.03) and anxiety component (p=0.05) were significantly different between groups. Concussed individuals had higher levels of perceived stress based on the PSS (p=0.07). Postural sway was not different between the 2 groups in all conditions tested.
Conclusions: Participants with concussions were at least a year post injury, however, many continued to have significant post-concussive symptoms. Concussed individuals had impaired sleep latency and efficiency resulting in more daytime sleepiness. They also had higher levels of anxiety, stress, and perception of stress. Participants were recruited from a University setting where they are actively pursuing college and graduate degrees. Poor sleep quality and higher stress levels can impair learning potential. Further studies examining the role of vestibular rehabilitation to reduce symptoms in this group of young adults are necessary.
Funding Source: No additional sources of funding
Acknowledgements: We would like to thank NeuroCom(™) for the use of their force plate for this study.
Purpose/Hypothesis: It is estimated that there are between 1.6 and 3.8 million sports-related concussions in the US every year. Concussed individuals present with signs and symptoms like irritability, drowsiness, “fogginess”, and emotional lability. As young athletes pursue school and occupational activities, they may continue to have symptoms. The purpose of this study was to evaluate if sleep, emotional status, and balance continue to be affected at least one year after a concussion injury.
Subjects: Adults between 20-30 years of age were recruited in 2 groups: with a diagnosed concussion at least a year prior, and age and sex matched controls.
Methods/ Materials: Subjects were excluded if they had neurological, inner ear, or musculoskeletal impairments. The Epworth Sleepiness Scale, Insomnia Severity Scale, and Pittsburgh Sleep Quality Index (PSQI) examined sleep quality. Stress, anxiety, and depression were examined using the Perceived Stress Scale (PSS) and the Depression and Anxiety Stress Scale- 21 (DASS-21). The NeuroCom Balance Manager (™) was used to assess postural sway in 6 conditions where vision and support surface were modified. Individuals with concussion completed the post-concussion symptom scale (PCSS) and history of the frequency of concussions. T--tests were utilized to compare differences between the 2 groups on all outcome measures.
Results: 12 participants, 6 with concussion (mean age 25 ± 3.3) and 6 controls (mean age 23.2 ± 1.8) completed the study. Participants with concussion injury had between 1-5 diagnosed concussions with PCSS scores ranging from 0-61. The PSQI total score was not significant (p=0.13), however, sleep latency (p=0.09) and sleep efficiency (p=0.08) and the Epworth Sleepiness Scale (p=0.08) scores were different between the 2 groups. The DASS-21 total score was trending toward significance (p=0.07), while the stress component (p=0.03) and anxiety component (p=0.05) were significantly different between groups. Concussed individuals had higher levels of perceived stress based on the PSS (p=0.07). Postural sway was not different between the 2 groups in all conditions tested.
Conclusions: Participants with concussions were at least a year post injury, however, many continued to have significant post-concussive symptoms. Concussed individuals had impaired sleep latency and efficiency resulting in more daytime sleepiness. They also had higher levels of anxiety, stress, and perception of stress. Participants were recruited from a University setting where they are actively pursuing college and graduate degrees. Poor sleep quality and higher stress levels can impair learning potential. Further studies examining the role of vestibular rehabilitation to reduce symptoms in this group of young adults are necessary.
Funding Source: No additional sources of funding
Acknowledgements: We would like to thank NeuroCom(™) for the use of their force plate for this study.