Abstract

Sport-related concussion (SRC) is a heterogenous injury with diverse symptoms and impairments that can be aggregated into clinical subtypes (cognitive, headache/migraine, vestibular, ocular-motor, anxiety/mood). Sleep disruption has been defined as potential exacerbating conditions that may accompany the five clinical subtypes. The authors sought to better characterize the role of impaired sleep in each clinical subtype and to identify other risk factors for sleep impairment after SRC. 281 patients (15.3 ± 2.1 years) aged 10–22 years within 21 days of SRC completed the Post-Concussion Symptom Scale (PCSS), the Vestibular/Ocular Motor Screening (VOMS), and a clinical assessment to identify clinical subtype. Subjects were then divided into HIGH (≥7; n = 82) and LOW (≤3; n = 132) sleep symptom groups for comparison. HIGH participants had greater proportions of females (p < 0.001), history of psychiatric disorder (p < 0.001); total PCSS (p < 0.001); and impairment on all VOMS items (p < 0.001). HIGH participants were associated with mood/anxiety (p < 0.001), vestibular (p = 0.003) and ocular (p = 0.03) subtypes. Results of a logistic regression (LR) model with adjusted odds ratios (OR) to predict HIGH sleep symptoms supported anxiety/mood profile (OR = 2.98), vestibular profile (OR = 2.81), psychiatric history (OR = 4.99), and history of motion sickness (OR = 2.13) as significant predictors. Prescribing behavioral and sleep interventions may improve outcomes in cases where these factors co-occur.

摘要

运动相关脑震荡 (SRC) 是一种异质性损伤，具有多种症状和损伤，可汇总为临床亚型（认知、头痛/偏头痛、前庭、眼球运动、焦虑/情绪）。睡眠中断被定义为可能伴随五种临床亚型的潜在恶化状况。作者试图更好地描述睡眠障碍在每种临床亚型中的作用，并确定 SRC 后睡眠障碍的其他危险因素。281 名 10-22 岁的患者（15.3 ± 2.1 岁）在 SRC 后 21 天内完成了脑震荡后症状量表 (PCSS)、前庭/眼部运动筛查 (VOMS) 和临床评估以确定临床亚型。然后将受试者分为高（≥7；n  = 82）和低（≤3；n = 132) 睡眠症状组进行比较。HIGH 参与者的女性比例更高（p  < 0.001），有精神疾病史（p  < 0.001）；总 PCSS ( p  < 0.001)；和所有 VOMS 项目的减值 ( p  < 0.001)。HIGH 参与者与情绪/焦虑 ( p  < 0.001)、前庭 ( p  = 0.003) 和眼部 ( p = 0.03) 亚型。具有调整优势比 (OR) 的逻辑回归 (LR) 模型预测高睡眠症状的结果支持焦虑/情绪特征 (OR = 2.98)、前庭特征 (OR = 2.81)、精神病史 (OR = 4.99) 和病史晕动病（OR = 2.13）作为重要的预测因素。在这些因素同时发生的情况下，开具行为和睡眠干预措施可能会改善结果。