The Integrated Effect of Physical Activity and Sleep Problems on Concussion Symptom Resolution.

Abstract

Context: Physical activity (PA) and sleep are modifiers of symptom resolution among children and adolescents with concussion.

Design: Retrospective chart review.

Methods: We conducted a chart review on 8-18-year-olds evaluated ≤ 21 days of concussion and followed until symptom resolution. From patient charts, we extracted demographics, initial symptom burden, and relevant medical history. At the initial visit, patients answered 2 yes/no questions about PA participation (yes/no) and experiencing sleep problems (yes/no) since their injury. Based on these responses, patients were grouped as: physically active without sleep problems (+PA/+Sleep), physically active with sleep problems (+PA/-Sleep), not physically active without sleep problems (-PA/+Sleep), and not physically active with sleep problems (-PA/-Sleep). Analysis of variance and chi-squared tests were run to determine significant differences between groups, and a cox proportional hazards model was constructed to identify differences in time to symptom resolution after covariate adjustment.

Results: Among 335 patients (14.4 [2.3] y old; 62% female; evaluated 8.6 [5.4] d postconcussion), 55% were not physically active and not experiencing sleep problems (n = 184), 29% were not physically active and experiencing sleep problems (n = 96), 14% were physically active and not experiencing sleep problems (n = 46), and 3% were physically active and experiencing sleep problems (n = 9). After adjusting for symptom severity, time since injury, anxiety history, and preinjury sleep problems, the physically active without sleep problems (+PA/+Sleep) group had an earlier symptom resolution time compared with all other groups (-PA/+Sleep group hazard ratio = 0.52, 95% CI, 0.37-0.74; P = .0002; -PA/-Sleep group hazard ratio = 0.56, 95% CI, 0.38-0.83; P = .0038 and +PA/-Sleep group hazard ratio = 0.38, 95% CI, 0.16-0.89; P = .0258).

Conclusions: Children and adolescents who reported both engaging in PA and not experiencing sleep problems at their initial evaluation for concussion experienced significantly earlier symptom resolution time compared with those who reported one or neither characteristic, suggesting a potential combined effect between sleep and PA on adolescent concussion recovery.