Long sleep duration after acute concussion in youths associated with more symptoms later

Long sleep duration after acute concussion in youths associated with more symptoms later | Image Credit: © Viacheslav Yakobchuk - © Viacheslav Yakobchuk - stock.adobe.com.

In a recent observational study published in JAMA Network Open, investigators found that adolescents who had a nightly sleep duration of more than 9.9 hours over the first 2 weeks of concussion recovery were linked to higher symptom burden and persistent symptoms. As a result, the study authors concluded clinicians should monitor sleep patters following a concussion in youth patients.

As an estimated half of all youth with concussions report disturbances of sleep, in both short- and long-term durations within the first week of recovery, study authors sought information about the association between mean nightly sleep duration over 1 week and 2 weeks post-injury, along with subsequent symptom burden at 1, 2, and 4 weeks post-injury.

"We hypothesized that longer sleep duration during the first 2 weeks after concussion would be associated with reduced symptom burden at 1, 2, and 4 weeks post-concussion and lower odds of being reliably symptomatic at 2 and 4 weeks," wrote the study investigators, led by Lauren Butterfield, MSc, of Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada.

The cohort study featured data from a randomized controlled trial conducted in 3 pediatric emergency departments in Ontario, Canada, from March 2017 to December 2019. Participants had to be between 10 and 18 years of age and had to have received treatment for a concussion within 48 hours. Post-injury sleep was measured via a waist-worn accelerometer for 24 hours per day for 2 weeks as well as daily sleep logs. Symptom burden was measured with the Health and Behavior Inventory at 1 week, 2 weeks, and 4 weeks post-concussion.

"A nonlinear mixed-effects model was applied that estimated symptom burden at 1, 2, and 4 weeks from mean sleep duration over days 1 to 7 and days 1 to 14," wrote the authors, who stated logistic regressions were performed to gauge the odds of being reliably symptomatic at 2 and 4 weeks by mean sleep duration. Conservative (z ≥ 1.65) and liberal (z ≥ 1.28) definitions of reliable change in symptoms were evaluated.

In all, 291 participants with a median age of 13.2 years (11.6-14.9), of which 44% were female, were included in the primary analysis. According to study results, those who had a mean nightly sleep duration beyond 9.5 hours in the first week after injury had a higher symptom burden at 1 week (75th percentile [10.5 h] vs 25th percentile [9.5 h]: estimate, 1.3 [95% CI, 0.25-2.28]; 90th percentile [11.3 h] vs 50th percentile [10.0 h]: estimate, 2.9 [95% CI, 1.22-4.69]).

Mean sleep duration longer than 9.9 hours in the first 2 weeks post-concussion was associated with higher symptom burden at:

• 2 weeks (90th percentile [10.9 h] vs 50th percentile [9.9 h]: estimate, 2.2 [95% CI, 0.85-3.47])
• 4 weeks (estimate, 2.2 [95% CI, 0.85-3.47])

Additionally, those with the mean sleep duration over 9.9 hours had increased odds of persisting symptoms at 4 weeks (conservative: odds ratio [OR], 1.73 [95% CI, 0.91-3.26]; liberal: OR, 1.93 [95% CI, 1.07-3.47]).

"In this observational study of youths with acute concussion, long sleep durations during the first 2 weeks post-concussion (ie, over 9.9 hours) were associated with more symptoms at 1, 2, and 4 weeks," the authors concluded. "Furthermore, long sleep duration may be associated with increased odds of being reliably symptomatic at 4 weeks, therefore a greater risk of PSAC. Clinicians should monitor youths’ sleep after concussion."

Reference:

Butterfield L, Zemek R, Borghese MM, et al. Nightly Sleep Duration and Symptom Burden Over 1 Month Following Pediatric Concussion. JAMA Netw Open. 2025;8(6):e2516333. doi:10.1001/jamanetworkopen.2025.16333