Insomnia and daytime sleepiness: risk factors for sports-related concussion.
Level 3 - non-randomized controlled study
Prospective cohort study evaluating baseline risk factors for future sports-related concussion
PubMed 31132574 · doi:10.1016/j.sleep.2019.03.008
What was done
A cohort of 190 NCAA Division-1 athletes completed baseline surveys including the Insomnia Severity Index (ISI) and the National Health and Nutrition Examination Survey (NHANES) Sleep module. Researchers calculated univariate risk ratios and used multiple logistic regression adjusted for sport and concussion history to evaluate insomnia symptoms and daytime sleepiness as prospective predictors of future sports-related concussions.
What was found
Clinically moderate-to-severe insomnia severity (RR = 3.13, 95% CI: 1.320–7.424, p = 0.015) and excessive daytime sleepiness two or more times per month (RR = 2.856, 95% CI: 0.681–11.977, p = 0.037) were associated with increased concussion risk. Both predictors remained significant with comparable effect sizes in the multivariable model adjusting for sport participation.
Why it matters
While previous work focused on concussions leading to sleep disruption, these findings indicate the relationship may be bidirectional, identifying baseline sleep impairment as an independent risk factor for sustaining a concussion.
Limits
The sample was limited to collegiate Division-1 athletes, which may not generalize to broader athletic or general populations. Sleep measures were based entirely on self-report questionnaires rather than objective assessments (e.g., actigraphy or polysomnography). The confidence interval for daytime sleepiness was wide and included 1.0 (95% CI: 0.681–11.977) despite a reported p = 0.037, reflecting statistical imprecision, and the abstract did not state the total number of concussions or follow-up duration.
Cited by
- supports In a study of Division I athletes, high insomnia severity and daytime sleepiness were stronger predictors of future concussions than prior concussion history, male sex, or sport risk category.