Subjective and Objective Sleep Quality Independently Predict Persistent Post-concussion Symptoms
Rida Ismail1, Akshata Kapadne1, Christopher Giza2, Kevin Bickart3
1Department of Neurology, 2Departments of Pediatrics and Neurosurgery, 3Departments of Neurology and Neurosurgery, UCLA
Objective:
This study investigates whether psychological and physiological factors, such as sleep, fear, anxiety, and resilience, serve as independent predictors of symptom burden in a cohort of subjects with significant persisting post-concussive symptoms (PPCS).
Background:
PPCS includes somatic, cognitive, and emotional symptoms lasting more than three months post injury, and can be influenced by a range of psychological and physiological factors. Previous studies have explored fear avoidance, catastrophizing, anxiety, and resilience as predictors of PPCS, yet other possible predictors such as sleep remain less well-studied in isolation and in the context of other known predictors.
Design/Methods:
Thirty participants with a high burden of PPCS (≥20 on the Rivermead Post Concussion Symptom Questionnaire (RPQ) ≥3 months post injury) were recruited into a clinical trial investigating the effects of neuromodulation on recovery. Leveraging baseline data from this trial, we analyzed first-order correlations to identify moderate-to-strong relationships (Pearson r≥0.4) between RPQ scores and demographic, injury-related, psychosocial, and both subjective and objective sleep variables. Sleep was assessed subjectively through participant-reported surveys and objectively over the course of one week using the Oura Ring, a wearable device that tracks sleep and physiological metrics. A multiple regression analysis of the top correlates was then conducted to determine significant independent predictors of PPCS (p<0.05).
Results:
Anxiety (Hospital Anxiety and Depression Scale, p=4.45 x 10-5) and resilience (PROMIS Self-Efficacy for Managing Symptoms, p=0.027) independently predicted PPCS, aligning with current literature. Adding sleep metrics produced a model with anxiety (State-Trait Anxiety Inventory, p=0.002), objective sleep efficiency (Oura Average Sleep Efficiency, p=0.026) and subjective sleep impairment (PROMIS Sleep Impairment, p=0.037), explaining 65% of the variance in post-concussion symptom burden (RPQ).
Conclusions:
Anxiety, sleep impairment, and resilience independently contribute to PPCS and may each be targeted through tailored interventions. Incorporating wearable physiological monitoring with post-injury assessment could further support personalized care.
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