What Is the Link Between Sleep and Concussion Recovery in Children?

A study of nearly 4,500 children and adolescents found that experiencing sleep disturbances following concussion was a strong predictor of prolonged recovery.

The Findings

Nearly 70% of 4,469 pediatric and adolescent patients who were diagnosed with concussions at Children's Hospital of Philadelphia self-reported new sleep disturbances within 28 days of their injury, according to a study led by researchers in CHOP's Minds Matter Concussion Program at the Center for Injury Research and Prevention (CIRP).

The single-site study, one of the largest of its kind to date, found that experiencing sleep disturbances following concussion was the second strongest predictor of prolonged recovery, only behind female sex. The researchers defined "prolonged recovery" as continuing to be in clinical care for the persistence of concussion symptoms more than 28 days after their injury. Comorbidities did not affect the relationship between sleep problems and recovery, according to the study.

The researchers also found that a higher percentage of girls reported sleep disturbance than boys, which reflects the higher prevalence of sleep disorders among girls and women in the general population.

Why It Matters

Concussion affects 4% of all children in the United States, according to the Centers for Disease Control and Prevention, making it a growing area of concern. Long-term side effects can include dizziness, memory problems, difficulty concentrating, headaches, depression, and anxiety. Sleep disturbance is another common side effect, which has been linked to problems with cognition, reaction times, mood regulation, and balance. Despite its prevalence, sleep disturbance has not been directly studied as a possible predictor of recovery time after concussion.

Their findings contribute to the growing body of evidence supporting the need for personalized concussion assessments and surveillance, with careful consideration of factors such as sex, to ensure accurate screening, diagnosis, and treatment, said lead author James Wilkes, PhD, a Research Scientist in CIRP's Minds Matter Concussion Program.

Who Conducted the Study

Dr. Wilkes led the study alongside Daniele Fedonni, a biostatistician in the Department of Biomedical and Health Informatics; CIRP Scientific Director and Minds Matter Co-Director Kristy Arbogast, PhD; and Minds Matter Co-Director Christina Master, MD.

What Is the Link Between Sleep and Concussion Recovery in Children? Access the video transcript.

How They Did It

CHOP researchers sought to describe subjective reports of sleep disturbances after injury and examine differences in those reports across demographic and clinical characteristics. They also wanted to explore whether self-reported sleep disturbances after concussion could predict prolonged recovery past 28 days.

The research team analyzed electronic health record data from 4,469 patients aged 5 to 18 who were diagnosed with concussions — both sports and non-sports-related — and seen by a clinician in CHOP's Minds Matter program between January 2018 and June 2024.

During their initial visit, patients completed a standardized demographic questionnaire, which included sex, race, ethnicity, and age. Patients were asked if their sleep had changed since their injury, and those who reported any changes to their sleep (including trouble sleeping, sleeping more than usual, sleeping less than usual, frequently waking up, or difficulty waking up) were considered to have sleep-related disturbances.

Quick Thoughts

"For this study, patients were asked a singular question about sleep, but that's just the tip of the iceberg," Dr. Wilkes said. "My goal would be for clinicians to adopt a standardized sleep questionnaire for any patient diagnosed with concussion, so that we can have much more granular data. That would help us ensure more accurate screening and treatment for each individual patient."

What's Next

Dr. Wilkes said this research will springboard the team's evaluation of therapies to treat sleep disturbances after concussion. Future research will use magnetic resonance imaging and electroencephalogram to evaluate the brains of children post-concussion and further explore the extent to which poor sleep is both a risk factor for injury and an indicator of prolonged recovery.

"The glymphatic system is the brain's drainage and waste filter system, which is most active when you sleep, and it's also injured after concussion," Dr. Wilkes said. "We're interested in imaging and investigating how targeting it could help treat patients."

Where the Study Was Published

The findings were published in Frontiers in Sleep in February. Read more in this CHOP press release.