Amplifying Factors in the Proposed Relationship between Sleep-Wake Dysfunction and Post-Concussion Syndrome Pathogenesis
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MEDICINE
Amplifying Factors in the Proposed Relationship between Sleep-Wake Dysfunction and Post-Concussion Syndrome Pathogenesis Christopher S. Waller 1 & Laura Pawlow 1 & Jonathan C. Pettibone 1 & Andrew M. Pomerantz 1 Accepted: 13 April 2020 / Published online: 11 May 2020 # Springer Nature Switzerland AG 2020
Abstract Objective: Examine factors contributing to the relationship between sleep-wake dysfunction and subacute post-concussion syndrome. Setting: Data collection online via Qualtrics survey. Participants: Forty seven adults reporting recent TBI recruited via Facebook and Reddit. Design: Moderation analysis via hierarchical multiple regression procedure. Main Measures: Neurobehavioral Symptom Inventory, Epworth Sleepiness Scale, Patient Health Questionnaire, General Anxiety Disorder Scale, and a General Health Questionnaire. Results: A relationship between sleep-wake dysfunction and symptoms of subacute post-concussion syndrome was observed. While premorbid mental health did not interact with this relationship, recent endorsement of depression and anxiety symptoms moderated the association. Exploratory analysis also suggested duration of posttraumatic amnesia inflated this relationship. Conclusion: These findings suggest that patients reporting post-concussive sleep dysfunction may benefit from mental health support. They also provide insight in to which early factors may be associated with the development of a sleep-related protracted recovery profile following a traumatic brain injury. Keywords Post-concussion syndrome . Mental health . Posttraumatic amnesia . Sleep dysfunction . Rehabilitation outcomes
Introduction In those with mild traumatic brain injury (TBI), a 12 month follow-up study demonstrated that 82% exhibited symptoms of subacute post-concussion syndrome (PCS) [1], a protracted recovery following TBI. Prognosis following a mild TBI is complex, and factors such as pre-existing physical disability, stress, being married, increased age, and being unable to work have been identified as predictors of protracted symptom profiles [2]. Injury-related factors, such as posttraumatic amnesia (PTA) or loss of consciousness (LOC), may also influence a delayed return to baseline [3]. Post-injury sleep-wake dysfunction is also under review. Sullivan and colleagues retrospectively examined pre- and This article is part of the Topical Collection on Medicine * Laura Pawlow [email protected] 1
Department of Psychology, Southern Illinois University Edwardsville, Campus Box 1121, Alumni Hall 0134, Edwardsville, IL 62026, USA
post-injury sleep-wake dysfunction in adults with TBI [4]. After controlling for demographics and pre-injury sleep dysfunction, they found that post-morbid sleep deficiencies relate to the severity of PCS symptoms, accounting for 32% of the variance. Gottschlich’s team similarly found a positive correlation between day-time drowsiness and symptom severity following a concussion [5]. Ponsford and Sinclair’s review suggested that post-TBI sleepiness contributes to increases in pain, vitamin
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