Objective(s) : To determine if sleep during the acute stage of a concussion influences outcomes.
Data Sources : Literature searches were performed July 1st-August 1st 2018 in Ovid MEDLINE, CINAHL, and Web of Science along with hand searching for grey literature and cited references. Out of the 610 search results, 359 unique references were reviewed after duplicates were removed. This systematic review was registered in the PROSPERO database.
Study Selection : Two reviewers (C.S., R.L.) independently reviewed and came to consensus on which titles/abstracts met (n=23) inclusion/exclusion criteria. The 23 full-text articles were assessed independently by the same two reviewers for eligibility. Consensus was achieved, leaving four articles for quality assessment and data extraction.
Data Extraction : One person (R.L.) extracted relevant data from each study using a standard data-extraction table. The data extraction table was reviewed (L.D., C.S.) and consensus achieved for completeness and accuracy. Quality appraisal was conducted to assess the risk for potential bias and quality of the included articles.
Data Synthesis : Two of the articles included children < 16 years old (one included only athletes) and two included a wide range of ages >16 years old. In general, poorer sleep was associated with poorer outcomes following concussion at reassessments across any age population. Also, poorer sleep in earlier phase was associated with poorer outcomes and recovery.
Conclusions : The variability in sleep assessments used, outcomes assessed, length of time to reassessments, and population included made data synthesis challenging. The use of standard valid and reliable sleep assessments is recommended. Studies are needed to determine if addressing sleep issues early following concussion will improve longer-term outcomes.