title: Relationship Between Short Sleep Duration and Preseason Concussion Testing.
abstract: OBJECTIVE
  Baseline, preseason assessment of cognition, symptoms, and balance has been recommended as part of a comprehensive sport concussion management program. We examined the relationship between sleep and baseline test results. We hypothesized that adolescents who slept fewer hours the night before would report more symptoms and perform more poorly on cognitive testing than students who had a full night sleep.
  
  
  METHODS
  Cross-sectional observation study.
  
  
  METHODS
  Preseason concussion testing for high school athletes.
  
  
  METHODS
  A large sample (n = 2928) of student athletes from Maine, USA, between the ages of 13 and 18 years completed preseason testing. Participants with developmental problems, a history of treatment for neurological or psychiatric problems, recent concussion, or 3 or more prior concussions were excluded.
  
  
  METHODS
  Athletes were divided into 4 groups based on their sleep duration the night before testing.
  
  
  METHODS
  Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT; ImPACT Applications, Inc, Pittsburgh, PA) cognitive composite scores and the embedded Post-Concussion Symptom Scale.
  
  
  RESULTS
  Sleep was not related to any ImPACT cognitive composite score, after covarying for age and controlling for multiple comparisons. In contrast, there were sleep duration, sex, and sleep duration by sex effects on the Post-Concussion Symptom Scale. The effect of sleep duration on symptom reporting was more pronounced in girls. Supplementary analyses suggested that sleep insufficiency was associated with a diverse array of postconcussion-like symptoms.
  
  
  CONCLUSIONS
  Poor sleep the night before baseline or postinjury testing may be an important confound when assessing postconcussion symptoms. Girls may be more vulnerable to experiencing and reporting symptoms following insufficient sleep.
  
  
  CONCLUSIONS
  Clinicians should routinely ask how the athlete slept the night before preseason baseline testing and consider deferring the symptom assessment or later retesting athletes who slept poorly.
authors.affiliation: *Division of Physical Medicine and Rehabilitation, Rehabilitation Research Program, University of British Columbia and GF Strong Rehab Centre, Vancouver, British Columbia, Canada; †Health Services and the Department of Biology, Colby College, Waterville, Maine; ‡Department of Psychology, Colby College, Waterville, Maine; §Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Massachusetts General Hospital, Brigham and Women's Hospital, Harvard Medical School, and Red Sox Foundation and Massachusetts General Hospital Home Base Program, Boston, Massachusetts; and ¶Department of Physical Medicine and Rehabilitation, Harvard Medical School; Spaulding Rehabilitation Hospital; Massachusetts General Hospital for Children Sports Concussion Program; and Red Sox Foundation and Massachusetts General Hospital Home Base Program, Boston, Massachusetts.
authors.forename: Noah D
authors.initials: ND
authors.lastname: Silverberg
authors.forename: Paul D
authors.initials: PD
authors.lastname: Berkner
authors.forename: Joseph E
authors.initials: JE
authors.lastname: Atkins
authors.forename: Ross
authors.initials: R
authors.lastname: Zafonte
authors.forename: Grant L
authors.initials: GL
authors.lastname: Iverson
mesh_terms: D000293:Adolescent; D001924:Brain Concussion / Q000175:diagnosis*; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D012890:Sleep