Abstract:
Objective: Sport concussion management programs recommend that athletes engage in preseason cognitive, balance, and symptom assessments. Poor sleep prior to preseason baseline testing is associated with greater reported symptoms. Pre-existing conditions, including mental health problems, are also associated with baseline symptom reporting, but the co-occurrence of these conditions and poor sleep has yet to be studied. This study examined the association between prior mental health treatment, sleep duration, and baseline symptom reporting in student athletes. Methods: A preseason baseline database contained 30,771 athletes ages 13-18 who had not sustained a concussion in the past 6 months and completed all sections of ImPACT, including how many hours they slept the night before. Of these, 21,866 athletes denied having all developmental/health conditions (controls) and 521 reported only having a history of psychiatric treatment (total sample: age M = 15.4, SD = 1.29; 48.3% girls). Participants were grouped based on the number of hours they slept prior to testing (£5, 5.5-6.5, 7-8.5, and ‡9 hours). Mann-Whitney U-Tests were used to compare baseline symptom severity on the ImPACT Post-Concussion Symptom Scale between athletes with prior psychiatric treatment and controls, stratified by sex and sleep duration. Results: Athletes with prior psychiatric treatment reported greater symptom severity than controls when matched on sex and sleep duration (all ps < .05). Effect sizes between psychiatric/control groups were larger for girls (d = 0.76-1.18) than boys (d = 0.50-0.75). In athletes who slept 5 or fewer hours the night before testing, 81% of girls and 54% of boys with psychiatric histories reported having a symptom burden resembling an ICD-10 diagnosis of postconcussional syndrome, compared to 49% of girls and 33% of boys without any comorbidities (girls: v2 (1) = 6.19, p = .01; boys: v2 (1) = 4.52, p = .03). Conclusions: The cooccurrence of inadequate sleep the night before testing and having a prior mental health treatment confounds baseline symptom reporting. Girls with mental health histories may be more vulnerable to these effects than boys. Clinicians may want to defer baseline symptom assessment on athletes with insufficient sleep, and consider the effects of preexisting health conditions, sex, and sleep duration when interpreting symptoms at baseline and following concussion