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49 A pilot meta-analysis on concussion-related sleep disturbances
  1. Suleyman Noordeen1,2,
  2. Mehmet Ergisi1,3,
  3. Rebeka Popovic1,2,
  4. Abinayan Mahendran1,3,
  5. Mohammed Memon1,3,
  6. Saahil Hegde1,3,
  7. Poh Wang1,3,
  8. Connor Qiu1,3 and
  9. Yizhou Yu1,2
  1. 1International Sleep Charity, UK
  2. 2University of Cambridge, UK
  3. 3Imperial College London, UK


Fatigue and poor sleep have been shown as factors of post-concussive symptoms (Broshek et al., 2015, Brain injury). Students, previously reported to have poor sleep, thus might be at increased risk of concussion-related sleep disturbances (McGrath et al., 2010, Journal of athletic training). This study explored the relationship between concussion and sleep, to serve as a pilot for a systematic meta-analysis.

We searched the following databases MEDLINE, EMBASE, CINAHL, Web of Science, PsycINFO, Cochrane Central Register of Controlled Trials, MedNar and OAIster with the search terms: sleep, concussion, mild traumatic brain injury, college/university and sports. Only studies using the Epworth sleepiness scale (ESS) and the Pittsburgh sleep quality index (PSQI) were included. Studies were excluded if they included non-human animals, patients with other neurological conditions or military personnel. Two researchers performed the filtering independently.

Our search produced 4460 results. We removed 834 duplicates and examined a random subset of 8 studies that met our exclusion criteria as a pilot study. Our analysis totaled 1086 participants (683 concussed). Using a random-effects model containing 4 studies per outcome test, we found that concussion was associated with increased PSQI (standardised mean difference: 0.76, 95% confidence intervals [0.52, 1.01], 𝜏2: 0.03, I2: 49.28%, p value < 0.0001), and ESS (standardised mean difference: 0.47, 95% confidence intervals [0.24, 0.70], 𝜏2: 0.02, I2: 42.56%, p value < 0.0001).

Our results suggest a diagnosis of concussion or mild traumatic brain injury is associated with lower sleep quality, as measured by PSQI, and sleepiness as measured by ESS, in this population. Further analyses of the rest of our dataset, covariates of the studies, verifications of the updated literature and assessments of the quality of each study are required.

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See:

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