Original Article| Volume 57, P46-50.e1, April 2016

Download started.


Sleep Disorders Associated With Mild Traumatic Brain Injury Using Sport Concussion Assessment Tool 3



      Sleep problems affect 30% to 80% of patients with mild traumatic brain injury. We assessed the prevalence of sleep disorders after mild traumatic brain injury and its correlation with other symptoms.

      Methods and Materials

      Individuals with mild traumatic brain injury were assessed at the New York University Concussion Center during 2013-2014 with the Sports Concussion Assessment Tool, third edition, data following mild traumatic brain injury. The relationship between sleep problems (drowsiness, difficulty falling asleep, fatigue or low energy), psychiatric symptoms (sadness, nervousness or anxiousness), headache, and dizziness were analyzed by Spearman correlation and logistic regression using moderate to severe versus none to mild categorization.


      Ninety-three patients were retrospectively considered. The most common injury causes were falls (34.4%) and motor vehicle accidents (21.5%). There was a positive correlation between dizziness, headache, psychiatric problems (sadness, anxiety, irritability), and sleep problems (fatigue, drowsiness, and difficulty falling asleep) (P < 0.001). Logistic regression showed a significant association between moderate to severe psychiatric symptoms and moderate to severe sleep symptoms (P < 0.05). Sleep symptoms became more severe with increased time interval from mild traumatic brain injury to Sport Concussion Assessment Tool 3 administration (odds ratio = 1.005, 1.006, and 1.008, P < 0.05). There was significant correlation between motor vehicle accident and drowsiness and difficulty falling asleep (P < 0.05). Medications given in the emergency department had a positive correlation with drowsiness (P < 0.05).


      Individuals who report moderate to severe headache, dizziness, and psychiatric symptoms have a higher likelihood of reporting moderate to severe sleep disorders following mild traumatic brain injury and should be counseled and initiated with early interventions.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Pediatric Neurology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Langlois J.
        • Rutland-Brown W.
        • Thomas K.
        Traumatic Brain Injury in the United States: Emergency Department Visits, Hospitalizations, and Deaths.
        Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, Atlanta, Georgia, USA2004
        • Langlois J.A.
        • Rutland-Brown W.
        • Wald M.M.
        The epidemiology and impact of traumatic brain injury: a brief overview.
        J Head Trauma Rehabil. 2006; 21: 375-378
        • Erlanger D.
        • Kaushik T.
        • Cantu R.
        • et al.
        Symptom-based assessment of the severity of a concussion.
        J Neurosurg. 2003; 98: 477-484
        • Iverson G.L.
        • Gaetz M.
        • Lovell M.R.
        • Collins M.W.
        Cumulative effects of concussion in amateur athletes.
        Brain Inj. 2004; 18: 433-443
        • Ouellet M.C.
        • Savard J.
        • Morin C.M.
        Insomnia following traumatic brain injury: a review.
        Neurorehabil Neural Repair. 2004; 18: 187-198
        • Baumann C.R.
        • Werth E.
        • Stocker R.
        • Ludwig S.
        • Bassetti C.L.
        Sleep-wake disturbances 6 months after traumatic brain injury: a prospective study.
        Brain. 2007; 130: 1873-1883
        • Borgaro S.R.
        • Baker J.
        • Wethe J.V.
        • Prigatano G.P.
        • Kwasnica C.
        Subjective reports of fatigue during early recovery from traumatic brain injury.
        J Head Trauma Rehabil. 2005; 20: 416-425
        • McCrory P.
        • Johnston K.
        • Meeuwisse W.
        • et al.
        Summary and agreement statement of the 2nd International Conference on Concussion in Sport, Prague 2004.
        Br J Sports Med. 2005; 39: 196-204
        • Thomas K.
        • Harrington D.E.
        • Adams R.
        • et al.
        Definition of mild traumatic brain injury.
        The J head Trauma Rehabil. 1993; 8: 86-87
        • Bell D.R.
        • Guskiewicz K.M.
        • Clark M.A.
        • Padua D.A.
        Systematic review of the balance error scoring system.
        Sports Health. 2011; 3: 287-295
        • Riemann B.L.
        • Guskiewicz K.
        • Shiels E.W.
        Relationship between clinical and forceplate measures of postural stability.
        J Sport Rehabil. 1999; 8: 71-82
        • McCrea M.
        Standardized mental status assessment of sports concussion.
        Clin J Sport Med. 2001; 11: 176-181
        • Krumholtz I.
        Results from a pediatric vision screening and its ability to predict academic performance.
        Optometry. 2000; 71: 426-430
        • King D.
        • Gissane C.
        • Hume P.A.
        • Flaws M.
        The King-Devick test was useful in management of concussion in amateur rugby union and rugby league in New Zealand.
        J Neurol Sci. 2015; 351: 58-64
      1. Practice parameter: the management of concussion in sports (summary statement). Report of the Quality Standards Subcommittee.
        Neurology. 1997; 48: 581-585
        • Barth J.T.
        • Freeman J.R.
        • Broshek D.K.
        • Varney R.N.
        Acceleration-deceleration sport-related concussion: the gravity of it all.
        J Athl Train. 2001; 36: 253-256
        • McCrory P.
        • Meeuwisse W.
        • Johnston K.
        • et al.
        Consensus statement on Concussion in Sport 3rd International Conference on Concussion in Sport held in Zurich, November 2008.
        Clin J Sport Med. 2009; 19: 185-200
        • Mathias J.L.
        • Alvaro P.K.
        Prevalence of sleep disturbances, disorders, and problems following traumatic brain injury: a meta-analysis.
        Sleep Med. 2012; 13: 898-905
        • Zeitzer J.M.
        • Friedman L.
        • O'Hara R.
        Insomnia in the context of traumatic brain injury.
        J Rehabil Res Dev. 2009; 46: 827-836
        • Worthington A.D.
        • Melia Y.
        Rehabilitation is compromised by arousal and sleep disorders: results of a survey of rehabilitation centres.
        Brain Inj. 2006; 20: 327-332
        • Johnson E.W.
        • Kegel N.E.
        • Collins M.W.
        Neuropsychological assessment of sport-related concussion.
        Clin Sports Med. 2011; 30 (viii-ix): 73-88
        • Aubry M.
        • Cantu R.
        • Dvorak J.
        • et al.
        Summary and agreement statement of the 1st International Symposium on Concussion in Sport, Vienna 2001.
        Clin J Sport Med. 2002; 12: 6-11
        • Guskiewicz K.M.
        • Cantu R.C.
        The concussion puzzle: evaluation of sport-related concussion.
        Am J Sports Med. 2004; 6: 13-21
        • Weber M.
        • Webb C.A.
        • Killgore W.D.
        A brief and selective review of treatment approaches for sleep disturbance following traumatic brain injury.
        J Sleep Disord. 2013; 2: 1-5
        • Chaput G.
        • Giguere J.F.
        • Chauny J.M.
        • Denis R.
        • Lavigne G.
        Relationship among subjective sleep complaints, headaches, and mood alterations following a mild traumatic brain injury.
        Sleep Med. 2009; 10: 713-716
        • Hou L.
        • Han X.
        • Sheng P.
        • et al.
        Risk factors associated with sleep disturbance following traumatic brain injury: clinical findings and questionnaire based study.
        PLoS One. 2013; 8: e76087
        • Alexander M.P.
        Mild traumatic brain injury: pathophysiology, natural history, and clinical management.
        Neurology. 1995; 45: 1253-1260
        • Saether R.
        • Jorgensen L.
        Intra- and inter-observer reliability of the Trunk Impairment Scale for children with cerebral palsy.
        Res Dev Disabil. 2011; 32: 727-739