Abstract Details

Title Subjective and Objective Sleep Quality Independently Predict Persistent Post-concussion Symptoms

Topic Neuro Trauma and Critical Care

Presentation(s) S34 - Neuro Trauma and Sports Neurology (11:15 AM-11:27 AM)

Poster/Presentation
Number 001

Objective

This study investigates whether psychological and physiological factors, such as sleep, fear, anxiety, and resilience, serve as independent predictors of symptom burden in a cohort of subjects with significant persisting post-concussive symptoms (PPCS).

Background PPCS includes somatic, cognitive, and emotional symptoms lasting more than three months post injury, and can be influenced by a range of psychological and physiological factors. Previous studies have explored fear avoidance, catastrophizing, anxiety, and resilience as predictors of PPCS, yet other possible predictors such as sleep remain less well-studied in isolation and in the context of other known predictors.

Design/Methods Thirty participants with a high burden of PPCS (≥20 on the Rivermead Post Concussion Symptom Questionnaire (RPQ) ≥3 months post injury) were recruited into a clinical trial investigating the effects of neuromodulation on recovery. Leveraging baseline data from this trial, we analyzed first-order correlations to identify moderate-to-strong relationships (Pearson r≥0.4) between RPQ scores and demographic, injury-related, psychosocial, and both subjective and objective sleep variables. Sleep was assessed subjectively through participant-reported surveys and objectively over the course of one week using the Oura Ring, a wearable device that tracks sleep and physiological metrics. A multiple regression analysis of the top correlates was then conducted to determine significant independent predictors of PPCS (p<0.05).

Results Anxiety (Hospital Anxiety and Depression Scale, p=4.45 x 10^-5) and resilience (PROMIS Self-Efficacy for Managing Symptoms, p=0.027) independently predicted PPCS, aligning with current literature. Adding sleep metrics produced a model with anxiety (State-Trait Anxiety Inventory, p=0.002), objective sleep efficiency (Oura Average Sleep Efficiency, p=0.026) and subjective sleep impairment (PROMIS Sleep Impairment, p=0.037), explaining 65% of the variance in post-concussion symptom burden (RPQ).

Conclusions Anxiety, sleep impairment, and resilience independently contribute to PPCS and may each be targeted through tailored interventions. Incorporating wearable physiological monitoring with post-injury assessment could further support personalized care.

Authors/Disclosures
Rida F. Ismail, BS PRESENTER	Miss Ismail has nothing to disclose.
Akshata Kapadne	Miss Kapadne has nothing to disclose.
Christopher Giza, MD, FAAN (UCLA, Depts of Pediatrics and Neurosurgery)	Dr. Giza has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Medical Network Speakers Bureau. Dr. Giza has stock in Highmark Interactive. The institution of Dr. Giza has received research support from UCLA: Brain Injury Research Center, Steve Tisch BrainSPORT Program, Easton Clinic for Brain Health. Dr. Giza has received publishing royalties from a publication relating to health care. Dr. Giza has a non-compensated relationship as a Advisory Board with Major League Soccer that is relevant to AAN interests or activities. Dr. Giza has a non-compensated relationship as a Advisory Board with National Basketball Association that is relevant to AAN interests or activities. Dr. Giza has a non-compensated relationship as a Consultant with United States Soccer Federation that is relevant to AAN interests or activities. Dr. Giza has a non-compensated relationship as a Co-founder & Advisor with Symptomwise that is relevant to AAN interests or activities.
Kevin Bickart, MD, PhD (UCLA)	Dr. Bickart has nothing to disclose.

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