Connecticut Medicine

Mar 2015

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volume 79, no. 3 161 Sleep Disturbances in Concussed Athletes: A Review of the Literature Regina Kostyun, Msed, atC Introduction t here has been a recent increase in the number of diagnosed concussions sustained by adolescent athletes. 1,2 as a result, emergency department physicians and pediatricians are seeing an increase in the number of concussion patients in their offices. 1,3,4 sleep disturbances are a hallmark sign of concussion. Changes in a patient's normal sleeping patterns often develop in the days and weeks following a concussion and may persist throughout the recovery course. 5 although the majority of adolescents will recover from a concussion within a month, 6,7,8 upwards of 30% will still experience concussion symptoms after four weeks. 9 erefore, clini- cians should have a thorough understanding of normal sleeping patterns in adolescents and be able to properly identify and understand how changes in sleeping patterns after a concussion may affect the individual. Sleeping Patterns and Cognitive Function in Healthy Adolescents adolescence is characterized as a period of significant changes, both in growth and development. 10 ese de- velopmental changes are especially important in regards to brain function and sleep cycles. 11 adolescents undergo adaptations to their circadian rhythms as they progress from childhood to adulthood. 12,13 during this time, upwards of 34% of healthy adolescents may report dif- ficulties falling asleep or staying asleep. 14 e national sleep Foundation recommends ado- lescents to obtain at least nine hours of sleep a night to maintain proper health, while noting that less than eight hours of sleep is insufficient for a developing child. 15 Recent studies 14,16 have found that most adolescents are not receiving the recommended hours of sleep on a nightly basis. Wolfson and Carskadon found that 68.9% of high school students are obtaining inadequate sleep during the school week, with many of these individuals receiving seven and a half to eight hours of sleep per night. 10 Females (71%) and senior students (78%) have been found to have a higher prevalence of insufficient sleep. 16 ere are several reasons that may contribute to insufficient sleep in healthy adolescents, including both internal and external factors. 17 intrinsic factors include changes in circadian rhythms, as previously noted. ex- trinsic factors include demanding academic and social schedules as well as poor sleep hygiene. 11 sleep is an essential component for normal cogni- tion. 12,18 during rapid eye movement (ReM) sleep, portions of the brain that are responsible for combining recently stored memories with previously stored memo- ries are actively engaged. 12 Healthy adolescents who obtain longer periods of sleep with a constant sleep and wake schedule have been shown to perform better in the classroom. 10,11 a study on high school students found that student who averaged a and B scores commonly reported earlier and consistent bedtimes. 11 similarly, higher gPa scores were associated with collegiate students who reported earlier weekday and weekend wake time and earlier bedtimes. 19 an understanding of disruptive sleeping patterns on cognitive function has been well established. 20,21 Wolfson and Carskadon 10 identified a significant body of literature that acknowledges an association between insufficient sleep and poor academic performance in adolescents and young adults. Link and ancoli-israel 22 identified high school students with a gPa of 3.5 or higher reported longer periods of sleep on school nights and earlier rise times on weekends. Meijer et al 23 identi- fied a relationship between quality of sleep and academic functioning in adolescents. Children with a low quality Regina Kostyun, Msed, atC, Coordinator, elite sports Medicine, Concussion Program, Connecticut Children's Medical Center, Farmington, 860-284-0220.

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