Lack of sleep, stress could lead to concussion-like symptoms

Individuals with no history of a recent concussion reported combinations of symptoms that met criteria for post-concussion syndrome (PCS) as defined by an international classification system in a new study published in the journal Sports Medicine.

The study was conducted by the Concussion Assessment, Research and Education (CARE) Consortium established by the NCAA and U.S. Department of Defense. Participants in this study included 12,039 military service academy cadets and 18,548 NCAA student-athletes who completed the Sport Concussion Assessment Tool symptom evaluation as part of the consortium's baseline testing. The consortium also collected demographic data and personal and family medical histories from participants.

Statistical analyses showed which factors in athletes' medical histories were most closely associated with reports of symptoms that aligned with PCS criteria. Among cadets, 17.8 percent of men and 27.6 percent of women reported a cluster of symptoms that met PCS criteria. Among NCAA athletes, 11.4 percent of men and 20 percent of women reported combined symptoms that mimicked the PCS criteria.

Among the nearly 31,000 student-athletes surveyed, three factors stood out as most likely to predict PCS-like symptoms, including lack of sleep, pre-existing mental health problems, and stress. Additionally, between one-half and three-quarters of all the athletes surveyed reported one or more symptoms commonly experienced by people who've had a concussion, the most common being fatigue or low energy and drowsiness.

For both groups, sleep problems, particularly insufficient sleep the night before the test, and pre-existing psychiatric disorders were the most predictive conditions, and a history of migraines also contributed to symptoms that met PCS criteria. In cadets, academic problems and being a first-year student increased odds of having symptoms that met PCS criteria, and in NCAA athletes, a history of ADHD or depression contributed to meeting PCS criteria.

The International Classification of Diseases, Tenth Revision uses the term post-concussion syndrome for persistent symptoms following concussion, although the cause or causes of these symptoms can be difficult to determine. Symptoms range from persistent headaches, dizziness and fatigue to anxiety, insomnia, and loss of concentration and memory, the researchers said.

A complicating factor with high symptom reporting is that recognizing concussion and determining return to play is based on reported symptoms. While some symptoms may be more closely connected to concussion than others, such as dizziness, pressure in the head, or sensitivity to light or noise, others, like fatigue, drowsiness, and headaches, can be linked to a variety of causes.

The researchers said athletes and others recovering from a brain injury should be assessed and treated on a highly individualized basis.

"When a patient comes into a clinic and they are a month or more out from their most recent concussion, we need to know what symptoms they were experiencing before their concussion to know if their symptoms are attributable to their concussion or something else,” said Jaclyn Caccese, PhD, study lead author and assistant professor in The Ohio State University School of Health and Rehabilitation Sciences. “Then we can start treating the concussion-related symptoms to hopefully help people recover more quickly.”