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Study Objectives: Whereas previous research has primarily focused on the immediate effects of concussion within the first year postinjury, this study examines the persistent effects of concussion on subsequent sleep quality in adolescent soccer players., Methods: This study used a cross-sectional design, recruiting a convenience sample of adolescent athletes from US Youth Soccer camps. Participants completed a self-reported questionnaire including the Pittsburgh Sleep Quality Index to assess their sleep quality. Athletes were also asked to report sport participation information, any past occurrence of concussion or knee injury, and any sport-related injury in the past 12 months. Independent samples t tests were performed to identify significant differences in Pittsburgh Sleep Quality Index scores between injured and noninjured participants., Results: A total of 177 participants (103 male, 14.61 ± 1.88 years of age) were included in the analysis. The concussion injury group exhibited later bedtimes (difference: 0.32 ± 0.05 hours, P = .047), fewer hours of sleep (difference: 0.56 ± 0.11 hours, P = .015), and more frequent sleep disturbances ( P = .012). Furthermore, these athletes reported lengthened sleep latency (difference: 2.55 ± 3.36 minutes, P = .016) and higher levels of daytime dysfunction ( P = .041) following their concussion injuries. Moreover, athletes in the concussion injury group displayed worse sleep quality scores (difference: 0.42 ± 0.06, P < .001) and higher total Pittsburgh Sleep Quality Index scores (difference: 1.91 ± 0.41, P < .001). No significant differences were found based on past knee injury or sport-related injury in the past 12 months., Conclusions: These findings suggest the need for targeted interventions aimed at improving sleep quality in adolescent athletes with a history of concussion., Citation: Sahin S, Erdman AL, Loewen A, et al. Concussion history is associated with poor sleep quality in adolescent athletes: a cross-sectional study. J Clin Sleep Med. 2025;21(1):129-135., (© 2025 American Academy of Sleep Medicine.)

Objectives: Youth soccer participation, particularly among females, continues to grow worldwide. With the high incidence of sport-related concussion (SRC) in soccer, it is important to investigate if SRC occurs disproportionally by positions. Our hypothesis was to see no positional differences in SRCs, SRC-related characteristics, and outcomes among in female youth soccer athletes., Methods: Data were prospectively collected from participants at a single sports medicine institution between August 2015-April 2021. Female participants aged 8-18 diagnosed with SRC sustained during an organized soccer practice, scrimmage, or game were separated into 4 groups based on position: Forward, Midfielder, Defender, and Goalkeeper. Demographics, medical history, injury-related details, and outcomes were reviewed. A chi-square test or Fisher's exact test was used for categorical variables. Continuous variables were compared with Mann-Whitney or Kruskal-Wallis test., Results: Two hundred fourteen participants were included: 52 Forwards, 65 Midfielders, 63 Defenders, and 34 Goalkeepers. There were no significant differences between the groups in age, race, ethnicity, or previous concussion history. Differences in mechanism existed with Goalkeepers most commonly reporting Head to Body Part. Goalkeepers, which make up 1/11 of the total positions on the field, had a significantly higher proportion of SRCs compared to Field Positions. (9.1% vs 15.9%)At 3-month post-enrollment, there were no significant differences in reported symptoms or return-to-play between the different positions., Conclusion: In youth female soccer players, goalkeepers sustained a higher proportion of sport-related concussions compared to field players based upon the composition of a soccer team. The mechanism of injury also differed among the different soccer positions. However, no differences in concussion characteristics, outcomes, or RTP were seen across the different soccer positions.

Objective: Accurate assessment of balance recovery throughout treatment of a sport-related concussion is imperative. This study examined differences in balance from diagnosis to return-to-play initiation in adolescent patients post-concussion. Second, this study investigated the extent to which the Balance Error Scoring System (BESS) correlated with center-of-pressure (COP) measures., Methods: Forty participants performed the BESS while standing on a force platform such that COP data were obtained simultaneously. Spatial and velocity COP-based measures were computed for the double-stance conditions., Results: BESS scores and COP-based measures indicated improved balance performance between visits. Specifically, 62.5/65.0% of participants exhibited improved firm/foam BESS final scores, respectively, and 56.4-71.8% exhibited improved COP-based measures. However, once normative ranges were referenced to identify maintained performance, the percentage of participants who substantially improved differed from initial findings (BESS: 2.5/7.5%, COP: 48.7-69.2%). Additionally, positive correlations between balance measures were primarily found at diagnosis (r=0.33-0.53), while only three correlations were maintained at return-to-play initiation (r=0.34-0.39)., Conclusions: BESS scores successfully identified poor balance performance at diagnosis when symptoms were most pronounced, but failed to accurately depict performance once balance impairment, indicated by COP-based measures, became less apparent. Further work is needed to implement more advanced balance assessments into clinical environments.

The medications used in postconcussion syndrome are typically used to help manage or minimize disruptive symptoms while recovery proceeds. These medications are not routinely used in most concussions that recover within days to weeks. However, it is beneficial to be aware of medication options that may be used in athletes with prolonged concussion symptoms or for those that have symptom burdens that preclude entry into basic concussion protocols. Medications and supplements remain a small part of the concussion treatment plan, which may include temporary academic adjustments, physical therapy, vestibular and ocular therapy, psychological support, and graded noncontact exercise., Competing Interests: Disclosure The authors have no financial relationships relevant to this study to disclose. Dr J.C. Jones has no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in this article, including employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties. Peer reviewers on this article have no relevant financial relationships to disclose. Dr M.J. O’Brien is reimbursed by Wolters Kluwer Publishing for authorship and ongoing editing of 2 concussion-related sections for UptoDate online clinical resource. He has no conflicts of interest to disclose., (Copyright © 2020 Elsevier Inc. All rights reserved.)

IntroductionMethodsResultsConclusions\nKEY POINTSAthletes with concussions experience heterogeneous symptoms and clinical trajectories. Subclassification provides diagnostic clarity that may improve prognostication and individualized treatments.We hypothesized that endophenotypes of adolescent athletes with concussions differ based on sex and time since injury. Post-concussive testing was performed for athletes (n = 1385) in the North Texas Concussion Registry (ConTex) at four timepoints: acute [0–3 days post-injury (DPI)], subacute-early (4-7DPI), subacute-late (8-28DPI), and persistent (29+DPI). Six endophenotypes (cognitive, headache, ocular-motor, vestibular, affective, sleep) were constructed by allocating post-concussion testing data elements described by the Concussion Subtype Workgroup.Endophenotypes were defined using correlations between data elements and compared based on sex or time since injury. Correlograms revealed endophenotypes differed based on sex and time since injury. The affective endophenotype was dependent on the interaction between sex and time since injury and was more prevalent at the subacute-late and persistent timepoints. The sleep endophenotype became more prevalent at the persistent timepoint. Affective and sleep endophenotypes were interrelated with cognitive, vestibular, and headache endophenotypes at the persistent timepoint suggesting that dysregulated mood and sleep influence lingering symptoms.Adolescent symptom-based concussion endophenotypes differ based on sex and time since injury. Clinical consideration may improve identification of separate trajectories following sport-related concussion and provide targeted care. Athletes report concussion symptoms differently based on sex and time since injury.Persisting concussion symptoms are interrelated with dysregulated mood and sleep.Characterization of concussion endophenotypes should consider sex and post-injury timeline as factors.Athletes report concussion symptoms differently based on sex and time since injury.Persisting concussion symptoms are interrelated with dysregulated mood and sleep.Characterization of concussion endophenotypes should consider sex and post-injury timeline as factors. [ABSTRACT FROM AUTHOR]

Background: Impairments in balance or postural control are common following sport-related concussion (SRC). The Balance Error Scoring System (BESS) is widely utilized to assess static postural stability, but laboratory-based balance measures have been shown to more accurately detect changes in postural control. Hypothesis/Purpose: To determine whether postural control improved between presentation to the sports medicine clinic and return-to-sport (RTS) initiation, and whether this trend mirrored symptom scores and cognitive performance. A secondary aim was to assess whether changes in postural control were more accurately captured with center of pressure (COP) based measures compared to BESS. Methods: Patients diagnosed with a SRC were tested within 10 days of presentation (V0) and when cleared by a physician to begin a RTS protocol (V1). Clinical measures included Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) and the King-Devick (K-D) test. The BESS was performed with eyes closed while standing barefoot on a force platform for 6 conditions: double-limb stance, single-limb stance, and tandem stance on both firm and foam surfaces. BESS scores and total balance time were recorded for each condition, and COP-based measures were computed for both double-limb stance conditions (Table 1). Sample entropy was computed to quantify COP regularity over time with increased values indicating improvement in postural control. Wilcoxon signed-rank tests were performed to determine significance between visits (α <0.05). Results: Forty patients (17 males, 13.8±2.0 years) were included for analysis. ImPACT verbal and visual memory scores improved by 10% and 12%, respectively, total symptom score decreased (V0 18.03±13.85, V1 0.97±2.08; p <0.01), and visual motor speed and reaction time were both 11% faster on the K-D test. For postural control, the BESS indicated significant improvement given the reduction in errors on both surfaces (Firm Total: V0 3.23±2.09, V1 2.25±2.11, p =0.01; Foam Total: V0 7.38±2.05, V1 6.08±1.76, p <0.01; Table 1). Similarly, COP-based measures exhibited better overall balance between visits (Figure 1), primarily in the medial-lateral direction on the firm and the anterior-posterior direction on the foam. Lastly, sample entropy improved between visits, indicating more effective postural control. Conclusion: Significant improvement in postural control was observed during the recovery period which mirrored improvement in symptom scores and cognitive performance. Additionally, while COP-based measures showed similar trends to the BESS, they provided more detailed information in regards to balance recovery. Specifically, findings from the double stance condition highlight the utility of a more advanced assessment of postural control for determining RTS readiness following a SRC. Table 1. COP-based measures of balance performance at diagnosis (V0) and clearance (V1) visits Figure 1. Representative stabilograms of double stance balance on firm and foam surfaces at diagnosis (V0) and clearance visits (V1) [ABSTRACT FROM AUTHOR]

Background: CDC and AAP guidelines discourage routine neuroimaging following concussion, as CT scans are only indicated if severe intracranial injury is suspected. Validated prediction rules such as Pediatric Emergency Care Applied Research Network (PECARN) criteria have decreased the number of unnecessary pediatric head CTs; however, are still commonly performed following pediatric sport-related concussion (SRC). Hypothesis/Purpose: To determine differences in injury characteristics and outcomes in athletes who did and did not undergo head CT following SRC. Methods: Data were prospectively collected from participants enrolled in the North Texas Concussion Network Registry (ConTex) between August 2015-May 2021. Participants aged 5-18 diagnosed with SRC and presenting within 30 days were included. Participants were separated into 2 groups based on whether they had a CT scan following SRC: CT (negative scan) and no CT. Positive CTs were excluded. Groups were matched in age and time to presentation (≤14, >14-30 days). Demographics, concussion-related details, and 3-month outcome variables were analyzed including days to symptom resolution (≤30 vs >30 days) and return-to-play (RTP). Results: 324 participants were included: 162 in each group. There were no significant differences between the groups in sex, race, ethnicity, or previous concussion history. Differences in injury-related characteristics are reported in Table 1. Participants in the CT group were more likely to be participating in unorganized events (p=0.05), and less likely to continue playing following SRC (p=0.003) than the no CT group. The CT group more frequently reported head to surface mechanism of injury than the no CT group. Significantly higher rates of loss of consciousness (LOC), amnesia, and vomiting following SRC were reported in the CT group. At 3-months post-SRC, the no CT group reported RTP a week sooner than the CT group (28.8±22.3 vs 35.7±27.3 days, p=0.019). However, there was no difference in prolonged recovery (>30 days: 29.6 vs 40.5%, p=0.07) or overall RTP rates (91.9 vs 85.8%, p=0.09) between the no CT and CT groups. Conclusion: Pediatric athletes who underwent CT following SRC exhibited significantly different injury-related characteristics compared to those who did not, but the differences observed did not impact symptom resolution or return-to-play. While LOC and vomiting differences align with the PECARN prediction rules and likely contribute to decision to perform CT, the additional differences of participating in an unorganized event, head-to-surface impact, and amnesia are not part of PECARN criteria. Further research is needed to discover which variables may contribute to unnecessary head CTs following SRC. Table 1. Injury related characteristics between the CT and no CT scan groups [ABSTRACT FROM AUTHOR]