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Sleep Medicine xxx (2008) xxx–xxx
Physical activity, contact sports and quality of sleep:
The good, the bad and the (possibly) ugly q
There is little argument that physical activity is beneficial for one’s health. Indeed, increasing the amount of
physical activity is associated with extensive health
improvement, mostly in coronary artery disease, hypertension, stroke, insulin sensitivity, osteoporosis, and
depression [1–4]. As such, the United States Department
of Health and Human Services recommends ‘‘physical
activity most days of the week for at least 30 minutes
for adults” [5]. Some sports (mainly the ‘‘contact
sports”) are, however, associated with various injuries,
among which brain concussion, or minor traumatic
brain injury (mTBI), is not unusual [6]. Although concussion has traditionally been described as a transient,
fully reversible, cerebral dysfunction, this ostensibly
mild injury sometimes results in long-lasting and disabling post-concussion symptoms as well as abnormal
neuropsychological profiles characteristic of frontal or
temporal lobe dysfunction, including some alterations
of sleep patterns [7]. The pathological changes following
concussion remain unclear, but it is widely thought that
concussion results mainly in functional disturbance
rather than in structural damage per se [8]. This damage
may persist and manifest as some degree of cognitive,
emotional and behavioral disturbances even decades
after the occurrence of the event [9]1 We also documented this phenomenon in a mouse model of mTBI
Studying mTBI in a mouse model allows for in-depth
and detailed examination of anatomical derangement
far beyond that possible in clinical settings. We demonstrated apoptotic process activation in the concussed
Conflict of interest declared: None whatsoever.
One possible (although never officially diagnosed) case illustration
may be President Gerald Ford, probably the most athletic president in
American history who had been an all-star football player at the
University of Michigan and drafted by the Green Bay Packers, whose
mishaps have been dismissed, at times, by saying that ‘‘he has had one
to many blows to his head”.
content/article/2006/12/28/AR2006122800106.html, http://www., http://seattletimes.
1389-9457/$ - see front matter Ó 2008 Elsevier B.V. All rights reserved.
mouse brains, with the most sensitive zones for trauma
being the anterior cingulate cortex and the CA3 area
of the hippocampus, with no hemispheric differences.
Based on these findings, we concluded that, apoptosis,
as a part of post-traumatic neurodegeneration, can be
activated diffusely in the brain even after minimal traumatic damage [11].
In the current issue of Sleep Medicine, Gosselin
et al.’s very nicely designed and well-conducted study
provides us with important new data on subjective complaints and objective measures of sleep and vigilance in
concussed athletes practicing contact sports [12]. Athletes who experienced concussions during the last year
(and had a self-reported history of previous sport-related concussions from participating in professional,
university, or semi-professional league hockey, football,
rugby, soccer or skating) were compared to a matched
group of athletes on teams of other university non-contact sports activities (tennis, swimming or volleyball)
without a history of concussion. The concussed athletes
reported more symptoms of sleep disturbances and
poorer sleep quality than the controls, but neither the
polysomnograph (PSG) nor the quantitative electroencephalograph (qEEG) recordings of REM and NREM
sleep demonstrated any measurable differences between
the groups. On the other hand, concussed athletes did
show significantly more delta activity and less alpha
activity during wakefulness than the controls, and these
findings point to a possible objective verification of a
physical source for their complaints.
The discrepancy between subjective distresses in the
face of normal objective measures of sleep has already
been observed in mTBI patients [13], as well as in
post-traumatic stress disorder (PTSD) patients. Interpretation of these unremarkable results may lead to dismissal of the subjective complaints as representing
altered sleep perception rather than true sleep disturbance (as has been suggested for PTSD) [14] or a tendency towards catastrophization (as has been
attributed to chronic pain patients) [15]. On the other
hand, the subjectively reported symptoms of mTBI pa-
Editorial / Sleep Medicine xxx (2008) xxx–xxx
tients may share the reversal of attitude towards PTSD
patients whose trauma-related nightmares are now considered an important factor in the occurrence of increased REM interruptions and wake time after sleep
onset [16]. As such, an altered perception of symptoms
as being consequences of physical injury may lead to
new approaches in analyzing data. This could result in
identifying the correlates of the neurophysiologic anomalies displayed by the concussed athletes during attention tasks, which may represent the early apoptotic
changes such as those documented in animal models
of brain concussion [17].
Further intensive research on large populations is
needed in the field of sports-related brain concussion
in order to better understand the associated hazards
and consequences of contact sports and further develop
and implement better methods of protection and
Esther Eshkol is thanked for editorial assistance.
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Pick CG. Closed-head minimal traumatic brain injury produces long term cognitive deficits in mice. Neuroscience
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Apoptotic changes in the cortex and hippocampus following
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Shaul Schreiber *
Department of Psychiatry, Tel Aviv Sourasky Medical
Center and Tel Aviv University Sackler
Faculty of Medicine, Tel Aviv, Israel
E-mail address: [email protected]
Chaim G. Pick
Department of Anatomy and Anthropology, Tel-Aviv
University Sackler Faculty of Medicine, Tel Aviv, Israel
Corresponding author. Tel.: +972 3 6974707; fax: +972 3 6974586.
Chapter 15
Chapter 15