{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,27]],"date-time":"2026-07-27T14:16:39Z","timestamp":1785161799940,"version":"3.55.0"},"reference-count":48,"publisher":"SAGE Publications","issue":"4","license":[{"start":{"date-parts":[[2025,4,1]],"date-time":"2025-04-01T00:00:00Z","timestamp":1743465600000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2025,4,1]],"date-time":"2025-04-01T00:00:00Z","timestamp":1743465600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Orthopaedic Journal of Sports Medicine"],"published-print":{"date-parts":[[2025,4]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Concussions can have negative implications for sleep quality. Self-report measures, such as the Pittsburgh Sleep Quality Index (PSQI), have been used in clinical and research settings to identify individuals with sleep impairments. However, the accuracy\/applicability of historically established PSQI scoring criteria for differentiating good versus poor sleep quality has not been critically examined in adolescents with concussion.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Purpose:<\/jats:title>\n                    <jats:p>To establish a relevant PSQI clinical cut point for adolescents with a recent concussion.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Study Design:<\/jats:title>\n                    <jats:p>Cross-sectional study; Level of evidence, 3.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>\n                      Adolescents within 16 days of concussion and uninjured controls completed the PSQI, and a global score of 0 to 21 was calculated. Independent-samples\n                      <jats:italic toggle=\"yes\">t<\/jats:italic>\n                      tests were used to compare PSQI global scores, and logistic regression was used to calculate odds ratios (outcome = group; predictors = PSQI, covariates). A receiver operating characteristic curve was used to evaluate the area under the curve (AUC) and determine the optimal cut point to distinguish between adolescents with and without a concussion.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      A total of 110 adolescents with a concussion (mean age, 14.9 \u00b1 1.6 years; 53% female; 9.8 \u00b1 3.6 days since injury) and 129 uninjured controls (mean age, 15.6 \u00b1 1.1 years; 86% female) were included for analysis. The concussion group had significantly worse (higher) PSQI scores than controls (mean, 7.41 \u00b1 3.62 vs 2.26 \u00b1 1.97;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; .001; Cohen\n                      <jats:italic toggle=\"yes\">d<\/jats:italic>\n                      = 1.8). Both the univariable model and multivariable model (controlling for age, sex, concussion history, history of anxiety and\/or depression, and self-reported use of sleep medication) had excellent diagnostic accuracy (univariable AUC, 0.90; multivariable AUC, 0.99). Within the multivariable model, a cut point of 4 correctly classified 81% of participants as concussed or control (sensitivity, 87%; specificity, 74%).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>Adolescents with a concussion demonstrated worse sleep quality than uninjured controls. The results suggest that sleep quality, as measured by the PSQI, can distinguish between adolescents with and without a concussion, using a cut point of 4.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/23259671251330571","type":"journal-article","created":{"date-parts":[[2025,4,19]],"date-time":"2025-04-19T07:28:18Z","timestamp":1745047698000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":3,"title":["Clinical Cut Point for the Pittsburgh Sleep Quality Index After Adolescent Concussion"],"prefix":"10.1177","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0009-0008-0071-2055","authenticated-orcid":false,"given":"Catherine C.","family":"Donahue","sequence":"first","affiliation":[{"name":"Department of Orthopedics, University of Colorado School of Medicine, Aurora, Colorado, USA"},{"name":"Sports Medicine Center, Children's Hospital Colorado, Aurora, Colorado, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9060-868X","authenticated-orcid":false,"given":"Katherine L.","family":"Smulligan","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, University of Colorado School of Medicine, Aurora, Colorado, USA"},{"name":"Sports Medicine Center, Children's Hospital Colorado, Aurora, Colorado, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mathew J.","family":"Wingerson","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, University of Colorado School of Medicine, Aurora, Colorado, USA"},{"name":"Sports Medicine Center, Children's Hospital Colorado, Aurora, Colorado, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Madison L.","family":"Brna","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, University of Colorado School of Medicine, Aurora, Colorado, USA"},{"name":"Sports Medicine Center, Children's Hospital Colorado, Aurora, Colorado, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stacey L.","family":"Simon","sequence":"additional","affiliation":[{"name":"Department of Pulmonary and Sleep Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA"},{"name":"Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julie C.","family":"Wilson","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, University of Colorado School of Medicine, Aurora, Colorado, USA"},{"name":"Sports Medicine Center, Children's Hospital Colorado, Aurora, Colorado, USA"},{"name":"Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2955-0191","authenticated-orcid":false,"given":"David R.","family":"Howell","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, University of Colorado School of Medicine, Aurora, Colorado, USA"},{"name":"Sports Medicine Center, Children's Hospital Colorado, Aurora, Colorado, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2025,4,18]]},"reference":[{"key":"e_1_3_2_2_2","article-title":"The two-process model of sleep regulation revisited","volume":"75","author":"Achermann P.","year":"2004","unstructured":"Achermann P. The two-process model of sleep regulation revisited. Aviat Space Environ Med. 2004;75(3 suppl):A37-A43.","journal-title":"Aviat Space Environ Med"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1186\/s40798-018-0140-5"},{"issue":"6","key":"e_1_3_2_4_2","first-page":"557","article-title":"Sleep homeostasis and models of sleep regulation","volume":"14","author":"Borb\u00e9ly AA","year":"1999","unstructured":"Borb\u00e9ly AA, Achermann P. Sleep homeostasis and models of sleep regulation. J Biol Rhythms. 1999;14(6):557-568.","journal-title":"J Biol Rhythms"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1177\/0009922816681603"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.5665\/sleep.3298"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.1016\/0165-1781(89)90047-4"},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.1093\/sleep\/21.8.871"},{"key":"e_1_3_2_9_2","doi-asserted-by":"publisher","DOI":"10.1177\/0883073819849741"},{"key":"e_1_3_2_10_2","volume-title":"Sleep Disorders and Sleep Deprivation: An Unmet Public Health Problem","author":"Colten HR","year":"2006","unstructured":"Colten HR, Altevogt BM. Sleep physiology. In: Colten HR, Altevogt BM, eds. Sleep Disorders and Sleep Deprivation: An Unmet Public Health Problem. National Academies Press (US); 2006."},{"key":"e_1_3_2_11_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.sleep.2006.12.002"},{"key":"e_1_3_2_12_2","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph18031082"},{"key":"e_1_3_2_13_2","doi-asserted-by":"publisher","DOI":"10.1097\/00002060-200105000-00003"},{"key":"e_1_3_2_14_2","doi-asserted-by":"publisher","DOI":"10.1002\/bimj.200410135"},{"key":"e_1_3_2_15_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.sleep.2007.11.023"},{"key":"e_1_3_2_16_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.sleep.2010.11.008"},{"key":"e_1_3_2_17_2","doi-asserted-by":"publisher","DOI":"10.1136\/bjsports-2018-100338"},{"key":"e_1_3_2_18_2","doi-asserted-by":"publisher","DOI":"10.1093\/sleep\/zsy222"},{"key":"e_1_3_2_19_2","doi-asserted-by":"publisher","DOI":"10.1089\/neu.2019.6761"},{"key":"e_1_3_2_20_2","doi-asserted-by":"publisher","DOI":"10.1177\/0883073818824000"},{"key":"e_1_3_2_21_2","doi-asserted-by":"publisher","DOI":"10.1177\/0363546518796830"},{"key":"e_1_3_2_22_2","doi-asserted-by":"publisher","DOI":"10.1136\/bjsports-2017-097729"},{"key":"e_1_3_2_23_2","doi-asserted-by":"publisher","DOI":"10.1177\/0363546514560727"},{"key":"e_1_3_2_24_2","doi-asserted-by":"publisher","DOI":"10.3389\/fpsyg.2013.00863"},{"key":"e_1_3_2_25_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamapediatrics.2018.3820"},{"key":"e_1_3_2_26_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.nicl.2022.103130"},{"key":"e_1_3_2_27_2","first-page":"838","volume-title":"Br J Sports Med","volume":"51","author":"McCrory P","year":"2017","unstructured":"McCrory P, Meeuwisse W, Dvorak J, et al. Consensus statement on concussion in sport\u2014the 5th International Conference on Concussion in Sport held in Berlin, October 2016. Br J Sports Med. 2017;51(11):838-847."},{"key":"e_1_3_2_28_2","doi-asserted-by":"publisher","DOI":"10.1177\/0363546511423503"},{"key":"e_1_3_2_29_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.smrv.2015.01.009"},{"key":"e_1_3_2_30_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.apmr.2018.01.005"},{"key":"e_1_3_2_31_2","first-page":"695","volume-title":"Br J Sports Med","volume":"57","author":"Patricios JS","year":"2023","unstructured":"Patricios JS, Schneider KJ, Dvorak J, et al. Consensus statement on concussion in sport: the 6th International Conference on Concussion in Sport\u2013Amsterdam, October 2022. Br J Sports Med. 2023;57(11):695-711."},{"key":"e_1_3_2_32_2","doi-asserted-by":"publisher","DOI":"10.5665\/sleep.6314"},{"key":"e_1_3_2_33_2","doi-asserted-by":"publisher","DOI":"10.1093\/arclin\/acu014"},{"issue":"2","key":"e_1_3_2_34_2","first-page":"111","article-title":"Evidence based emergency medicine; part 5 receiver operating curve and area under the curve","volume":"4","author":"Safari S","year":"2016","unstructured":"Safari S, Baratloo A, Elfil M, Negida A. Evidence based emergency medicine; part 5 receiver operating curve and area under the curve. Emerg (Tehran). 2016;4(2):111-113.","journal-title":"Emerg (Tehran)"},{"key":"e_1_3_2_35_2","doi-asserted-by":"publisher","DOI":"10.1097\/WNN.0000000000000056"},{"key":"e_1_3_2_36_2","doi-asserted-by":"publisher","DOI":"10.3402\/jchimp.v4.24983"},{"key":"e_1_3_2_37_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jsams.2023.02.001"},{"key":"e_1_3_2_38_2","doi-asserted-by":"publisher","DOI":"10.1136\/bjsports-2023-106859"},{"key":"e_1_3_2_39_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2869.2005.00467.x"},{"key":"e_1_3_2_40_2","doi-asserted-by":"publisher","DOI":"10.1080\/02699052.2019.1643921"},{"key":"e_1_3_2_41_2","doi-asserted-by":"publisher","DOI":"10.1089\/neu.2014.3559"},{"key":"e_1_3_2_42_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.sleep.2015.04.013"},{"key":"e_1_3_2_43_2","doi-asserted-by":"publisher","DOI":"10.18637\/jss.v098.i11"},{"key":"e_1_3_2_44_2","doi-asserted-by":"publisher","DOI":"10.1097\/JSM.0000000000000413"},{"key":"e_1_3_2_45_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2017.9087"},{"key":"e_1_3_2_46_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2021.1538"},{"key":"e_1_3_2_47_2","doi-asserted-by":"crossref","DOI":"10.1177\/2325967120S00223","article-title":"Adolescents report sleep quality impairments acutely post-concussion","volume":"8","author":"Wilson JC","year":"2020","unstructured":"Wilson JC, Kirkwood MW, Provance AJ, Walker GA, Wilson PE, Howell DR. Adolescents report sleep quality impairments acutely post-concussion. Orthop J Sports Med. 2020;8(4 suppl 3):2325967120S00223.","journal-title":"Orthop J Sports Med"},{"key":"e_1_3_2_48_2","doi-asserted-by":"publisher","DOI":"10.1080\/17518423.2020.1858456"},{"key":"e_1_3_2_49_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2016.1203"}],"container-title":["Orthopaedic Journal of Sports Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/23259671251330571","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/23259671251330571","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/23259671251330571","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T00:27:08Z","timestamp":1777595228000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/23259671251330571"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,4]]},"references-count":48,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2025,4]]}},"alternative-id":["10.1177\/23259671251330571"],"URL":"https:\/\/doi.org\/10.1177\/23259671251330571","relation":{},"ISSN":["2325-9671","2325-9671"],"issn-type":[{"value":"2325-9671","type":"print"},{"value":"2325-9671","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,4]]},"article-number":"23259671251330571"}}