{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T10:36:33Z","timestamp":1777890993967,"version":"3.51.4"},"reference-count":38,"publisher":"SAGE Publications","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["WOR"],"published-print":{"date-parts":[[2020,12,22]]},"abstract":"<jats:p>BACKGROUND: Recent studies have started disentangling components of disturbed sleep as part of the post-concussive syndrome, but little is known about the workers with an injury\u2019 perspectives on post-injury sleep changes or what causes these changes. OBJECTIVES: To determine the effects of work-related concussion\/mild traumatic brain injury (wr-mTBI) on perceptions of refreshing sleep in workers with an injury and to identify the relevant factors responsible for sleep changes. METHODS: We studied post-concussive changes in sleep in 66 adults (50% male workers, 42% aged 30\u201350 years, median post-injury days: 155) who had sustained wr-mTBI and experienced functional limitations long after the injury. We collected sociodemographic, occupational and health status data and identified variables related to post-concussive changes in refreshing sleep. RESULTS: Forty-seven workers with wr-mTBI (79% of male workers, 64% of female workers) perceived their sleep as being refreshing before injury and unrefreshing afterwards (\u03c72\u200a=\u200a67.70 for change, \u03c72\u200a=\u200a27.6 for female and \u03c72\u200a=\u200a41.1 for male workers, p\u200a&lt;\u200a0.0001). Post-concussive losses in refreshing sleep were associated with socio demographic, occupational, and health status data variables. Sex stratification revealed differences between male and female workers. CONCLUSIONS: Workers with wr-mTBI experience clinically meaningful changes in refreshing sleep that are associated with modifiable variables. The observed differences in functional outcomes between male and female workers warrant further study.<\/jats:p>","DOI":"10.3233\/wor-203343","type":"journal-article","created":{"date-parts":[[2020,12,11]],"date-time":"2020-12-11T12:58:00Z","timestamp":1607691480000},"page":"927-938","source":"Crossref","is-referenced-by-count":3,"title":["Sleep before and after work-related concussion: Sex differences in effects and functional outcomes"],"prefix":"10.1177","volume":"67","author":[{"given":"Tatyana","family":"Mollayeva","sequence":"first","affiliation":[{"name":"Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Toronto, Canada"},{"name":"KITE Toronto Rehabilitation Institute University Health Network, Toronto Rehabilitation Institute University Health Network, Toronto, Canada"},{"name":"Acquired Brain Injury Research Lab, University of Toronto, Toronto, Canada"},{"name":"Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada"},{"name":"Department of Occupational Science & Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bhanu","family":"Sharma","sequence":"additional","affiliation":[{"name":"KITE Toronto Rehabilitation Institute University Health Network, Toronto Rehabilitation Institute University Health Network, Toronto, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lee","family":"Vernich","sequence":"additional","affiliation":[{"name":"Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Steve","family":"Mantis","sequence":"additional","affiliation":[{"name":"Ontario Network of Injured Workers Groups, Research Action Committee, Toronto, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"John","family":"Lewko","sequence":"additional","affiliation":[{"name":"School of Rural and Northern Health, Laurentian University, Sudbury, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Brian","family":"Gibson","sequence":"additional","affiliation":[{"name":"Division of Clinical Public Health, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gary","family":"Liss","sequence":"additional","affiliation":[{"name":"Division of Occupational and Environmental Health, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pia","family":"Kontos","sequence":"additional","affiliation":[{"name":"KITE Toronto Rehabilitation Institute University Health Network, Toronto Rehabilitation Institute University Health Network, Toronto, Canada"},{"name":"Division of Social and Behavioural Health Sciences, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alisa","family":"Grigorovich","sequence":"additional","affiliation":[{"name":"KITE Toronto Rehabilitation Institute University Health Network, Toronto Rehabilitation Institute University Health Network, Toronto, Canada"},{"name":"Division of Social and Behavioural Health Sciences, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Angela","family":"Colantonio","sequence":"additional","affiliation":[{"name":"Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Toronto, Canada"},{"name":"KITE Toronto Rehabilitation Institute University Health Network, Toronto Rehabilitation Institute University Health Network, Toronto, Canada"},{"name":"Acquired Brain Injury Research Lab, University of Toronto, Toronto, Canada"},{"name":"Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada"},{"name":"Department of Occupational Science & Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","reference":[{"issue":"4","key":"10.3233\/WOR-203343_ref2","doi-asserted-by":"crossref","first-page":"353","DOI":"10.1002\/ajim.22418","article-title":"Epidemiology of work-related traumatic brain injury: a systematic review","volume":"58","author":"Chang","year":"2015","journal-title":"Am J Ind Med"},{"key":"10.3233\/WOR-203343_ref4","doi-asserted-by":"crossref","first-page":"579","DOI":"10.1016\/0003-9993(93)90155-4","article-title":"Current perceptions of rehabilitation professionals towards mild traumatic brain injury","volume":"74","author":"Harrington","year":"1993","journal-title":"Arch Phys Med Rehabil"},{"issue":"3 Suppl","key":"10.3233\/WOR-203343_ref5","doi-asserted-by":"crossref","first-page":"S132","DOI":"10.1016\/j.apmr.2013.08.299","article-title":"Systematic review of self-reported prognosis in adults after mild traumatic brain injury: results of the International Collaboration on Mild Traumatic Brain Injury Prognosis","volume":"95","author":"Cassidy","year":"2014","journal-title":"Arch Phys Med Rehabil"},{"issue":"6","key":"10.3233\/WOR-203343_ref6","doi-asserted-by":"crossref","first-page":"E67","DOI":"10.1097\/HTR.0000000000000119","article-title":"Persistent Sleep Disturbances Independently Predict Poorer Functional and Social Outcomes 1 Year After Mild Traumatic Brain Injury","volume":"30","author":"Chan","year":"2015","journal-title":"J Head Trauma Rehabil"},{"key":"10.3233\/WOR-203343_ref7","doi-asserted-by":"crossref","first-page":"153","DOI":"10.1016\/j.sleep.2015.05.014","article-title":"Insomnia in workers with delayed recovery from mild traumatic brain injury","author":"Mollayeva","year":"2016","journal-title":"Sleep Med"},{"issue":"10 Suppl 2","key":"10.3233\/WOR-203343_ref8","doi-asserted-by":"crossref","first-page":"S354","DOI":"10.1016\/j.pmrj.2011.07.017","article-title":"Epidemiology of concussion and mild traumatic brain injury","volume":"3","author":"Laker","year":"2011","journal-title":"PM R"},{"issue":"1","key":"10.3233\/WOR-203343_ref9","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1016\/j.pmrj.2017.06.010","article-title":"Characteristics of a Mild Traumatic Brain Injury Sample Recruited Using Amazon\u2019s Mechanical Turk","volume":"10","author":"Bernstein","year":"2018","journal-title":"PM R"},{"key":"10.3233\/WOR-203343_ref10","doi-asserted-by":"crossref","first-page":"85","DOI":"10.1093\/sleep\/29.1.85","article-title":"Sex differences in insomnia: a meta-analysis","volume":"29","author":"Zhang","year":"2006","journal-title":"Sleep"},{"issue":"4","key":"10.3233\/WOR-203343_ref11","doi-asserted-by":"crossref","first-page":"279","DOI":"10.1016\/j.jnma.2017.04.005","article-title":"Racial\/Ethnic and Social Inequities in Sleep Medicine: The Tip of the Iceberg?","volume":"109","author":"Pandi-Perumal","year":"2017","journal-title":"J Natl Med Assoc"},{"key":"10.3233\/WOR-203343_ref12","doi-asserted-by":"crossref","first-page":"682","DOI":"10.1097\/PSY.0b013e31814ceada","article-title":"Socioeconomic status predicts objective and subjective sleep quality in aging women","volume":"69","author":"Friedman","year":"2007","journal-title":"Psychosom Med"},{"key":"10.3233\/WOR-203343_ref13","doi-asserted-by":"publisher","DOI":"10.3233\/WOR-193066"},{"issue":"8","key":"10.3233\/WOR-203343_ref14","doi-asserted-by":"crossref","first-page":"47","DOI":"10.1007\/s11920-017-0800-z","article-title":"Sleep and Psychiatric Disorders in Persons With Mild Traumatic Brain Injury","volume":"19","author":"Mollayeva","year":"2017","journal-title":"Curr Psychiatry Rep"},{"issue":"11","key":"10.3233\/WOR-203343_ref15","doi-asserted-by":"crossref","first-page":"1759","DOI":"10.1017\/S0033291709992261","article-title":"What is a mental\/psychiatric disorder? From DSM-IV to DSM-V","volume":"40","author":"Stein","year":"2010","journal-title":"Psychol Med"},{"issue":"4","key":"10.3233\/WOR-203343_ref16","doi-asserted-by":"crossref","first-page":"339","DOI":"10.1089\/neu.2015.3926","article-title":"Acute alcohol intoxication in patients with mild traumatic brain injury: Characteristics, recovery, and outcome","volume":"33","author":"Scheenen","year":"2016","journal-title":"Neurotrauma"},{"issue":"6","key":"10.3233\/WOR-203343_ref17","doi-asserted-by":"crossref","first-page":"561","DOI":"10.1016\/j.sleep.2012.02.002","article-title":"Nonrestorative sleep: symptom or unique diagnostic entity?","volume":"13","author":"Wilkinson","year":"2012","journal-title":"Sleep Med"},{"key":"10.3233\/WOR-203343_ref18","doi-asserted-by":"crossref","first-page":"7170610","DOI":"10.1155\/2016\/7170610","article-title":"Refreshing Sleep and Sleep Continuity Determine Perceived Sleep Quality","volume":"2016","author":"Libman","year":"2016","journal-title":"Sleep Disord"},{"issue":"2","key":"10.3233\/WOR-203343_ref20","doi-asserted-by":"crossref","first-page":"319","DOI":"10.3233\/WOR-192866","article-title":"Work-related traumatic brain injury: The injured workers\u2019 perspective on job and health and safety training, supervision, and injury preventability","volume":"62","author":"Sharma","year":"2019","journal-title":"Work"},{"issue":"4","key":"10.3233\/WOR-203343_ref21","doi-asserted-by":"crossref","first-page":"434","DOI":"10.1176\/appi.ps.56.4.434","article-title":"Reliability of global assessment of functioning ratings made by clinical psychiatric staff","volume":"56","author":"S\u00f6derberg","year":"2005","journal-title":"Psychiatr Serv"},{"issue":"10","key":"10.3233\/WOR-203343_ref22","doi-asserted-by":"crossref","first-page":"1121","DOI":"10.1001\/archneur.1989.00520460115022","article-title":"The fatigue severity scale. Application to patients with multiple sclerosis and systemic lupus erythematosus","volume":"46","author":"Krupp","year":"1989","journal-title":"Arch Neurol"},{"issue":"8","key":"10.3233\/WOR-203343_ref23","doi-asserted-by":"crossref","first-page":"804","DOI":"10.1177\/0269215514521043","article-title":"How to measure fatigue in neurological conditions? A systematic review of psychometric properties and clinical utility of measures used so far","volume":"28","author":"Tyson","year":"2014","journal-title":"Clin Rehabil"},{"issue":"12","key":"10.3233\/WOR-203343_ref24","doi-asserted-by":"crossref","first-page":"1373","DOI":"10.1016\/S0895-4356(96)00236-3","article-title":"A simulation study of the number of events per variable in logistic regression analysis","volume":"49","author":"Peduzzi","year":"1996","journal-title":"J Clin Epidemiol"},{"key":"10.3233\/WOR-203343_ref25","doi-asserted-by":"crossref","first-page":"926","DOI":"10.1016\/j.sleep.2015.04.013","article-title":"BIONIC Research Group. Sleep difficulties one year following mild traumatic brain injury in a population-based study","volume":"16","author":"Theadom","year":"2015","journal-title":"Sleep Med"},{"issue":"5","key":"10.3233\/WOR-203343_ref26","doi-asserted-by":"crossref","first-page":"309","DOI":"10.1097\/00003072-199805000-00009","article-title":"SPECT brain perfusion abnormalities in mild or moderate traumatic brain injury","volume":"23","author":"Abdel-Dayem","year":"1998","journal-title":"Clin Nucl Med"},{"key":"10.3233\/WOR-203343_ref27","doi-asserted-by":"crossref","first-page":"614","DOI":"10.2214\/AJR.13.11091","article-title":"Evaluation of tentorial length and angle in sleep-wake disturbances after mild traumatic brain injury","volume":"202","author":"Yaeger","year":"2014","journal-title":"AJR Am J Roentgenol"},{"key":"10.3233\/WOR-203343_ref28","unstructured":"Kendler KS , Prescott CA . Genes, environment, and psy-chopathology: understanding the causes of psychiatric and substance use disorders. New York, NY: Guilford Press, 2006."},{"issue":"4","key":"10.3233\/WOR-203343_ref29","doi-asserted-by":"crossref","first-page":"339","DOI":"10.1089\/neu.2015.3926","article-title":"Acute alcohol intoxication in patients with mild traumatic brain injury: Characteristics, recovery, and outcome","volume":"33","author":"Scheenen","year":"2016","journal-title":"Neurotrauma"},{"issue":"1","key":"10.3233\/WOR-203343_ref30","doi-asserted-by":"crossref","first-page":"A6","DOI":"10.1176\/appi.neuropsych.16110307","article-title":"Chronic alcohol use and sleep homeostasis: Risk factors and neuroimaging of recovery","volume":"29","author":"Martindale","year":"2017","journal-title":"J Neuropsychiatry Clin Neurosci"},{"issue":"3","key":"10.3233\/WOR-203343_ref31","doi-asserted-by":"crossref","first-page":"304","DOI":"10.1111\/jnc.14470","article-title":"A single episode of binge alcohol drinking causes sleep disturbance, disrupts sleep homeostasis and downregulates equilibrative nucleoside transporter 1","volume":"146","author":"Sharma","year":"2018","journal-title":"J Neurochem"},{"key":"10.3233\/WOR-203343_ref32","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1186\/1471-2342-9-11","article-title":"Magnetic resonance imaging after most common form of concussion","volume":"9","author":"Schrader","year":"2009","journal-title":"BMC Med Imaging"},{"issue":"2","key":"10.3233\/WOR-203343_ref33","doi-asserted-by":"crossref","first-page":"192","DOI":"10.1111\/sjop.12427","article-title":"Alexithymia as a potential source of symptom over-reporting: An exploratory study in forensic patients and non-forensic participants","volume":"59","author":"Merckelbach","year":"2018","journal-title":"Scand J Psychol"},{"issue":"2","key":"10.3233\/WOR-203343_ref34","doi-asserted-by":"crossref","first-page":"119","DOI":"10.1080\/21622965.2014.1003066","article-title":"Sex Differences and Self-Reported Attention Problems During Baseline Concussion Testing","volume":"5","author":"Brooks","year":"2016","journal-title":"Appl Neuropsychol Child"},{"issue":"1","key":"10.3233\/WOR-203343_ref35","doi-asserted-by":"crossref","first-page":"2","DOI":"10.1037\/pha0000165","article-title":"Is antidepressant use associated with difficulty identifying feelings? A brief report","volume":"26","author":"Kajanoja","year":"2018","journal-title":"Exp Clin Psychopharmacol"},{"issue":"6","key":"10.3233\/WOR-203343_ref38","doi-asserted-by":"crossref","first-page":"519","DOI":"10.1002\/ajim.22022","article-title":"Preserving workers\u2019 dignity in workers\u2019 compensation systems: An international perspective","volume":"55","author":"Lippel","year":"2012","journal-title":"Am J Industr Med"},{"issue":"2","key":"10.3233\/WOR-203343_ref39","first-page":"86","article-title":"Assessment of mild traumatic brain injury\/concussion-related fatigue, alertness, and daytime sleepiness: A diagnostic modeling study","volume":"7","author":"Mollayeva","year":"2017","journal-title":"Neuropsychiatry (Lon-don)"},{"key":"10.3233\/WOR-203343_ref40","doi-asserted-by":"crossref","first-page":"157","DOI":"10.1016\/j.sleep.2015.09.008","article-title":"The relationship between insomnia and disability in workers with mild traumatic brain injury\/concussion: Insomnia and disability in chronic mild traumatic brain injury","volume":"20","author":"Mollayeva","year":"2016","journal-title":"Sleep Med"},{"issue":"11","key":"10.3233\/WOR-203343_ref41","doi-asserted-by":"crossref","first-page":"100","DOI":"10.1007\/s11910-016-0697-7","article-title":"Post-Concussive Syndrome: a Focus on Post-Traumatic Headache and Related Cognitive, Psychiatric, and Sleep Issues","volume":"16","author":"Minen","year":"2016","journal-title":"Curr Neurol Neurosci Rep"},{"key":"10.3233\/WOR-203343_ref42","doi-asserted-by":"crossref","first-page":"179","DOI":"10.1016\/j.sleep.2017.02.021","article-title":"Sleep stage distribution in persons with mild traumatic brain injury: a polysomnographic study according to American Academy of Sleep Medicine standards","volume":"34","author":"Mollayeva","year":"2017","journal-title":"Sleep Med"},{"issue":"3","key":"10.3233\/WOR-203343_ref43","doi-asserted-by":"crossref","first-page":"241","DOI":"10.1016\/j.pmrj.2015.07.006","article-title":"Interdisciplinary Rehabilitation Referrals in a Concussion Clinic Cohort: An Exploratory Analysis","volume":"8","author":"Vargo","year":"2016","journal-title":"PM R"}],"container-title":["Work"],"original-title":[],"link":[{"URL":"https:\/\/content.iospress.com\/download?id=10.3233\/WOR-203343","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T05:51:19Z","timestamp":1777614679000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/full\/10.3233\/WOR-203343"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,12,22]]},"references-count":38,"journal-issue":{"issue":"4"},"URL":"https:\/\/doi.org\/10.3233\/wor-203343","relation":{},"ISSN":["1051-9815","1875-9270"],"issn-type":[{"value":"1051-9815","type":"print"},{"value":"1875-9270","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,12,22]]}}}