Concussions significantly impact sleep quality among adolescents. Despite increasing recognition of these effects, the complex relationship between adolescent concussions and sleep disturbances is still not fully understood and presents mixed findings. Here, we conducted a systematic review and meta-analysis to assess how concussions affect sleep-related symptoms in adolescents. We included papers presenting Pittsburgh Sleep Quality Index (PSQI) differences following concussion in high school and collegiate patients, with sleep measures recorded following concussion. Animal studies, research on participants with conditions other than concussion, non-English articles and papers failing to present PSQI data were excluded. We searched MEDLINE^®, Embase^®, CINAHL, Web of Science™, PsycINFO^®, Google Scholar, and Cochrane Central Register of Controlled Trials databases until 23 August 2024. In addition, we performed hand-searching of relevant reference lists and conference proceedings to identify further studies. Risk of bias was assessed using the Newcastle–Ottawa scale. In total, we considered 4477 studies, with nine meeting the inclusion criteria. Our analysis involved 796 participants, 340 of whom had experienced a concussion. Analysis was carried out using the meta and metafor packages in R (version 4.0.0). We showed a deterioration in sleep quality post-concussion, as evidenced by increased PSQI (standardised mean difference 0.84; 95% CI 0.53–1.16; p < 0.0001). Subgroup and quality assessments confirmed the consistency of these findings. Since poor sleep quality impacts daytime activities, we analysed the relationship between concussion and daytime dysfunction. We showed that concussion is associated with a significant worsening of the daytime dysfunction score by 0.55 (95% CI 0.24–0.70; p = 0.006). We conclude that concussions impair both sleep quality and daytime functioning in adolescents. Our research underscores the need for systematic inclusion of sleep quality assessments in post-concussion protocols and calls for targeted interventions to manage sleep disturbances post-concussion to mitigate their broader impacts on daily functioning.

Background Ewing sarcoma is the second most common primary bone cancer in adolescents and young adults, with a poor prognosis. It is usually treated with a combination of treatment options, including but not limited to chemotherapy, surgery, and radiation therapy. In this systematic review, we focus on comparing two different chemotherapeutic regimens i.e., VDC/IE (vincristine, doxorubicin, and cyclophosphamide alternating with ifosfamide and etoposide) and VIDE (vincristine, ifosfamide, doxorubicin, and etoposide), for patients with Ewing Sarcoma, with Overall survival as the primary outcome and event-free survival as the secondary outcome. Methods MEDLINE, Embase (via Ovid), and Web of Science were searched methodically to identify studies which satisfied our inclusion and exclusion criteria. After obtaining the studies, deduplication was performed (manually and automatically). Once duplicates were removed, the studies were scanned against the inclusion and exclusion criteria predefined in the registered Prospero protocol. The process of screening was carried out in two phases: in the first stage, the Titles and Abstracts were scanned, and those which were included were scanned in the second stage of full-eligibility screening. The studies obtained were assessed for Risk of Bias using the JBI’s checklist. Results Post Risk of Bias Assessment, three studies were deemed suitable for inclusion. Through analysis of the data and text of these studies, we conclude that the VDC/IE regime yields better survival outcomes when compared to the VIDE regime, and hence should tentatively be used as standard of care for treating Ewing Sarcoma.