Abstract
Objective:
To systematically review the evidence on the treatments of sleep disturbances in individuals with acquired brain injury.
Data sources:
PubMed, Embase, Web of Science, and PsycINFO were searched from inception to January 2021.
Review method:
Eligibility criteria were (1) participants with mild to severe acquired brain injury from traumatic brain injury and stroke (⩾three months post-injury), (2) individuals aged 16 years and older, (3) participants with self-reported sleep disturbances, (4) controlled group studies and single case (experimental) studies, and (5) interventions aimed at treatment of sleep disturbances. Two researchers independently identified relevant studies and assessed their study quality using the revised Cochrane assessment of bias tool (RoB 2.0) and the risk-of-bias in N-of-1 trials (RoBiNT) scale.
Results:
The search yielded 655 records; 11 studies met the inclusion criteria and were included, with a total of 227 participants (207 individuals with traumatic brain injury, 20 stroke patients). Two studies included pharmacological therapy, six studies examined the effects of cognitive behavioral therapy and three studies investigated alternative interventions such as acupuncture.
Conclusion:
Although there was heterogeneity in the study quality of the included studies, their outcomes suggest that cognitive behavioral therapy is recommended as treatment of choice for improving sleep in individuals with acquired brain injury, especially for patients with mild to severe traumatic brain injury. Future research should examine the effects of cognitive behavioral therapy in more high-quality randomized controlled designs.
Introduction
Sleep disturbances are commonly reported following acquired brain injury and have a negative impact on functioning.1 In the context of this review, acquired brain injury includes traumatic brain injury and stroke. It is estimated that fifty to seventy percent of individuals with traumatic brain injury (50%) or stroke (67%) in the chronic phase of recovery suffer from sleep disturbances, which is much higher than the incidence in the general population.2–4 Up to a third of the persons with acquired brain injury experience insomnia, which is defined as an inability to sleep, particularly associated with problems of falling asleep and maintaining sleep.5–7 Since many studies did not diagnose sleep complaints as sleep disorders, this review focuses on sleep disturbances refering to sleep problems that occur at night and are characterized by the inability to initiate and maintain sleep. Several studies have reported a poorer sleep quality and a reduced sleep efficiency (ratio of time spent asleep compared with time spent in bed) due to more frequent awakenings at night.8–10 Following acquired brain injury, sleep disturbances can exacerbate other injury-related symptoms (e.g. cognitive functioning and fatigue) and have a negative impact on recovery.11,12 The high prevalence of sleep disturbances, its negative outcomes and also the persisting nature of sleep disturbances stress the need for effective sleep interventions for individuals with acquired brain injury.
Available treatment options for sleep disturbances in the general population could be divided into pharmacological treatment, cognitive behavioral therapy (CBT) or other, alternative interventions (e.g. acupuncture).13 Although clear guidelines exist for treatment of sleep disturbances, little research has been done on the effects of these treatments in people with acquired brain injury. As a result, sleep disturbances are often not part of standard care within the longer-term outpatient rehabilitation of patients with acquired brain injury.3,14
Recently, a systematic review on non-pharmacological treatment for insomnia showed beneficial effects of cognitive behavioral therapy in patients with acquired brain injury.15 However, a general overview including both pharmacological and non-pharmacological treatments for sleep disturbances following acquired brain injury is lacking. Our review aims to systematically review the evidence on the treatments of sleep disturbances in individuals with acquired brain injury. Specific aims are to evaluate the effectiveness of pharmacological treatment, cognitive behavioral therapy and other interventions in sleep disturbances and to discuss the implications of the findings for clinical practice, based on the study quality of the included studies.[…]
TBI Rehabilitation 