Sleep Disturbances in Traumatic Brain Injury: A Meta-Analysis

Abstract

Study Objectives: Sleep disturbances are frequently reported following traumatic brain injury (TBI); however, the exact disturbances remain unclear. This meta-analysis aimed to characterize sleep disturbance in community dwelling patients with TBI as compared to controls. Methods: Two investigators independently conducted a systematic search of multiple electronic databases from inception to May 27, 2015. Studies were selected if they compared sleep in community dwelling individuals with TBI relative to a control population without head injury. Data were pooled in metaanalysis with outcomes expressed as the standard mean difference (SMD) and 95% confidence interval (CI). The primary outcomes were derived from polysomnography and secondary outcomes were derived from subjective sleep measures. Results: Sixteen studies were included, combining 637 TBI patients and 567 controls, all of whom were community dwelling. Pooled polysomnography data revealed that TBI patients had poorer sleep efficiency (SMD = −0. I NTRO DUCTI O NSleep disturbances are frequently reported following traumatic brain injury (TBI), with over 50% of people experiencing some form of sleep disturbance post TBI.1 Although a large majority of people with TBI generally make a good physical recovery, disrupted sleep can often go untreated, impacting quality of life, impeding rehabilitation and return to pre-injury activities.2-5 Our recent work showed significant interrelationships between daytime sleepiness, daytime fatigue, cognitive impairment, and mood disturbances in TBI. 6 While individuals with TBI are known to report sleep problems, 1 the specific changes to sleep remain poorly characterized.7 Studies have been limited by small sample sizes, with variable and inconsistent findings. [8][9][10][11][12] This makes for a difficult characterization of sleep post TBI. Thus, there is a need to establish the specific aspects of sleep that are most affected post TBI as these have important implications for treatment and rehabilitation. The aim of the current meta-analysis was to characterize both objective sleep disturbances and subjective sleep complaints in individuals with TBI relative to healthy controls. Study outcomes included the comparison of TBI patients to controls across both polysomnography and subjective measures of sleep. It ; Matthew P. Pase, PhD was hypothesized that those with TBI would display widespread objective and subjective sleep deficits as compared to controls without head injury. The present study aimed to summarize current literature, which would identify important avenues for future research. M ETHO DS Study DesignThe search strategy was conducted in accordance with the meta-analysis of observational studies in epidemiology guidelines. 13 Article SearchingOvid Medline, Embase, PsychInfo, Scopus, and the Cochrane Library were systematically searched until May, 27 2015. The search was initially developed by all authors and refined by a librarian at Monash University. The references of recent publications were also hand searc...

Mild Traumatic Brain Injury Chronically Impairs Sleep- and Wake-Dependent Emotional Processing

“…However, consistent with previous work, 14,16,49 the TBI group had marginally higher PSQI scores, which was driven by a significant difference in the sleep latency component of the scale (time to fall asleep; non-TBI = 1.42, TBI = 2.1; t(78) = 2.57, p = .01). The Sleep and Wake conditions did not differ based on MEQ, SSS2, or ESS scores.…”

“…14,16,49 In the current sample, the difference in PSQI scores was mainly driven by the sleep latency component of the scale, which queries how long it takes the individual to fall asleep. Participants with a history of TBI reported significantly longer sleep latency.…”

“…Objective recordings of sleep (via polysomnography [PSG]) demonstrate decreased sleep efficiency (time asleep/time in bed 14 ), increased awakenings 12 , hypersomnia 15 , and sleep stage proportion changes several years post TBI. Recently, a large meta-analysis, which comprised nine studies, found individuals with a history of TBI tend to have less rapid eye movement (REM) than uninjured individiauls 16 . However, at present, it remains unclear whether TBI-induced sleep alterations have chronic, deleterious effects on health after brain injury.…”

“…21,22,25 We predicted emotional sleep-dependent memory consolidation would be reduced in a chronic, mild TBI population. Additionally, given the reduction in REM sleep following a mild TBI, 16 the second study aim was to assess whether sleep-dependent emotion generation is intact in a mild TBI population. We hypothesized that sleep's preservation of emotionality might be disrupted in individuals with chronic TBI as well.…”

Sleep and Weight among Our Veterans

“…3 In traumatic brain injury patients, subjective complaints of daytime sleepiness and poor sleep quality, as well as poorer sleep efficiency and reduced sleep time on polysomnography, are quite common. 4,5 That said, there is evidence that ubiquity of sleep disorders may not be limited to veterans of recent conflicts; in one study, 87% of older veterans, age 55-89, were found to have sleep-disordered breathing. 6 The relationships between sleep and metabolism are plausibly bidirectional and interwoven.…”