Treatments for sleep disturbances in individuals with acquired brain injury: A systematic review

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.

Pharmacotherapy to Improve Cognitive Functioning After Acquired Brain Injury: A Meta‐Analysis and Meta‐Regression

“…For example, the use of pharmacotherapy alongside structured rehabilitation programs and combining pharmacological treatments with cognitive therapy, 51 noninvasive brain stimulation techniques 85 or physical exercise programs 60,86 . Moreover, treatment of cognitive impairment may also involve targeting other underlying factors, such as treating sleep disturbances through cognitive behavior therapy 87 or pharmacological agents, 88 highlighting the multifaceted nature of handling cognitive impairment in ABI. Last, future research should extend to understanding how pharmacological improvements in cognition translate into daily life functioning and quality of life for patients with ABI 89 …”

Improving Care for Veterans with Traumatic Brain Injury Across the Lifespan

“…Brain stimulation effectively improved physical outcomes in one systematic review (Dhaliwal, Meek, and Modirrousta, 2015) and had uncertain conclusions in two studies (Argyriou et al, 2021;O'Neil et al, 2020), including one exclusively composed of veterans (O'Neil et al, 2020). Complementary and alternative medicine was effective at improving physical outcomes in three systematic reviews (Lowe et al, 2020;Srisurapanont et al, 2021;Xu et al, 2017), demonstrated mixed findings in one (Pilon, Frankenmolen, and Bertens, 2021), and drew uncertain conclusions in one (Cantor et al, 2014).…”

“…Pharmacotherapy was assessed for its effect on physical outcomes in 11 systematic reviews; in none was it found to be effective. One systematic review demonstrated no effect of pharmacotherapy on physical outcomes (Wilson et al, 2018), and the findings in the other ten reviews were either mixed (Borghol et al, 2018;Iaccarino et al, 2020;Pilon, Frankenmolen, and Bertens, 2021;Sheng et al, 2013) or uncertain (Barlow et al, 2019;Cantor et al, 2014;Lew et al, 2006;Synnot et al, 2017;Watanabe et al, 2012;Zhao et al, 2018). Psychotherapy effectively improved physical outcomes in three studies (Bogdanov, Naismith, and Lah, 2017;Lowe et al, 2020;Pilon, Frankenmolen, and Bertens, 2021), with mixed results in another (Snell et al, 2009); conclusions were uncertain in five systematic reviews (Argyriou et al, 2021;Bergersen et al, 2017;Cantor et al, 2014;Lew et al, 2006;Sullivan et al, 2018).…”

Associations of Nightmares and Sleep Disturbance With Neurobehavioral Symptoms Postconcussion

“…Specifically, cognitive-behavioral treatment of insomnia serves as an ideal nonpharmacological intervention for sleep problems in mTBI, with documented improvement in sleep parameters and preliminary data, suggesting increases in other domains of functioning. 50 However, there is a paucity of evidence about the treatment of nightmares in mTBI, with the majority focused on trauma-related dreams. 51 Further studies are still needed to delineate the impacts of reducing nightmare frequency on neurobehavioral and psychosocial functioning.…”