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 meta-analysis 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 = -0.47, CI: -0.89, -0.06), shorter total sleep duration (SMD = -0.37, CI: -0.59, -0.16), and greater wake after sleep onset time (SMD = 0.60, CI: 0.33, 0.87). Although sleep architecture was similar between the groups, a trend suggested that TBI patients may spend less time in REM sleep (SMD = -0.22, CI: -0.45, 0.01). Consistent with polysomnographic derangement, TBI patients reported greater subjective sleepiness and poorer perceived sleep quality.

Conclusions: The evidence suggests that TBI is associated with widespread objective and subjective sleep deficits. The present results highlight the need for physicians to monitor and address sleep deficits following TBI.

Keywords: TBI; brain injury; polysomnography; sleep; traumatic brain injury.

Figure 1. Systematic review flowchart.

ESS, Epworth Sleepiness Scale; MSLT, multiple sleep latency test; MWT, maintenance wakefulness test; PSG; polysomnography; PSQI, Pittsburgh Sleep Quality Index; TBI, traumatic brain injury.

Figure 2. Forest plot for primary outcomes.

Sleep quality as measured by polysomnography in patients with traumatic brain injury relative to control. Favors TBI indicates that TBI patients score higher values while favors control indicates that controls score higher values. I², heterogeneity index; SMD, standard mean difference; TBI, traumatic brain injury.

Figure 3. Forest plot for sleep architecture.

Sleep architecture as measured by polysomnography in patients with traumatic brain injury relative to control. Favors TBI indicates that TBI patients score higher values, while favors control indicates that controls score higher values. I², heterogeneity index; REM, rapid eye movement sleep; SMD, standard mean difference; SWS, slow wave sleep TBI, traumatic brain injury.