Research Reports - Sleep disturbances in traumatic brain injury
J Clin Sleep Med. 2015 Nov 6. pii: jc-00271-15. [Epub ahead of print]
Grima N, Ponsford J, Rajaratnam S, Mansfield D, Pase MP.
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
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.