Subacute sleep disturbance in moderate to severe traumatic brain injury: a systematic review

ABSTRACT

Objective: This systematic review evaluated subacute sleep disturbance following moderate to severe traumatic brain injury (TBI) and the impact of secondary factors such as mood or pain.

Methods: A comprehensive search strategy was applied to nine databases. Inclusion criteria included: adults ≥18 years, moderate and severe TBI and within 3 months of injury. Eligible studies were critically appraised using the McMaster Quantitative Critical Review Form. Study characteristics, outcomes, and methodological quality were synthesized. This systematic review was registered with PROSPERO (Registration number: CRD42018087799).

Results: Ten studies were included. Research identified early-onset sleep disturbances; characterized as fragmented sleep periods and difficulty initiating sleep. Alterations to sleep architecture (e.g. rapid eye movement sleep) were reported. Sleep disturbance appears to associate with alterations of consciousness. Sleep disturbance tended to be particularly increased during the phase of post-traumatic amnesia (PTA) (78.7%).

Conclusions: There is a limited amount of research available, which has inherent measurement and sample size limitations. The gold standard for measuring sleep (polysomnography) was rarely utilized, which may affect the detection of sleep disturbance and sleep architecture. Secondary factors potentially influencing sleep were generally not reported. Further evaluation on associations between sleep and PTA is needed.

KEYWORDS:

• Traumatic brain injury
• sleep disturbance
• post-traumatic amnesia
• subacute care

Acknowledgments

We thank the authors of the included studies who provided summary statistics for the purpose of this review. Thanks to Dr Bridget Hill for assisting in the critical appraisal process, and for the support of the ERI Jack Cade Major Development Grant to undertake this review. Also, we thank Susie Moreton (Epworth HealthCare Library Manager) and library team for your support with the search strategy.

Disclosure of Interest

The authors report no conflict of interest.

Notes

1. Rancho Los Amigos Scale (RLAS) Levels of Cognitive Functioning Scale scores converted to GCS by study authors.

2. Chen et al.: data is reported for moderate and severe TBI groups at 1 and 3 months post injury (Tables 1 and 2).

3. Duclos et al. (2017): Authors confirmed that the majority of patients were in PTA at the time of measurement (indicated by <8 on RLAS Score).

4. George & Landau-Ferey: data were extracted for Adults at Time 1 (Tables 1 and 2).

5. Holcomb et al.: demographics based on the initial assessment of sleep disturbance.

6. Nakase-Richardson et al.: results are reported for participants at 1-month post injury (Tables 1 and 2).

7. PTA status at the time of assessment was missing for 46 participants.

8. Wiseman-Hakes et al.: results were calculated based on participants ≥18 years old (Tables 1 and 2).

9. Table was modeled on Bialocerkowski et al. (40).

10. Row total scores were scaled down by 1 point for each NA rating.

11. Modeled on PRISMA Flow Chart.

Additional information

Funding

This work was supported by Professor Jack Cade AM Intensivist Major Development Grant from the Epworth Research Institute (ERI).