Treatments for sleep disturbances in individuals with acquired brain injury: A systematic review.
Louise Pilon, Nikita Frankenmolen, Dirk Bertens
PMID 34013776WHAT IT FOUND
Cognitive behavioral therapy packages for sleep problems after chronic acquired brain injury improved self-reported sleep in small studies; melatonin, amitriptyline and acupuncture showed limited or short-term benefit.
Key findings
01All six cognitive behavioral therapy studies reported significant improvements in self-reported sleep quality, and 18 of 25 patients showed clinically reliable improvement.
02Pharmacological studies gave mixed results: 2 mg melatonin improved self-reported sleep quality but not sleep onset latency, while 5 mg melatonin and 25 mg amitriptyline showed no improvement compared with baseline.
03Acupuncture improved self-reported sleep quality in two studies, but effects were not maintained at follow-up; a 41°C warm footbath produced very small effects that were not clinically relevant.
STILL TO COME
How it was doneWhat they foundWhat it means for OTs
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What it does not show
The review included only 11 studies and 227 participants, and it did not perform a meta-analysis, so the evidence base is small. Most included studies were pilot trials or single-case studies, and several had some concerns or high risk of bias. Sleep outcomes were mostly self-reported, and patients knew which treatment they received, which can affect ratings. The review looked only at people at least three months after brain injury, so it does not show what to do in the acute or subacute period. Only two studies included stroke patients, and both were cognitive behavioral therapy studies; other interventions were tested only in traumatic brain injury. No benzodiazepine treatment studies were included, although guidelines for the general population still recommend them. Cognitive behavioral therapy was delivered as a multi-component package, so the review cannot identify which technique is essential. Most studies required self-reported sleep problems rather than a diagnosed sleep disorder, so the group is broader than a clinic population with formal insomnia.
Declared interests
The authors declared no potential conflicts of interest. D. Bertens was funded by the European Regional Development Fund.
The easy way to misread this
Do not conclude that cognitive behavioral therapy is proven effective for sleep problems after acquired brain injury. The positive findings came from small pilot and single-case studies, mostly with self-reported outcomes, and the review did not perform a meta-analysis.