Treatment of Sleep Disorders Following Traumatic Brain Injury: A Systematic Review and Network Meta-Analysis.
Level 1 - systematic review of randomized trials
Systematic review and network meta-analysis of randomized controlled trials
PubMed 41851059 · doi:10.1097/HTR.0000000000001155
What was done
A systematic review and network meta-analysis of randomized controlled trials (RCTs) searched across PubMed, Web of Science, Embase, and Cochrane up to November 15, 2025. The study evaluated pharmacological and nonpharmacological interventions for sleep disorders related to traumatic brain injury (TBI). Primary outcomes were the Insomnia Severity Index (ISI), Pittsburgh Sleep Quality Index (PSQI), and Epworth Sleepiness Scale (ESS).
What was found
A total of 22 RCTs involving 1,299 patients were analyzed. Nonpharmacological treatments significantly improved sleep outcomes compared to control treatments, whereas pharmacotherapy did not demonstrate superior efficacy. Reductions in ISI were observed with cognitive behavioral therapy (CBT, 4 trials), acupuncture (2 trials), transcranial direct current stimulation (tDCS, 1 trial), and branched-chain amino acids (BCAA, 1 trial). PSQI improvements were found with CBT (4 trials), acupuncture (2 trials), tDCS (1 trial), hyperbaric oxygen therapy (HBOT, 1 trial), and problem-solving therapy (PST, 1 trial). CBT also improved ESS scores (4 trials). Exact numerical effect sizes, relative rankings, and confidence intervals were not provided in the abstract.
Why it matters
This synthesis provides comparative evidence indicating that behavioral, complementary, and neuromodulatory interventions should be prioritized over pharmacotherapy for sleep disturbances following TBI.
Limits
The abstract reports no numerical effect sizes, confidence intervals, or network consistency metrics. Many interventions (tDCS, BCAA, HBOT, PST) were supported by only a single trial, and the average trial size was small (averaging under 60 participants per study). Risk of bias and adverse effects were not described.
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