REVIEW article
Front. Neurol.
Sec. Sleep Disorders
Volume 16 - 2025 | doi: 10.3389/fneur.2025.1592266
Treatment of Sleep Disorders after Traumatic Brain Injury: A Systematic Review and Network Meta-Analysis
Provisionally accepted
- 1Shanghai University of Traditional Chinese Medicine, Shanghai, China
- 2Chongming Hospital Affiliated to Shanghai University of Medicine & Health Sciences, Shanghai, China
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Background: Traumatic brain injury (TBI) is an alteration in the brain's structure or function as a result of an outside force. Sleep disorders (SDs) following TBI are a common problem that seriously affect quality of life after TBI.Objective: This study used a systematic review and network meta-analysis to compare the efficacy of different interventions in the treatment of TBI-SD.Methods: This study followed the PRISMA statement and was preregistered. Randomized controlled trials of pharmacological or non-pharmacological interventions with a placebo- or active-control design were searched in PubMed, Web of Science, Embase, and Cochrane from inception to May 30, 2025. The ISI score, PSQI score, and ESS score were primary outcome measures. A network meta-analysis was performed using the GeMtc package in R. Changes in the sleep score after different interventions were calculated and expressed as mean difference (MDs) and their 95% credible intervals (95% CrIs).Results: This network meta-analysis of 22 randomized controlled trials based on 1299 patients showed that compared with the control, CBT (MD [95% CrI] = -5.00 [-5.80, -4.10]), acupuncture (MD [95% CrI] = -0.55 [-1.00, -0.04]), tDCS (MD [95% CrI] = - 12.00 [-14.00, -11.00]), and BCAA (MD [95% CrI] = -2.20 [-3.50, -0.83]) significantly improved the ISI score. Compared with the control, CBT (MD [95% CrI] = -2.80 [-3.60, -2.00]), acupuncture (MD [95% CrI]) = -2.10 [-3.80, -0.31]), tDCS (MD [95% CrI] = -9.20 [-11.00, -7.60]), HBOT (MD [95% CrI] = -3.30 [-5.70, -0.98]), and PST (MD [95% CrI] = -1.50 [-2.60, -0.46]) significantly improved the PSQI score. Compared with the control, CBT (MD [95%CrI] = -1.30 [-2.10, -0.35]) significantly improved the ESS score. Pharmacotherapy did not show better efficacy.Conclusion: Notwithstanding the fact that it is imperative to conduct further high-quality studies to confirm this issue, evidence from the present study showed that non-pharmacotherapy appears to be more effective than pharmacotherapy for TBI-SD, with CBT, acupuncture, tDCS, BCAA, and HBOT all efficacious in improving TBI-SD.
Keywords: Traumatic Brain Injury, sleep disorder, cognitive behavioral therapy, transcranial direct current stimulation, Network meta-analysis
Received: 12 Mar 2025; Accepted: 11 Jun 2025.
Copyright: © 2025 Wang, Yan, Zhang, Yang and Zhang. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Hongbo Zhang, Chongming Hospital Affiliated to Shanghai University of Medicine & Health Sciences, Shanghai, China
Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.