Sleep in patients with traumatic brain injury: a systematic review and meta-analysis of actigraphy studies

Sleep disturbances are common in patients with traumatic brain injury. Actigraphy can provide an objective and naturalistic assessment of sleep patterns in patients with traumatic brain injury. Yet, the evidence of objective sleep-wake abnormalities using actigraphy in this clinical population remained unclear. To explore whether there might be differences in actigraphy-based sleep measures between patients with traumatic brain injury and controls.

An electronic systematic literature search was conducted using the following databases: PubMed, EMBASE, and PsycINFO, from inception to December 2023. Studies that used actigraphy to measure sleep-wake patterns objectively in patients with traumatic brain injury and controls were included. Actigraphy-based sleep measures, including nighttime and 24-h total sleep time, sleep onset latency, wake after sleep onset, sleep efficiency, and their night-to-night variability were extracted and synthesized. Effect sizes for actigraphy-assessed sleep measures were calculated and presented as the mean differences and 95% confidence intervals.

Twenty-three studies involving 881 patients with traumatic brain injury and 769 controls were included. Compared to controls, patients with traumatic brain injury showed significantly longer sleep onset latency, more wake after sleep onset, poorer sleep efficiency, and increased night-to-night variability in total sleep time and wake after sleep onset.

Patients with traumatic brain injury demonstrated abnormalities in several actigraphy-assessed sleep measures compared with controls. The findings underscored the importance of developing target sleep interventions, particularly focusing on addressing night-to-night sleep variability, to meet the specific needs of this clinical population. Statement of Significance This study found significant sleep-wake abnormalities as assessed by actigraphy in patients with traumatic brain injury (TBI). As compared to controls, patients with TBI show longer sleep onset latency, increased wake after sleep onset, poorer sleep efficiency, and greater night-to-night variability in total sleep time and wake after sleep onset. These findings underscore the significant impact of TBI on sleep and highlight the importance of targeted sleep interventions for patients with TBI, with a special emphasis on managing night-to-night sleep variability.