Treatment of Sleep Disorders Following Traumatic Brain Injury: A Systematic Review and Network Meta-Analysis.

Area of Science:

• Neuroscience
• Sleep Medicine
• Rehabilitation

Background:

• Traumatic brain injury (TBI) frequently causes sleep disorders (SDs), diminishing patients' quality of life.
• TBI-related sleep disorders (TBI-SD) represent a significant clinical challenge requiring effective management strategies.

Purpose of the Study:

• To systematically review and conduct a network meta-analysis comparing the efficacy of various interventions for TBI-SD.
• To identify the most effective pharmacological and nonpharmacological treatments for improving sleep in TBI patients.

Main Methods:

• A comprehensive search of PubMed, Web of Science, Embase, and Cochrane databases was performed for randomized controlled trials (RCTs).
• Included RCTs evaluated pharmacological and nonpharmacological treatments for TBI-SD up to November 15, 2025.
• Primary outcome measures included the Insomnia Severity Index (ISI), Pittsburgh Sleep Quality Index (PSQI), and Epworth Sleepiness Scale (ESS).

Main Results:

• Twenty-two RCTs involving 1299 patients were analyzed.
• Nonpharmacological interventions including cognitive behavioral therapy (CBT), acupuncture, transcranial direct current stimulation (tDCS), branched-chain amino acids (BCAA), and hyperbaric oxygen therapy (HBOT) significantly improved sleep outcomes compared to controls.
• CBT, acupuncture, tDCS, and BCAA demonstrated effectiveness in improving ISI scores, while CBT, acupuncture, tDCS, HBOT, and problem-solving therapy (PST) improved PSQI scores. CBT also improved ESS scores. Pharmacotherapy was not found to be superior.

Conclusions:

• Nonpharmacological interventions show promise for managing TBI-related sleep disorders.
• Further high-quality research is warranted to confirm the efficacy and optimal application of these nonpharmacological approaches for TBI-SD.