Treatment of Post-Concussion Sleep Disturbances in Children and Adults: A Scoping Review

OBJECTIVE: To provide a comprehensive summary of the existing literature that describes treatment options for post-concussion sleep disturbances in children and adults. CONTEXT: Studies have shown that 30%-70% of individuals who sustain a concussion develop a post-injury sleep disturbance. The presence of sleep disturbance contributes to prolonged recovery from concussion and poorer long-term outcomes. Thus, identifying effective treatments for post-concussion sleep disturbances is essential to reduce the burden of persisting post-concussion symptoms. DESIGN: Scoping review. METHODS: A systematic literature search was conducted in MEDLINE, Embase, CINAHL, Web of Science, and ProQuest Dissertations & Theses Global. Two reviewers screened titles and abstracts, then full-text articles against the inclusion and exclusion criteria. Primary studies that investigated at least 1 treatment for post-concussion sleep disturbances were included. RESULTS: Of the 3660 articles yielded from the initial search, 19 were included in this review. The most commonly studied intervention was CBT (n = 3), followed by blue-light therapy (n = 2), photobiomodulation (n = 2), and melatonin (n = 2). Other treatments included an educational intervention, trauma-focused psychotherapy, 2 novel forms of psychotherapy, acoustic neuromodulation, multisensory integration therapy, gabapentin, hand self-shiatsu, interdisciplinary rehabilitation, and music therapy. The most common study design was a randomized controlled trial (n = 8, 42%). Over half of the studies (n = 13, 68%) used pre-existing validated scoring tools as subjective measures of sleep. Only 4 studies were conducted exclusively in children 18 years and younger. CONCLUSION: This review supports current guidelines that recommend CBT as a first-line therapy for post-concussion sleep disturbances. However, higher-quality evidence is needed before other interventions should be incorporated into routine practice, particularly for children. Future research should consider the impact of other post-concussion symptoms on adherence to sleep-promoting therapies.