What type of study is this?

This is a Meta-Analysis study (also classified as: Systematic Review).

What question did this study set out to answer?

To assess the efficacy of non-pharmacologic therapies on sleep disturbances following traumatic brain injury.

May 7, 2026

Non-pharmacologic therapies for sleep disturbances after traumatic brain injury: a systematic review and meta-analysis

Key Points

To assess the efficacy of non-pharmacologic therapies on sleep disturbances following traumatic brain injury.
Systematic review and meta-analysis of randomised controlled trials
Searched databases include PubMed, APA PsycInfo, PsychArticles, Medline Complete, and CINAHL Plus
Outcomes measured: sleep quality, daytime sleepiness, and dysfunction using validated scales
CBT significantly improved sleep quality (PSQI) by an average of 3.44 points
CBT also improved daytime sleepiness (ESS) with a mean difference of -1.45
Evidence for HBO2, BWLT, and rTMS showed low efficacy and high variability, with HBO2 linked to increased mild ear barotrauma risk

Abstract

Background Sleep disturbances are common after traumatic brain injury (TBI), yet there are no guidelines specific to non-pharmacologic management in this population. Objective To evaluate whether adults with post-TBI sleep disturbances benefit from commonly described non-pharmacologic therapies – cognitive behavioural therapy (CBT) (including for insomnia, CBT-I), hyperbaric oxygen (HBO2), blue-wavelength light therapy (BWLT) and repetitive transcranial magnetic stimulation (rTMS) – with attention to both statistical and minimally clinically important differences (MCIDs). Methods A systematic review (registered with the International Prospective Register of Systematic Reviews) and meta-analysis of randomised controlled trials (RCTs) were used. Databases (PubMed, APA PsycInfo and PsychArticles, Medline Complete, CINAHL Plus) were originally searched in October 2023 and updated in PubMed on 14 March 2026. The searches were conducted separately for each intervention. Outcomes included sleep quality and duration (Pittsburgh Sleep Quality Index, PSQI; Insomnia Severity Index, ISI; actigraphy), daytime sleepiness (Epworth Sleepiness Scale, ESS) and daytime dysfunction. The quality of evidence was appraised using the Grading of Recommendations, Assessment, Development, and Evaluation approach. Results Twelve RCTs met inclusion criteria. CBT significantly improved PSQI (MD: −3.44), ISI at 6–8 weeks (mean difference, MD: −2.23) and 12–16 weeks (MD: −0.91) and ESS (MD: −1.45) at 16 weeks. Only the change in PSQI reached the MCID. Evidence for HBO2, BWLT and rTMS remained very low, with small samples and heterogeneity precluding definitive conclusions regarding sleep outcomes; HBO2 showed a higher risk of mild ear barotrauma v. sham (relative risk: 2.66). Conclusions CBT/CBT-I appears to improve sleep quality and daytime sleepiness in adults with TBI; online CBT-I (eCBT-I) may expand access. The paucity and heterogeneity of trials for HBO2, BWLT and rTMS precludes definitive conclusions for proposed outcomes. Larger RCTs with standardised protocols are needed.

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