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

Study objectives: Sleep disturbances are common in patients with traumatic brain injury (TBI). Actigraphy can provide an objective and naturalistic assessment of sleep patterns in patients with TBI. 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 TBI and controls.

Methods: 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 TBI and controls were included. Actigraphy-based sleep measures, including nighttime and 24-h total sleep time (TST), sleep onset latency (SOL), wake after sleep onset (WASO), sleep efficiency (SE), 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 (MDs) and 95% confidence intervals (95% CIs).

Results: Twenty-three studies involving 881 patients with TBI and 769 controls were included. Compared to controls, patients with TBI showed significantly longer SOL, more WASO, poorer sleep efficiency, and increased night-to-night variability in TST and WASO.

Conclusions: Patients with TBI 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.