Journal of Sleep Disorders & Therapy
Open Access

Abstract

Sleep Changes After Acquired Brain Injury and its Impact on Recovery Outcomes: A Scoping Review of Existing Literature

Ethan Leung1*, Lai Gwen Chan2

Background: While sleep and Acquired Brain Injuries (ABI) have an intimate relationship, there are limitations to elucidating the underlying aetiology of sleep disturbances and the effects of sleep on ABI outcomes. Differing disease trajectory, iatrogenic influences and the numerous challenges in sleep research further confound the relationship between sleep and ABI.

Objectives: To summarize the research findings of the relationship between ABI and sleep, and the relationship between post-ABI sleep disturbances and ABI outcomes as well as the methodological limitations that would affect the applicability of the results.

Design: A scoping review was conducted from research published within 5 years from 2019-2023.

Method: Sources of evidence were PubMed, Cumulative Index of Nursing and Allied Health Literature (CINAHL), Cochrane and Embase. MeSH terms used were “sleep and stroke or brain injury” in PubMed and adapted accordingly to other search engines. Studies were included if they met the criteria: Adult sample >21 years old; papers with objective or subjective measures of sleep; papers published within 5 years from 2019-2023; papers that measured sleep after stroke or brain injury; unpublished papers (conference abstracts); translated papers (official translations from other languages); observational or epidemiological quantitative studies.

Result: The search yielded 4336 articles. After 1472 duplicates were removed, 2864 abstracts were screened. 93 articles were found to meet the inclusion criteria. There were ample descriptions of sleep disturbances measured both subjectively and objectively occurring after stroke, but no convincing elucidation of the extent of causality and causal mechanisms of stroke and disturbed sleep. There are also convincing correlations between sleep disturbance and poorer stroke outcomes, however the findings suffer from a lack of clarity of which type of sleep disturbance causes which specific outcome and the lack of a plausible causal mechanism. There is a clear relationship between Traumatic Brain Injuries (TBIs) and sleep related disorders and symptoms. The wide variety of sleep measures and their combinations allowed for a greater breadth of evidence but the heterogeneity in measures used, and methodologies poses a challenge for direct comparison between studies. There is also a general direction towards sleep disturbances having significant effects on patient outcomes, of particular interest would be the time taken to recover post-TBI. Patients were also more likely to experience psychological issues like depression and anxiety with poor sleep.

Conclusion: Future research and interventional trials can only proceed after the dilemma between small low-powered studies using precise but resource-heavy measurements and large high-powered studies using imprecise measurements can be satisfactorily resolved and there is more detailed understanding of post-ABI sleep pathophysiology in humans.

Published Date: 2024-12-23; Received Date: 2024-11-21