Conservative interventions can enhance the standard of sleep of sufferers after TBI, stroke

Psychotherapy-based approaches and acupuncture may allow some patients with acquired brain injury to sleep better, research results published in Disability and Rehabilitation show. In addition, patients with a history of stroke after acupuncture may have less insomnia.

Researchers in the UK looked at published experimental studies to determine which conservative interventions could improve sleep in adults with a history of stroke or traumatic brain injury (TBI), the leading causes of acquired brain injury in Europe.

The research team used Embase, PubMed, and the Cochrane Library to find peer-reviewed published original experimental studies published through March 28, 2020 that looked at conservative interventions to improve sleep or sleep disorders in patients aged 16 years and older from stroke (ischemic or hemorrhagic in the brain) or TBI (any severity), either in a hospital or in a community.

The studies had to evaluate sleep objectively or through a formal sleep questionnaire or a sleep-wake diary. They excluded case reports, studies using pharmacological or ventilatory treatments to improve sleep or sleep disorders, and articles that rated only daytime sleepiness (unless hypersomnia was officially diagnosed).

Of the 23 studies identified, 19 were originally randomized controlled trials (RCTs) and 4 were pre-post designs. The neurological diagnosis was stroke in 7 studies and TBI in 16 studies. 5 studies were conducted during early hospital or inpatient rehabilitation while the majority were conducted in a community or outpatient setting.

Compared to baseline in studies of psychotherapy-based interventions in adults with a history of TBI, patients showed improved sleep efficiency (77.2% versus 88%; P <0.017) or one after 8 weekly sessions of cognitive behavioral therapy (CBT) for insomnia Reduction in Insomnia Severity (ISI) (17.6 vs. 8.8; P <0.017) in an outpatient setting according to sleep-wake diaries and the ISI, and after 3 months (sleep efficiency 90.9)%; ISI 10.3; P <0.017 for both).

In another study that followed 8 weekly CBT sessions, the Pittsburgh Sleep Quality Index (PSQI) (standardized mean difference 3.1; 95% CI 1.5-4.7) and ISI values ​​(standardized mean Difference 3.12; 95% CI 1.29-4.95) also improved significantly and was retained during the 2-month follow-up examination (standardized mean difference 4.85 [95% CI, 2.56–7.14] and 5.96 [95% CI, 3–8.93], respectively).

In 2 studies with patients with a history of stroke, intradermal acupuncture over 2 days improved sleep latency (126.7 ± 128.7 versus 186 ± 141.3 minutes) and the quality of sleep in the morning questionnaire (57.3 ± 24.6 versus 22nd) , 7 ± 18.3) and the ISI (14.9) ± 5.5) and Athens Insomnia Scale Scores (10.6 ± 5.1 vs 15.6 ± 3.8) compared to a placebo group. When patients received intradermal acupuncture for 3 days versus placebo, the ISI scores (mean difference 5.4 versus 1.6; P <0.001) and Athens Insomnia Scale scores (mean difference 4.6 versus 1) also improved , 2; P <0.001).

In a pilot study in adults with a history of TBI and reported insomnia, adults who received acupuncture showed significant reductions after treatment (Z = -3.07, P <0.01) and after 1 month of follow-up (Z) of the ISI value = -3.07, P <0.01).

The limitations of the study included only 1 author doing the initial literature research and primary screening of articles, including English publications only, and reporting secondary measures of outcome.

The study’s researchers concluded that “psychotherapy-based approaches may be useful for post-TBI sleep disorders and that acupuncture can help improve insomnia or post-stroke or TBI insomnia”. However, further studies may also want to examine interventions earlier after injury and use a combination of subjective and objective measures to assess sleep disorders and specific sleep disorders. ”


Lowe A., Bailey M, O’Shaughnessy T, Macavei V. Treatment of sleep disorders after stroke and traumatic brain injury: a systematic review of conservative interventions. Disable Rehabil. Published online on December 11, 2020. doi: 10.1080 / 09638288.2020.1856948

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