title: Sleep Disturbances in Traumatic Brain Injury: A Meta-Analysis.
abstract: OBJECTIVE
  Sleep disturbances are frequently reported following traumatic brain injury (TBI); however, the exact disturbances remain unclear. This meta-analysis aimed to characterize sleep disturbance in community dwelling patients with TBI as compared to controls.
  
  
  METHODS
  Two investigators independently conducted a systematic search of multiple electronic databases from inception to May 27, 2015. Studies were selected if they compared sleep in community dwelling individuals with TBI relative to a control population without head injury. Data were pooled in meta-analysis with outcomes expressed as the standard mean difference (SMD) and 95% confidence interval (CI). The primary outcomes were derived from polysomnography and secondary outcomes were derived from subjective sleep measures.
  
  
  RESULTS
  Sixteen studies were included, combining 637 TBI patients and 567 controls, all of whom were community dwelling. Pooled polysomnography data revealed that TBI patients had poorer sleep efficiency (SMD = -0.47, CI: -0.89, -0.06), shorter total sleep duration (SMD = -0.37, CI: -0.59, -0.16), and greater wake after sleep onset time (SMD = 0.60, CI: 0.33, 0.87). Although sleep architecture was similar between the groups, a trend suggested that TBI patients may spend less time in REM sleep (SMD = -0.22, CI: -0.45, 0.01). Consistent with polysomnographic derangement, TBI patients reported greater subjective sleepiness and poorer perceived sleep quality.
  
  
  CONCLUSIONS
  The evidence suggests that TBI is associated with widespread objective and subjective sleep deficits. The present results highlight the need for physicians to monitor and address sleep deficits following TBI.
authors.affiliation: Harvard Medical School Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston, MA.|Monash-Epworth Rehabilitation Research Centre, Melbourne, Australia.|School of Psychological Sciences and Institute for Cognitive and Clinical Neurosciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Australia.
authors.forename: Natalie
authors.initials: N
authors.lastname: Grima
authors.affiliation: Monash-Epworth Rehabilitation Research Centre, Melbourne, Australia.|School of Psychological Sciences and Institute for Cognitive and Clinical Neurosciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Australia.
authors.forename: Jennie
authors.initials: J
authors.lastname: Ponsford
authors.affiliation: School of Psychological Sciences and Institute for Cognitive and Clinical Neurosciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Australia.|Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA.|Division of Sleep Medicine, Department of Medicine, Harvard Medical School, Boston, MA.
authors.forename: Shantha M
authors.initials: SM
authors.lastname: Rajaratnam
authors.affiliation: Monash Lung and Sleep, Monash Health, Australia.|School of Psychological Sciences and Institute for Cognitive and Clinical Neurosciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Australia.
authors.forename: Darren
authors.initials: D
authors.lastname: Mansfield
authors.affiliation: Department of Neurology, Boston University School of Medicine & Framingham Heart Study, Boston, MA.|Centre for Human Psychopharmacology, Swinburne University of Technology, Hawthorn, Australia.
authors.forename: Matthew P
authors.initials: MP
authors.lastname: Pase
mesh_terms: D000070642:Brain Injuries, Traumatic / Q000150:complications*; D006801:Humans; D012893:Sleep Wake Disorders / Q000209:etiology*; D011795:Surveys and Questionnaires
keywords: TBI; brain injury; polysomnography; sleep; traumatic brain injury