Grima Natalie, Ponsford Jennie, Rajaratnam Shantha M, Mansfield Darren, Pase Matthew P
Harvard Medical School Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston, MA.
Monash-Epworth Rehabilitation Research Centre, Melbourne, Australia.
J Clin Sleep Med. 2016 Mar;12(3):419-28. doi: 10.5664/jcsm.5598.
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.
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.
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.
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.
创伤性脑损伤（TBI）后睡眠障碍的报告屡见不鲜；然而，确切的睡眠障碍仍不明确。本荟萃分析旨在描述与对照组相比，社区居住的TBI患者的睡眠障碍情况。
两名研究人员独立对多个电子数据库进行系统检索，检索时间范围从数据库创建至2015年5月27日。如果研究比较了社区居住的TBI个体与无头部损伤的对照人群的睡眠情况，则纳入该研究。数据在荟萃分析中进行合并，结果以标准平均差（SMD）和95%置信区间（CI）表示。主要结果来自多导睡眠图，次要结果来自主观睡眠测量。
纳入16项研究，共637名TBI患者和567名对照，所有患者均为社区居住。汇总的多导睡眠图数据显示，TBI患者的睡眠效率较差（SMD = -0.47，CI：-0.89，-0.06），总睡眠时间较短（SMD = -0.37，CI：-0.59，-0.16），睡眠开始后觉醒时间更长（SMD = 0.60，CI：0.33，0.87）。尽管两组之间的睡眠结构相似，但有趋势表明TBI患者在快速眼动睡眠中的时间可能较少（SMD = -0.22，CI：-0.45，0.01）。与多导睡眠图紊乱一致，TBI患者报告主观困倦感更强，睡眠质量感知更差。
证据表明TBI与广泛的客观和主观睡眠缺陷有关。目前的结果强调医生在TBI后监测和解决睡眠缺陷的必要性。
