Dietch Jessica R, Furst Ansgar J
War Related Illness and Injury Study Center (WRIISC CA), VA Palo Alto Health Care System, Palo Alto, CA, United States.
Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, CA, United States.
Front Neurol. 2020 Oct 7;11:530273. doi: 10.3389/fneur.2020.530273. eCollection 2020.
Mild traumatic brain injury (mTBI) is a significant public health problem. Insomnia is one of the most common symptoms of TBI, occurring in 30-50% of patients with TBI, and is more frequently reported in patients with mild as opposed to moderate or severe TBI. Although insomnia may be precipitated by mTBI, it is unlikely to subside on its own without specific treatment even after symptoms of mTBI reduce or remit. Insomnia is a novel, highly modifiable treatment target in mTBI, treatment of which has the potential to make broad positive impacts on the symptoms and recovery following brain injury. Cognitive-behavioral therapy for insomnia (CBT-I) is the front-line intervention for insomnia and has demonstrated effectiveness across clinical trials; between 70 and 80% of patients with insomnia experience enduring benefit from CBT-I and about 50% experience clinical remission. Examining an existing model of the development of insomnia in the context of mTBI suggests CBT-I may be effective for insomnia initiated or exacerbated by sustaining a mTBI, but this hypothesis has yet to be tested via clinical trial. Thus, more research supporting the use of CBT-I in special populations such as mTBI is warranted. The current paper provides a background on existing evidence for using CBT-I in the context of TBI, raises key challenges, and suggests considerations for future directions including need for increased screening and assessment of sleep disorders in the context of TBI, examining efficacy of CBT-I in TBI, and exploring factors that impact dissemination and delivery of CBT-I in TBI.
轻度创伤性脑损伤（mTBI）是一个重大的公共卫生问题。失眠是TBI最常见的症状之一，在30%-50%的TBI患者中出现，并且在轻度TBI患者中比中度或重度TBI患者更频繁地被报告。虽然失眠可能由mTBI引发，但即使mTBI症状减轻或缓解，如果没有特定治疗，它也不太可能自行消退。失眠是mTBI中一个新的、高度可调节的治疗靶点，对其进行治疗有可能对脑损伤后的症状和恢复产生广泛的积极影响。失眠的认知行为疗法（CBT-I）是失眠的一线干预措施，并且在临床试验中已证明有效；70%-80%的失眠患者从CBT-I中获得持久益处，约50%的患者实现临床缓解。在mTBI背景下审视现有的失眠发展模型表明，CBT-I可能对因遭受mTBI而引发或加重的失眠有效，但这一假设尚未通过临床试验进行验证。因此，需要更多研究来支持在mTBI等特殊人群中使用CBT-I。本文提供了在TBI背景下使用CBT-I的现有证据背景，提出了关键挑战，并对未来方向提出了考虑因素，包括需要在TBI背景下加强对睡眠障碍的筛查和评估、研究CBT-I在TBI中的疗效，以及探索影响CBT-I在TBI中的传播和实施的因素。
