Traumatic Brain Injury Center of Excellence, Silver Spring, Maryland.
Em Key Solutions, St. Petersburg, Florida.
Prim Care Companion CNS Disord. 2024 Sep 12;26(5):23nr03691. doi: 10.4088/PCC.23nr03691.
To develop an evidence and consensus-based clinical recommendation (CR) regarding primary care management of insufficient and disturbed sleep associated with concussion/mild traumatic brain injury (mTBI) in service members and veterans. A multidisciplinary expert working group (EWG) of 23 subject matter experts was selected by the Defense Health Agency (DHA) Traumatic Brain Injury Center of Excellence (TBICoE), based on relevant expertise and experience, from candidates nominated by DHA communities of interest. The TBICoE core working group (CWG) conducted a literature search using PubMed and Google Scholar databases for articles relevant to sleep and mTBI from 2014 to 2018. Resulting studies were reviewed by the CWG, and questions addressing gaps in the literature were formulated. Questions addressing gaps in the literature were distributed to the EWG, and consensus was achieved over the course of 5 online meetings. Based on the available evidence and EWG consensus, TBICoE developed a draft of the clinical recommendations and submitted it to the EWG for review and feedback. Feedback was adjudicated by TBICoE, and areas of nonconsensus were addressed via email utilizing a modified Delphi method. The evidence and EWG agree that addressing sleep early following mTBI is imperative to promoting recovery and preventing chronic mTBI symptoms, maladaptive sleep behaviors, and chronic sleep disorders. .
为制定一项基于证据和共识的临床推荐意见（CR），以指导现役军人和退伍军人中与脑震荡/轻度创伤性脑损伤（mTBI）相关的初级保健管理中出现的睡眠不足和睡眠障碍问题。根据相关专业知识和经验，由国防卫生局（DHA）创伤性脑损伤卓越中心（TBICoE）选定了一个由 23 名专家组成的多学科专家工作组（EWG），从 DHA 利益相关者提名的候选人中挑选。TBICoE 核心工作组（CWG）使用 PubMed 和 Google Scholar 数据库对 2014 年至 2018 年与睡眠和 mTBI 相关的文章进行了文献检索。由 CWG 对检索到的研究进行了审查，并提出了针对文献空白的问题。针对文献空白的问题分发给 EWG，通过 5 次在线会议达成了共识。根据现有证据和 EWG 的共识，TBICoE 制定了临床推荐意见的草案，并提交给 EWG 进行审查和反馈。TBICoE 对反馈意见进行了裁决，并通过电子邮件利用修改后的 Delphi 方法解决了存在分歧的领域。证据和 EWG 一致认为，在 mTBI 后尽早解决睡眠问题对于促进康复和预防慢性 mTBI 症状、适应不良的睡眠行为和慢性睡眠障碍至关重要。
