Insomnia in spinal cord injury: A meta-analysis of observational studies.

Sleep problems are frequent following spinal cord injury or disease (SCI/D), however the severity of insomnia - including difficulty falling asleep and staying asleep - is not fully understood. Differing assessment methods, variations in diagnostic criteria, and the characteristics of SCI/D may also impact reported prevalence estimates. This PRISMA-guided review synthesizes the available evidence, with consideration of study-level characteristics. The CINAHL, Embase, MEDLINE and PsycINFO databases were searched on March 22nd, 2024 (updated February 12th, 2025), to identify observational studies with an adult SCI/D sample and a validated measure to assess insomnia symptom severity or aid in diagnosis. Studies were appraised (JBI Critical Appraisal tool) and effect size estimates (proportions) meta-analyzed using a random effects model. Nineteen studies (k) representing 11,879 adults with SCI/D, and reporting requisite methodological parameters, were included. Sixty-one percent (CI: 53%-69%; k = 18) endorsed symptoms of insomnia, with 15% (CI: 14%-16%, k = 1) meeting the criteria for insomnia disorder. Findings show routine sleep assessment is needed throughout the continuum of care. There is also a need to consider insomnia as a potential confound in SCI/D research through the active collection of sleep data. Protocol registered on Open Science Framework (https://osf.io/hfr4v).