The efficacy of cognitive behavioral therapy for sleep disorders following acquired brain injury: a systematic review and meta-analysis.

BACKGROUND

Sleep disturbances are highly prevalent among individuals with acquired brain injury (ABI)and pose a significant barrier to both functional recovery and long-term quality of life. Cognitive Behavioral Therapy (CBT), a widely validated non-pharmacological intervention, has demonstrated robust efficacy in managing sleep disorders across diverse populations. However, its therapeutic effectiveness in individuals with brain injuries has yet to be systematically evaluated.

OBJECTIVE

This study aimed to systematically evaluate and meta-analyze the efficacy of CBT for sleep disturbances following ABI, with a specific focus on its effectiveness across distinct sleep domains and the influence of intervention modalities.

METHODS

A comprehensive and systematic search of the Cochrane Library, Embase, OVID, PubMed, Web of Science, and CINAHL databases was conducted to identify randomized controlled trials (RCTs) evaluating the efficacy of CBT for sleep disturbances in individuals with ABI. Meta-analyses were performed using RevMan version 5.4, calculating pooled effect sizes as standardized mean differences (SMD) or mean differences (MD), with evaluation of heterogeneity and subsequent sensitivity and subgroup analyses.

RESULTS

Eight RCTs were included in the analysis. The pooled results demonstrated that CBT significantly alleviated sleep disturbances in individuals with ABI (SMD = -0.95, 95 % CI: -1.47 to -0.43, P = 0.0003). In specific sleep domains, CBT improved subjective sleep quality (MD = -2.34, 95 % CI: -3.23 to -1.45, P < 0.00001), reduced insomnia symptoms (MD = -3.46, 95 % CI: -4.27 to -2.64, P < 0.00001), and increased objective sleep efficiency (SMD = -0.38, 95 % CI: -0.67 to -0.09, P = 0.01). Subgroup analyses indicated that both traditional CBT and eCBT yielded significant improvements, with no statistically significant differences observed between the two modalities.

CONCLUSIONS

CBT appears to be an effective and safe intervention for improving sleep disturbances in individuals with ABI, with considerable potential for broader clinical adoption. Both face-to-face and digital CBT modalities may be recommended as viable therapeutic strategies for this population. Future research involving larger sample sizes and extended follow-up periods is warranted to further validate the effectiveness of CBT and refine intervention protocols.