Sleep-Wake Disturbances in Pediatric Traumatic Brain Injury: A Systematic Review and Meta-Analysis of Interventions.

BACKGROUND

Sleep-wake disturbances (SWD) are frequent and persistent complications following pediatric traumatic brain injury (TBI), negatively affecting cognitive, emotional, and academic outcomes. This systematic review and meta-analysis aimed to evaluate the effectiveness of behavioral, pharmacological, and emerging interventions for SWD in children and adolescents with mild to severe TBI and examined related sleep outcomes and functional measures.

METHOD: Following PRISMA guidelines, a systematic search was conducted across PubMed, Web of Science, and ScienceDirect for studies published between 1998 and 2025. Nineteen studies (N = 1113) met inclusion criteria, encompassing cognitive behavioral therapy for insomnia (CBT-I), sleep hygiene, mindfulness, pharmacological treatments (melatonin, branched-chain amino acids), physical activity, and family-based interventions. Meta-analytic models using random effects were employed to calculate pooled standardized mean differences and mean raw scores across sleep, cognitive, and quality-of-life outcomes.

RESULTS

CBT-I demonstrated efficacy in reducing persistent post-concussion symptoms and improving subjective sleep outcomes, although heterogeneity varied across outcomes. In contrast, melatonin did not produce statistically significant pooled effects on persistent post-concussion symptoms or cognitive outcomes, and treatment effects varied across dosage groups. Few studies examined mindfulness or educational outcomes, revealing key research gaps. Discrepancies between objective (actigraphy) and subjective (self-report) measures emphasized the need for multi-method sleep assessment.

CONCLUSION

CBT-I is the most consistently effective intervention for sleep problems following pediatric TBI. Melatonin showed mixed and nonsignificant pooled effects, indicating that its role in pediatric TBI recovery requires further investigation. Future research should focus on personalized, multidisciplinary treatment models integrating behavioral, pharmacological, and rehabilitative approaches to optimize long-term neurocognitive and educational outcomes.