Background: Traumatic brain injury (TBI) often leads to sleep disorders (SDs), which significantly impact quality of life. This study aimed to compare the efficacy of various interventions for TBI-related sleep disorders (TBI-SD) through a systematic review and network meta-analysis.
Methods: PubMed, Web of Science, Embase, and Cochrane were comprehensively searched for randomized controlled trials (RCTs) on pharmacological and nonpharmacological treatments up to November 15, 2025. Primary outcomes were the Insomnia Severity Index (ISI), Pittsburgh Sleep Quality Index (PSQI), and Epworth Sleepiness Scale (ESS) scores.
Results: A total of 22 RCTs were included, involving 1299 patients. The results showed that nonpharmacological treatments, such as cognitive behavioral therapy (CBT), acupuncture, transcranial direct current stimulation (tDCS), branched-chain amino acids (BCAA), and hyperbaric oxygen therapy (HBOT), all significantly improved sleep outcomes compared with control treatments. Specifically, CBT (4 trials), acupuncture (2 trials), tDCS (1 trial), and BCAA (1 trial) were particularly effective in improving the ISI score, whereas CBT (4 trials), acupuncture (2 trials), tDCS (1 trial), HBOT (1 trial), and problem-solving therapy (PST 1 trial) showed significant effects in improving PSQI score. Furthermore, CBT (4 trials) was found to improve the ESS score. Pharmacotherapy did not demonstrate superior efficacy.
Conclusion: These findings suggest that nonpharmacological interventions might be effective for managing TBI-SD, although further high-quality research is needed to confirm these results.
Keywords: cognitive behavioral therapy; network meta-analysis; sleep disorder; transcranial direct current stimulation; traumatic brain injury.
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