A Systematic Review of Psychological Interventions for Sleep and Fatigue after Mild Traumatic Brain Injury

This review evaluated the evidence for psychological interventions to improve sleep and reduce fatigue after mild traumatic brain injury (mTBI). Eight electronic databases were searched up until August 2016 for studies that: 1) included adults; 2) tested intervention effectiveness on sleep quality and fatigue post-acutely; and 3) applied a broadly-defined psychological intervention (e.g., cognitive behavioral therapy [CBT], counseling, or education). Only randomized controlled trials were eligible for inclusion. Of the 698 studies identified, four met the eligibility criteria and underwent data extraction. These studies were assessed for risk of bias by two independent reviewers using the Scottish Intercollegiate Guidelines Network Methodology Checklist 2 for randomized controlled trials. One study applied CBT and three studies used enhanced education to improve outcomes. Limited evidence and methodological bias prevents strong conclusions about the effectiveness of psychological interventions for sleep and fatigue after mTBI. All but one study targeted general post-concussion symptoms rather than sleep or fatigue specifically. This runs the risk that the potential benefits of a targeted approach are underestimated in this literature, and future sleep- and fatigue-focused interventions are recommended. It is tentatively concluded that compared with standard care or the provision of generic advice, small improvements in sleep and fatigue are observed through psychological intervention post-mTBI.