Evidence map›Paper›PMID 42768896›Full record

SynthesisBrain and behavior2026

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

K Lofitou, E P Kouki, C Gavriel, H Achilleos, V Themistokleous, P Bargiotas, J Haarbauer-Krupa, E Paraskevopoulos, F Constantinidou

Abstract readSystematic ReviewMeta-Analysis
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in Brain and behavior, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

0numbers the graph read from it
0cells of the map it votes in
0citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

0 citing papers in PubMed.

No citing paper in PubMed yet.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

9 authors.

K LofitouCenter for Applied Neuroscience, University of Cyprus, Nicosia, Cyprus.ORCID https://orcid.org/0009-0003-5140-8399
E P KoukiCenter for Applied Neuroscience, University of Cyprus, Nicosia, Cyprus.
C GavrielDepartment of Psychology, University of Limassol, Limassol, Cyprus.
H AchilleosDepartment of Pediatric Accident & Emergency, Nicosia General Hospital, State Health Services Organization, Nicosia, Cyprus.
V ThemistokleousDepartment of Psychology, University of Cyprus, Nicosia, Cyprus.
P BargiotasMedical School, University of Cyprus, Nicosia, Cyprus.
J Haarbauer-KrupaDepartment of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA.ORCID https://orcid.org/0000-0002-2013-6453
E ParaskevopoulosCenter for Applied Neuroscience, University of Cyprus, Nicosia, Cyprus.
F ConstantinidouCenter for Applied Neuroscience, University of Cyprus, Nicosia, Cyprus.

Funding

Center for Applied Neuroscience, University of Cyprus
6 · The paper itself

Abstract

backgroundSleep-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.

methodFollowing 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.

resultsCBT-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.

conclusionCBT-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.

Indexed as

Brain Injuries, TraumaticCognitive Behavioral TherapySleep Wake DisordersAdolescentChildHumansMelatoninMelatonincognitive behavioral therapy for insomniameta‐analysispediatric traumatic brain injurysleep interventionssleep–wake disturbances

Identifiers

PMID42768896
PMCPMC13594777

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.