Evidence suggests that sleep disturbance is common in patients who have burn injuries and can occur at different stages of their recovery and persist for years. Studies also indicate that pain and itch contribute to the problem and that sleep disturbance can alter patients’ perception of pain and play a role in worsening their discomfort. A systematic review and meta-analysis by Sheera F. Lerman, PhD, and colleagues, published in Sleep Medicine Reviews assessed the prevalence of sleep disturbance in adult burn survivors and evaluated the effects of interventions to improve sleep. “This was the first study to systematically review the body of literature for postburn sleep disturbance and evaluate the evidence for effective intervention to improve sleep,” says Dr. Lerman.
Gaps in Research on Sleep Issues
The systematic review and meta-analysis analyzed data from 49 studies (13 interventional and 36 noninterventional) that enrolled a total of 17,667 participants. “Through multiple studies, we demonstrated the large magnitude of the problem and highlighted the need for additional research to better understand the mechanism by which burn injuries impact sleep, as well as the most effective way to implement interventions to improve sleep and benefit overall quality of life,” says Dr. Lerman (Table). “We found that most of the published sleep data are based on self-report measures, and studies are lacking that use validated sleep scales and objective measures of sleep, such as actigraphy and polysomnography. In addition, data are insufficient on the prevalence of actual sleep disorders, such as insomnia, nightmare disorders, or sleep apnea, although we know that risk factors for poor sleep include pain, itch, large size of burn injury, and female sex.”
Interventions to Improve Sleep Hold Promise
Pharmacological, behavioral/psychological, alternative medicine, and surgical methods were among the approaches to sleep disturbance that were employed in the studies analyzed by Dr. Lerman and team. Although the interventions were so varied, most studies showed that they improved self-reported measures of sleep, such as general sleep quality, sleep continuity, and nightmares. “Early assessment and intervention are key to prevent further negative consequences of poor sleep on physical and emotional health,” explains Dr. Lerman. “Asking patients—especially those at increased risk—about their sleep and referring those with sleep disturbances to appropriate sleep and behavioral sleep medicine clinics is the best way to ensure that patients get access to effective interventions that may have a profound impact on their healing and quality of life.”
Unmet Needs in Treatment & Clinical Trials
The study group found significant gaps in the literature regarding sleep disturbance in patients with burns in assessment of both the impact of the condition and the effectiveness of evidence-based interventions. “Sleep disturbance is largely underdiagnosed and undertreated in patients with burn injuries, yet sleep plays a vital role in their physical and emotional health and recovery,” notes Dr. Lerman. “Improved documentation and assessment of sleep disorders will allow us to better understand the scope of the problem. Objective measures of sleep continuity and sleep architecture with wearable technology should be used in research. Rigorous study also is needed of gold standard interventions and the impact of behavioral and pharmacological methods on patients.”
