Comparative efficacy and acceptability of pharmacological treatments for insomnia in adults: a systematic review and network meta-analysis

Crescenzo, Franco De; Foti, Francesca; Ciabattini, Marco; Giovane, Cinzia Del; Watanabe, Norio; Schepisi, Monica Sañé; Quested, Digby; Cipriani, Andrea; Barbui, Corrado; Amato, Laura

doi:10.1002/14651858.cd012364

Cited by 11 publications

(8 citation statements)

References 86 publications

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“… 29 Additionally, a network meta-analysis is being conducting to compare the efficacy and acceptability of all pharmacological treatments for insomnia among adults. 30 These SRs will be useful both for healthcare professionals and for patients, to aid in decision-making.…”

Section: Discussionmentioning

confidence: 99%

What do Cochrane systematic reviews say about interventions for insomnia?

et al. 2018

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Section: Discussionmentioning

confidence: 99%

What do Cochrane systematic reviews say about interventions for insomnia?

et al. 2018

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“…Placebo, no treatment, or active controls, including conventional medication, were allowed as control interventions. The inclusion for conventional medication was as follow according to the Cochrane NMA review protocol of pharmacological treatments for insomnia ( 30 ): antidepressants (amitriptyline, doxepin, mirtazapine, and trazodone), benzodiazepines (brotizolam, clonazepam, diazepam, estazolam, flunitrazepam, flurazepam, haloxazolam, loprazolam, lorazepam, lormetazepam, midazolam, nimetazepam, nitrazepam, quazepam, rilmazafone, temazepam, and triazolam), benzodiazepine-like agents (eszopiclone, zaleplon, zolpidem, and zopiclone), melatoninergic drugs (melatonin and ramelteon), and orexin receptor antagonists (suvorexant). For the combined treatment study, up to two combinations of defined interventions for the intervention group and control group (e.g., CBT-I plus walking, relaxation plus benzodiazepines) were allowed.…”

Section: Methodsmentioning

confidence: 99%

Non-pharmacological Treatment for Elderly Individuals With Insomnia: A Systematic Review and Network Meta-Analysis

et al. 2021

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Background: Insomnia causes a huge socioeconomic burden among the elderly, and is not simply a health problem. This study aimed to determine the comparative advantage of the effectiveness and acceptability of non-pharmacological interventions available for elderly individuals with insomnia.Methods: Comprehensive searches in 13 medical databases were performed to find relevant randomized controlled trials (RCTs) up to August 2019. Two independent reviewers performed study selection, data extraction, and quality assessment of included RCTs using the Cochrane Collaboration's risk of bias. A network meta-analysis within the frequentist model was performed by combining direct and indirect evidence from all available RCTs. The primary outcomes were effectiveness as measured by the Pittsburgh Sleep Quality Index (PSQI) total score and acceptability by the incidence of all-cause drop-out.Results: Twenty-eight RCTs involving 2,391 participants were included. Compared to wait-list, acupuncture (standardized mean difference −4.37, 95% confidence interval −8.53 to −0.12), acupuncture combined with benzodiazepines (−5.20, −9.82 to −0.57), behavioral therapy (−10.44, −17.31 to −3.58), benzodiazepines (−4.28, −8.45 to −0.11), benzodiazepines combined with cognitive behavioral therapy (CBT) (−7.18, −12.17 to −2.19), and CBT (−4.93, −8.63 to −1.22) showed significant superiority in their effectiveness. No significant comparative superiority or inferiority was found in terms of acceptability.Conclusions: In terms of effectiveness as indicated by the PSQI total score, compared to wait-list, superior benefits were observed for acupuncture, acupuncture combined with benzodiazepines, behavioral treatment, benzodiazepines, benzodiazepines combined with CBT, and CBT. Importantly, combined treatments, including benzodiazepines combined with CBT or with acupuncture, were generally superior to other monotherapies. In terms of acceptability, there was not enough data to draw conclusions. However, most RCTs included had methodological problems related to the lack of blinding procedure, suggesting a risk of effect size overestimation.Registration: CRD42019145518.

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“…Several aspects of insomnia (defined in TABLE 2 [31][32][33] ) are targeted as outcome measures when treating patients. Sleep-onset latency, total sleep time, and wake-after-sleep onset are all formally measured by polysomnography.…”

Section: Measuring Sleep Performancementioning

confidence: 99%

“…Sleep-onset latency, total sleep time, and wake-after-sleep onset are all formally measured by polysomnography. [31][32][33] Use polysomnography when you suspect OSA, narcolepsy, idiopathic hypersomnia, periodic limb movement disorder, RLS, REM behavior disorder (characterized by the loss of normal muscle atonia and dream enactment behavior that is violent in nature 34 ), or parasomnias. Home polysomnography testing is appropriate for adult patients who meet criteria for OSA and have uncomplicated insomnia.…”

Section: Measuring Sleep Performancementioning

confidence: 99%

“…Poor sleep hygiene can contribute to insomnia but does not cause it. 31 Healthy sleep habits include keeping the sleep environment quiet, free of interruptions, and at an adequate temperature; adhering to a regular sleep schedule; avoiding naps; going to bed when drowsy; getting out of bed if not asleep within 15 to 20 minutes and returning when drowsy; exercising regularly; and avoiding caffeine, nicotine, alcohol, and other substances that interfere with sleep. 24 Technology use prior to bedtime is prevalent and associated with sleep and circadian rhythm disturbances.…”

Section: Nonpharmacologic Interventions ❚ Sleep Hygienementioning

confidence: 99%

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