BACKGROUND: Insomnia is a common problem in modern society. It is associated with reduced quality of life and impairments in physical and mental health. Listening to music is widely used as a sleep aid, but it remains unclear if it can actually improve insomnia in adults. This Cochrane Review is an update of a review published in 2015.
OBJECTIVES: To assess the effects of listening to music on sleep in adults with insomnia and to assess the influence of specific variables that may moderate the effect.
SEARCH METHODS: For this update, we searched CENTRAL, MEDLINE, Embase, nine other databases and two trials registers up to December 2021. In addition, we handsearched reference lists of included studies, and contacted authors of published studies to identify additional studies eligible for inclusion, including any unpublished or ongoing trials.
SELECTION CRITERIA: Randomised controlled trials comparing the effects of listening to music with no treatment or treatment as usual (TAU) in adults complaining of sleep difficulties.
DATA COLLECTION AND ANALYSIS: Two review authors independently screened records for eligibility, selected studies for inclusion, extracted data and assessed risk of bias of the included studies. We assessed the certainty of the evidence using GRADE. The primary outcomes were sleep quality, insomnia severity, sleep-onset latency, total sleep time, sleep interruption, sleep efficiency and adverse events. Data on the predefined outcome measures were included in meta-analyses when consistently reported by at least two studies that were homogeneous in terms of participants, interventions and outcomes. We undertook meta-analyses using random-effects models.
MAIN RESULTS: We included 13 studies (eight studies new to this update) comprising 1007 participants. The studies examined the effect of listening to prerecorded music daily, for 25 to 60 minutes, for a period of three days to three months. The risk of bias within the studies varied, with all studies being at high risk of performance bias, because of limited possibilities to blind participants to the music intervention. Some studies were at high risk of detection bias or other bias. Four studies reported funding from national research councils, three studies reported financial support from university sources and one study reported a grant from a private foundation. Five studies did not report any financial support. At the end of the intervention, we found moderate-certainty evidence for improved sleep quality measured with the Pittsburgh Sleep Quality Index (PSQI) in themusic groups compared to no intervention or TAU (mean difference (MD) -2.79, 95% confidence interval (CI) -3.86 to -1.72; 10 studies, 708 participants). The PSQI scale ranges from 0 to 21 with higher scores indicating poorer sleep. The size of the effect indicates an increase in sleep quality of the size of about one standard deviation in favour of the intervention. We found no clear evidence of a difference in the effects of listening to music compared to no treatment or TAU on insomnia severity (MD -6.96, 95% CI -15.21 to 1.28; 2 studies, 63 participants; very low-certainty evidence). We found low-certainty evidence that, compared to no treatment or TAU, listening to music may reduce problems with sleep-onset latency (MD -0.60, 95% CI -0.83 to -0.37; 3 studies, 197 participants), total sleep time (MD -0.69, 95% CI -1.16 to -0.23; 3 studies, 197 participants) and sleep efficiency (MD -0.96, 95% CI -1.38 to -0.54; 3 studies, 197 participants), but may have no effect on perceived sleep interruption (MD -0.53, 95% CI -1.47 to 0.40; 3 studies, 197 participants). In addition, three studies (136 participants) included objective measures of sleep-onset latency, total sleep time, sleep efficiency and sleep interruption and showed that listening to music may not improve these outcomes compared to no treatment or TAU. None of the included studies reported any adverse events.
AUTHORS' CONCLUSIONS: The findings of this review provide evidence that music may be effective for improving subjective sleep quality in adults with symptoms of insomnia. More research is needed to establish the effect of listening to music on other aspects of sleep as well as the daytime consequences of insomnia.
BACKGROUND: Sleep disturbances, including reduced nocturnal sleep time, sleep fragmentation, nocturnal wandering, and daytime sleepiness are common clinical problems in dementia, and are associated with significant carer distress, increased healthcare costs, and institutionalisation. Although non-drug interventions are recommended as the first-line approach to managing these problems, drug treatment is often sought and used. However, there is significant uncertainty about the efficacy and adverse effects of the various hypnotic drugs in this clinically vulnerable population.
OBJECTIVES: To assess the effects, including common adverse effects, of any drug treatment versus placebo for sleep disorders in people with dementia.
SEARCH METHODS: We searched ALOIS (www.medicine.ox.ac.uk/alois), the Cochrane Dementia and Cognitive Improvement Group's Specialized Register, on 19 February 2020, using the terms: sleep, insomnia, circadian, hypersomnia, parasomnia, somnolence, rest-activity, and sundowning.
SELECTION CRITERIA: We included randomised controlled trials (RCTs) that compared a drug with placebo, and that had the primary aim of improving sleep in people with dementia who had an identified sleep disturbance at baseline.
DATA COLLECTION AND ANALYSIS: Two review authors independently extracted data on study design, risk of bias, and results. We used the mean difference (MD) or risk ratio (RR) with 95% confidence intervals (CI) as the measures of treatment effect, and where possible, synthesised results using a fixed-effect model. Key outcomes to be included in our summary tables were chosen with the help of a panel of carers. We used GRADE methods to rate the certainty of the evidence.
MAIN RESULTS: We found nine eligible RCTs investigating: melatonin (5 studies, n = 222, five studies, but only two yielded data on our primary sleep outcomes suitable for meta-analysis), the sedative antidepressant trazodone (1 study, n = 30), the melatonin-receptor agonist ramelteon (1 study, n = 74, no peer-reviewed publication), and the orexin antagonists suvorexant and lemborexant (2 studies, n = 323). Participants in the trazodone study and most participants in the melatonin studies had moderate-to-severe dementia due to Alzheimer's disease (AD); those in the ramelteon study and the orexin antagonist studies had mild-to-moderate AD. Participants had a variety of common sleep problems at baseline. Primary sleep outcomes were measured using actigraphy or polysomnography. In one study, melatonin treatment was combined with light therapy. Only four studies systematically assessed adverse effects. Overall, we considered the studies to be at low or unclear risk of bias. We found low-certainty evidence that melatonin doses up to 10 mg may have little or no effect on any major sleep outcome over eight to 10 weeks in people with AD and sleep disturbances. We could synthesise data for two of our primary sleep outcomes: total nocturnal sleep time (TNST) (MD 10.68 minutes, 95% CI -16.22 to 37.59; 2 studies, n = 184), and the ratio of day-time to night-time sleep (MD -0.13, 95% CI -0.29 to 0.03; 2 studies; n = 184). From single studies, we found no evidence of an effect of melatonin on sleep efficiency, time awake after sleep onset, number of night-time awakenings, or mean duration of sleep bouts. There were no serious adverse effects of melatonin reported. We found low-certainty evidence that trazodone 50 mg for two weeks may improve TNST (MD 42.46 minutes, 95% CI 0.9 to 84.0; 1 study, n = 30), and sleep efficiency (MD 8.53%, 95% CI 1.9 to 15.1; 1 study, n = 30) in people with moderate-to-severe AD. The effect on time awake after sleep onset was uncertain due to very serious imprecision (MD -20.41 minutes, 95% CI -60.4 to 19.6; 1 study, n = 30). There may be little or no effect on number of night-time awakenings (MD -3.71, 95% CI -8.2 to 0.8; 1 study, n = 30) or time asleep in the day (MD 5.12 minutes, 95% CI -28.2 to 38.4). There were no serious adverse effects of trazodone reported. The small (n = 74), phase 2 trial investigating ramelteon 8 mg was reported only in summary form on the sponsor's website. We considered the certainty of the evidence to be low. There was no evidence of any important effect of ramelteon on any nocturnal sleep outcomes. There were no serious adverse effects. We found moderate-certainty evidence that an orexin antagonist taken for four weeks by people with mild-to-moderate AD probably increases TNST (MD 28.2 minutes, 95% CI 11.1 to 45.3; 1 study, n = 274) and decreases time awake after sleep onset (MD -15.7 minutes, 95% CI -28.1 to -3.3: 1 study, n = 274) but has little or no effect on number of awakenings (MD 0.0, 95% CI -0.5 to 0.5; 1 study, n = 274). It may be associated with a small increase in sleep efficiency (MD 4.26%, 95% CI 1.26 to 7.26; 2 studies, n = 312), has no clear effect on sleep latency (MD -12.1 minutes, 95% CI -25.9 to 1.7; 1 study, n = 274), and may have little or no effect on the mean duration of sleep bouts (MD -2.42 minutes, 95% CI -5.53 to 0.7; 1 study, n = 38). Adverse events were probably no more common among participants taking orexin antagonists than those taking placebo (RR 1.29, 95% CI 0.83 to 1.99; 2 studies, n = 323).
AUTHORS' CONCLUSIONS: We discovered a distinct lack of evidence to guide decisions about drug treatment of sleep problems in dementia. In particular, we found no RCTs of many widely prescribed drugs, including the benzodiazepine and non-benzodiazepine hypnotics, although there is considerable uncertainty about the balance of benefits and risks for these common treatments. We found no evidence for beneficial effects of melatonin (up to 10 mg) or a melatonin receptor agonist. There was evidence of some beneficial effects on sleep outcomes from trazodone and orexin antagonists and no evidence of harmful effects in these small trials, although larger trials in a broader range of participants are needed to allow more definitive conclusions to be reached. Systematic assessment of adverse effects in future trials is essential.
BACKGROUND: Insomnia disorder is a subjective condition of unsatisfactory sleep (e.g. sleep onset, maintenance, early waking, impairment of daytime functioning). Insomnia disorder impairs quality of life and is associated with an increased risk of physical and mental health problems including anxiety, depression, drug and alcohol abuse, and increased health service use. hypnotic medications (e.g. benzodiazepines and 'Z' drugs) are licensed for sleep promotion, but can induce tolerance and dependence, although many people remain on long-term treatment. Antidepressant use for insomnia is widespread, but none is licensed for insomnia and the evidence for their efficacy is unclear. This use of unlicensed medications may be driven by concern over longer-term use of hypnotics and the limited availability of psychological treatments.
OBJECTIVES: To assess the effectiveness, safety and tolerability of antidepressants for insomnia in adults.
SEARCH METHODS: This review incorporated the results of searches to July 2015 conducted on electronic bibliographic databases: the Cochrane Central Register of Controlled Trials (CENTRAL, 2015, Issue 6), MEDLINE (1950 to 2015), Embase (1980 to 2015) and PsycINFO (1806 to 2015). We updated the searches to December 2017, but these results have not yet been incorporated into the review.
SELECTION CRITERIA: Randomised controlled trials (RCTs) of adults (aged 18 years or older) with a primary diagnosis of insomnia and all participant types including people with comorbidities. Any antidepressant as monotherapy at any dose whether compared with placebo, other medications for insomnia (e.g. benzodiazepines and 'Z' drugs), a different antidepressant, waiting list control or treatment as usual.
DATA COLLECTION AND ANALYSIS: Two review authors independently assessed trials for eligibility and extracted data using a data extraction form. A third review author resolved disagreements on inclusion or data extraction.
MAIN RESULTS: The search identified 23 RCTs (2806 participants).Selective serotonin reuptake inhibitors (SSRIs) compared with placebo: three studies (135 participants) compared SSRIs with placebo. Combining results was not possible. Two paroxetine studies showed significant improvements in subjective sleep measures at six (60 participants, P = 0.03) and 12 weeks (27 participants, P < 0.001). There was no difference in the fluoxetine study (low quality evidence).There were either no adverse events or they were not reported (very low quality evidence).Tricyclic antidepressants (TCA) compared with placebo: six studies (812 participants) compared TCA with placebo; five used doxepin and one used trimipramine. We found no studies of amitriptyline. Four studies (518 participants) could be pooled, showing a moderate improvement in subjective sleep quality over placebo (standardised mean difference (SMD) -0.39, 95% confidence interval (CI) -0.56 to -0.21) (moderate quality evidence). Moderate quality evidence suggested that TCAs possibly improved sleep efficiency (mean difference (MD) 6.29 percentage points, 95% CI 3.17 to 9.41; 4 studies; 510 participants) and increased sleep time (MD 22.88 minutes, 95% CI 13.17 to 32.59; 4 studies; 510 participants). There may have been little or no impact on sleep latency (MD -4.27 minutes, 95% CI -9.01 to 0.48; 4 studies; 510 participants).There may have been little or no difference in adverse events between TCAs and placebo (risk ratio (RR) 1.02, 95% CI 0.86 to 1.21; 6 studies; 812 participants) (low quality evidence).'Other' antidepressants with placebo: eight studies compared other antidepressants with placebo (one used mianserin and seven used trazodone). Three studies (370 participants) of trazodone could be pooled, indicating a moderate improvement in subjective sleep outcomes over placebo (SMD -0.34, 95% CI -0.66 to -0.02). Two studies of trazodone measured polysomnography and found little or no difference in sleep efficiency (MD 1.38 percentage points, 95% CI -2.87 to 5.63; 169 participants) (low quality evidence).There was low quality evidence from two studies of more adverse effects with trazodone than placebo (i.e. morning grogginess, increased dry mouth and thirst).
AUTHORS' CONCLUSIONS: We identified relatively few, mostly small studies with short-term follow-up and design limitations. The effects of SSRIs compared with placebo are uncertain with too few studies to draw clear conclusions. There may be a small improvement in sleep quality with short-term use of low-dose doxepin and trazodone compared with placebo. The tolerability and safety of antidepressants for insomnia is uncertain due to limited reporting of adverse events. There was no evidence for amitriptyline (despite common use in clinical practice) or for long-term antidepressant use for insomnia. High-quality trials of antidepressants for insomnia are needed.
ANTECEDENTES: A pesar de los tratamientos convencionales no farmacológicos y farmacológicos para el insomnio son efectivos en muchas personas, las terapias alternativas como la acupuntura se practica ampliamente. Sin embargo, no queda claro si la evidencia actual es lo suficientemente riguroso como para apoyar la acupuntura para el tratamiento del insomnio.
OBJETIVOS: Determinar la eficacia y seguridad de la acupuntura para el insomnio.
ESTRATEGIA DE BÚSQUEDA: Se realizaron búsquedas en el Registro Cochrane Central de Ensayos Controlados (CENTRAL), MEDLINE, EMBASE, PsycINFO, Dissertation Abstracts Sistema Internacional, CINAHL, AMED, el análisis tradicional china literatura médica y recuperación (TCMLARS), la Organización Mundial de la Salud (OMS) Portal de ensayos (ICTRP) y las correspondientes registros especializados de la Colaboración Cochrane, en octubre de 2011. Se revisaron las listas de referencias de todos los informes elegibles y contacto con los autores y expertos en el campo.
CRITERIOS DE SELECCIÓN: Ensayos controlados aleatorios que evaluaran cualquier forma de acupuntura para el insomnio. Ellos compararon la acupuntura con / sin tratamiento adicional contra placebo o tratamiento simulado o ningún tratamiento o tratamiento adicional misma. Se excluyeron los ensayos que compararon diferentes métodos de acupuntura o acupuntura contra otros tratamientos.
RECOPILACIÓN Y ANÁLISIS DE DATOS: Dos revisores de forma independiente extrajeron los datos y evaluaron el riesgo de sesgo. Se utilizaron los odds ratio (OR) y diferencia de medias para los resultados binarios y continuos, respectivamente. Se combinaron los datos de los meta-análisis, en su caso.
RESULTADOS PRINCIPALES: Treinta y tres ensayos fueron incluidos. Ellos reclutaron 2293 participantes con insomnio, de 15 a 98 años, algunos con condiciones médicas que contribuyen al insomnio (accidente cerebrovascular, enfermedad terminal renal, la perimenopausia, embarazo, enfermedades psiquiátricas). Se evaluó la acupuntura con agujas, electroacupuntura, acupuntura o acupresión magnético.
En comparación con ningún tratamiento (dos estudios, los participantes 280) o falsas / placebo (dos estudios, 112 participantes), la acupresión dio lugar a más personas con la mejora en la calidad del sueño (comparado con ningún tratamiento: OR 13,08, intervalo de confianza del 95% (IC) 1,79 a 95,59, en comparación con el tratamiento simulado / placebo: OR 6,62, IC 95%: 1,78 a 24,55). Sin embargo, cuando se asume que los abandonos tenían un peor resultado en el análisis de sensibilidad el efecto beneficioso de la acupuntura no fue concluyente. En comparación con otro tratamiento solo, la acupuntura como complemento de otro tratamiento podría aumentar ligeramente el porcentaje de personas con la calidad del sueño mejora (13 estudios, 883 participantes, OR 3,08, IC del 95%: 1,93 a 4,90). En el análisis de subgrupos, sólo la acupuntura con agujas pero no electroacupuntura mostró beneficios. Todos los ensayos tuvieron alto riesgo de sesgo y heterogéneos en la definición de insomnio, características de los participantes, los puntos de acupuntura y el régimen de tratamiento. Los tamaños del efecto fueron generalmente pequeños, con intervalos de confianza amplios. El sesgo de publicación fue probablemente presente. Los efectos adversos fueron reportados raramente y que fueron menores.
CONCLUSIONES DE LOS REVISORES: Debido a la mala calidad metodológica, los altos niveles de heterogeneidad y sesgo de publicación, la evidencia actual no es suficientemente rigurosa para apoyar o refutar la acupuntura para el tratamiento del insomnio. Más grandes de alta calidad Se requieren ensayos clínicos.
ANTECEDENTES: La prevalencia de los trastornos del sueño en la edad adulta aumenta con la edad. Mientras que no todos los cambios en el sueño son patológicos en la etapa tardía de la vida, los trastornos graves pueden provocar depresión, deterioros cognitivos, deterioro en la calidad de vida, situaciones de estrés significativas para los cuidadores y mayores costos de asistencia sanitaria. El tratamiento más común para los trastornos del sueño (en particular el insomnio) es el farmacológico. Se ha sugerido que la eficacia de las intervenciones no farmacológicas es más lenta que la de los métodos farmacológicos, pero no presenta riesgos de tolerancia o dependencia ligada a los fármacos. Los tratamientos cognitivos y conductuales para los trastornos del sueño intentan mejorar el sueño mediante el cambio de hábitos deficientes del sueño, la promoción de mejores prácticas de higiene del sueño y el desafío de pensamientos, actitudes y creencias negativos sobre el sueño.
OBJETIVOS: Evaluar la eficacia de las intervenciones cognitivo-conductuales en la mejoría de la calidad del sueño, la duración y la eficiencia en los adultos ancianos (de 60 años o más).
ESTRATEGIA DE BÚSQUEDA: SE HICIERON BÚSQUEDAS EN LAS SIGUIENTES BASES DE DATOS: MEDLINE (1966 - octubre de 2001); EMBASE (1980 - enero 2002), CINAHL ( 1982 - enero 2002; PsychINFO 1887 hasta 2002; The Cochrane Library (Número 1, 2002); National Research Register (NRR [2002]). Se buscaron bibliografías de revisiones existentes en el área, así como de todos los informes de ensayos obtenidos. Se consultó con expertos en el tema.
CRITERIOS DE SELECCIÓN: Ensayos controlados aleatorios de los tratamientos cognitivo-conductuales para el insomnio primario en que el 80% o más de los participantes tenía más de 60. Se debe haber sometido a cribaje (screening) a los participantes para excluir aquellos con demencia o depresión.
RECOPILACIÓN Y ANÁLISIS DE DATOS: Se leyeron y evaluaron los resúmenes de los estudios identificados en las búsquedas de las bases de datos electrónicas para determinar si podrían cumplir con los criterios de inclusión. Los datos se analizaron por separado en función de si los resultados se habían obtenido de forma subjetiva u objetiva.
RESULTADOS PRINCIPALES: Seis ensayos, que incluyen 282 participantes con insomnio, examinaron la efectividad de los tratamientos cognitivo-conductuales (TCC) para los trastornos del sueño en esta población. El total final de participantes incluidos en el metanálisis fue de 224. Los datos indican un efecto leve de TCC para los trastornos del sueño en los adultos ancianos, mejor demostrado para el insomnio de mantenimiento del sueño.
CONCLUSIONES DE LOS AUTORES: Cuando se consideran los posibles efectos secundarios del tratamiento estándar (hipnóticos), se debe realizar una discusión para el uso clínico de los tratamientos cognitivo-conductuales. Se necesita realizar una investigación para establecer los indicadores de pronóstico probables del éxito de dichos tratamientos. En caso de que la eficacia del tratamiento de la terapia cognitivo-conductual no sea duradera en sí misma, merece la pena investigar la provisión de sesiones "adicionales" ("de perfeccionamiento") del entrenamiento de TCC para mejorar la durabilidad del efecto.
ANTECEDENTES: La prevalencia de trastornos del sueño en la adultez aumenta con la edad. Aunque no todos los cambios en el sueño son patológicos en la vida adulta, los trastornos graves puede conducir a la depresión, deterioro cognitivo, deterioro de la calidad de vida, estrés significativo para los cuidadores y los costos de asistencia sanitaria. El tratamiento más común para los trastornos del sueño (especialmente el insomnio) es farmacológico. La eficacia de las intervenciones no farmacológicas ha sugerido a ser más lento que los métodos farmacológicos, pero sin el riesgo de las drogas tolerancia o dependencia. El ejercicio físico, se toma regularmente, puede promover la relajación y aumentar la temperatura corporal de manera que sean beneficiosas para iniciar y mantener el sueño.
OBJETIVOS: Evaluar la eficacia del ejercicio físico entre los adultos mayores (60 años o más).
ESTRATEGIA DE BÚSQUEDA: Se realizaron búsquedas en la Cochrane Library (Número 1, 2002), MEDLINE (1966 hasta enero 2002), EMBASE (1980 hasta enero 2002), CINAHL (1982 hasta enero 2002), PsycINFO (1887 hasta enero 2002); Nacional de Investigación Registro (número 1, 2002). Bibliografías de las revisiones existentes en la zona, así como de los informes obtenidos, se realizaron búsquedas. Expertos en la materia fueron consultados.
Criterios de selección: Ensayos controlados aleatorios de los ejercicios físicos para el insomnio primario donde el 80% o más de los participantes eran mayores de 60 años. Los participantes deben haber sido seleccionadas para excluir aquellos con demencia y / o depresión.
Recopilación y análisis de datos: Los resúmenes de los estudios identificados en las búsquedas de bases de datos electrónicas fueron leídos y evaluados para determinar si cumplían los criterios de inclusión. Los datos se analizaron por separado en función de si los resultados se habían obtenido de forma subjetiva u objetivamente.
Resultados principales: Se incluyó un ensayo, incluyendo 43 participantes con insomnio, analizó la efectividad de los ejercicios en una población dentro de una población de edad avanzada. Luego del tratamiento, dormir latencia del comienzo mejorado ligeramente, tanto para hombres como para mujeres. Duración total del sueño, latencia del inicio del sueño y las puntuaciones en una escala de calidad global del sueño mostraron una mejoría significativa. Las mejoras en la eficiencia del sueño no fueron significativas. En algunos casos mejoras indicadas cae por debajo de lo que normalmente se consideran niveles patológicos pero los intervalos de confianza amplios y el tamaño pequeño de la muestra indican que estos hallazgos deben ser interpretados con cautela.
Conclusiones de los revisores: Cuando los posibles efectos secundarios del tratamiento estándar (hipnóticos) se consideran, no es un argumento a favor del uso clínico de tratamientos alternativos en personas mayores. El ejercicio, aunque no es apropiado para todos en esta población, pueden mejorar el sueño y contribuir a una mejor calidad de vida. La investigación en programas de ejercicios diseñados con los ancianos en cuenta que se necesita.
ANTECEDENTES: La prevalencia de problemas de sueño en la madurez aumenta con la edad. Aunque no todos los cambios de sueño son patológicos en la vida adulta, las perturbaciones severas pueden conducir a la depresión, deterioros cognoscitivos, deterioro de la calidad de vida, estrés significativo para las personas a cargo de la atención y mayores costes de atención de la salud. El tratamiento más común para los trastornos del sueño (particularmente el insomnio) es farmacológico. Se ha sugerido que la eficacia de las intervenciones no farmacológicas es más lenta que los métodos farmacológicos, pero sin el riesgo de tolerancia o dependencia a fármacos.
El tratamiento con luz brillante consiste en que los participantes se sienten delante de una "caja de luz" que emite luz fluorescente muy intensa (normalmente 10,000 lux) durante períodos de alrededor de dos horas diarios. El momento de este tratamiento con luz dependerá del esquema irregular del patrón de sueño del participante.
OBJETIVOS: Evaluar la eficacia del tratamiento con luz brillante para mejorar la calidad del sueño (en particular el ritmo del sueño) en adultos de 60 o más años de edad.
ESTRATEGIA DE BÚSQUEDA: SE HICIERON BÚSQUEDAS EN LAS BASES DE DATOS SIGUIENTES: MEDLINE (1966 - enero de 2001); EMBASE (1980 - enero de 2001), CINAHL (1982 - enero de 2001); PsychINFO 1887 a 2001; Cochrane Library (Número 1, 2001); National Research Register (NRR [2001]). Se hicieron búsquedas en las bibliografías de las revisiones existentes sobre el tema, así como de todos los informes de ensayos obtenidos. Se consultaron expertos en el tema.
CRITERIOS DE SELECCIÓN: Ensayos controlados con asignación al azar de tratamiento con luz brillante para el insomnio primario, en los que el 80% o más de los participantes tuvieran más de 60 años de edad. Los participantes debían haberse examinado para excluir aquéllos con demencia y/o depresión.
RECOPILACIÓN Y ANÁLISIS DE DATOS: Se leyeron los resúmenes de los estudios identificados por las búsquedas en bases de datos electrónicas y se evaluaron para determinar si podrían cumplir los criterios de inclusión.
RESULTADOS PRINCIPALES: Los revisores no encontraron ningún ensayo en el que basar conclusiones acerca de la efectividad de este tratamiento.
CONCLUSIONES DE LOS AUTORES: Si se consideran los posibles efectos colaterales del tratamiento estándar (los fármacos hipnóticos), existe un argumento a favor del uso clínico de los tratamientos no farmacológicos. En vista de los resultados prometedores del tratamiento con luz brillante en otras poblaciones con problemas de ritmo de sueño, las investigaciones adicionales acerca de su efectividad en adultos mayores parecerían justificadas.
Insomnia is a common problem in modern society. It is associated with reduced quality of life and impairments in physical and mental health. Listening to music is widely used as a sleep aid, but it remains unclear if it can actually improve insomnia in adults. This Cochrane Review is an update of a review published in 2015.
OBJECTIVES:
To assess the effects of listening to music on sleep in adults with insomnia and to assess the influence of specific variables that may moderate the effect.
SEARCH METHODS:
For this update, we searched CENTRAL, MEDLINE, Embase, nine other databases and two trials registers up to December 2021. In addition, we handsearched reference lists of included studies, and contacted authors of published studies to identify additional studies eligible for inclusion, including any unpublished or ongoing trials.
SELECTION CRITERIA:
Randomised controlled trials comparing the effects of listening to music with no treatment or treatment as usual (TAU) in adults complaining of sleep difficulties.
DATA COLLECTION AND ANALYSIS:
Two review authors independently screened records for eligibility, selected studies for inclusion, extracted data and assessed risk of bias of the included studies. We assessed the certainty of the evidence using GRADE. The primary outcomes were sleep quality, insomnia severity, sleep-onset latency, total sleep time, sleep interruption, sleep efficiency and adverse events. Data on the predefined outcome measures were included in meta-analyses when consistently reported by at least two studies that were homogeneous in terms of participants, interventions and outcomes. We undertook meta-analyses using random-effects models.
MAIN RESULTS:
We included 13 studies (eight studies new to this update) comprising 1007 participants. The studies examined the effect of listening to prerecorded music daily, for 25 to 60 minutes, for a period of three days to three months. The risk of bias within the studies varied, with all studies being at high risk of performance bias, because of limited possibilities to blind participants to the music intervention. Some studies were at high risk of detection bias or other bias. Four studies reported funding from national research councils, three studies reported financial support from university sources and one study reported a grant from a private foundation. Five studies did not report any financial support. At the end of the intervention, we found moderate-certainty evidence for improved sleep quality measured with the Pittsburgh Sleep Quality Index (PSQI) in themusic groups compared to no intervention or TAU (mean difference (MD) -2.79, 95% confidence interval (CI) -3.86 to -1.72; 10 studies, 708 participants). The PSQI scale ranges from 0 to 21 with higher scores indicating poorer sleep. The size of the effect indicates an increase in sleep quality of the size of about one standard deviation in favour of the intervention. We found no clear evidence of a difference in the effects of listening to music compared to no treatment or TAU on insomnia severity (MD -6.96, 95% CI -15.21 to 1.28; 2 studies, 63 participants; very low-certainty evidence). We found low-certainty evidence that, compared to no treatment or TAU, listening to music may reduce problems with sleep-onset latency (MD -0.60, 95% CI -0.83 to -0.37; 3 studies, 197 participants), total sleep time (MD -0.69, 95% CI -1.16 to -0.23; 3 studies, 197 participants) and sleep efficiency (MD -0.96, 95% CI -1.38 to -0.54; 3 studies, 197 participants), but may have no effect on perceived sleep interruption (MD -0.53, 95% CI -1.47 to 0.40; 3 studies, 197 participants). In addition, three studies (136 participants) included objective measures of sleep-onset latency, total sleep time, sleep efficiency and sleep interruption and showed that listening to music may not improve these outcomes compared to no treatment or TAU. None of the included studies reported any adverse events.
AUTHORS' CONCLUSIONS:
The findings of this review provide evidence that music may be effective for improving subjective sleep quality in adults with symptoms of insomnia. More research is needed to establish the effect of listening to music on other aspects of sleep as well as the daytime consequences of insomnia.
