Efficacy, acceptability, and tolerability of all available treatments for insomnia in the elderly: a systematic review and network meta-analysis.
Level 1 - systematic review of randomized trials
Systematic review and network meta-analysis of randomized controlled trials
PubMed 32521042 · doi:10.1111/acps.13201
What was done
Authors conducted a systematic review and network meta-analysis of randomized controlled trials across multiple electronic databases up to May 25, 2019, evaluating treatments for insomnia in adults over 65 years old. Primary outcomes were total sleep time and sleep quality, alongside six other efficacy and eight safety outcomes. The review included 53 RCTs with 6,832 participants (mean age 75 years); 43 trials evaluated drug efficacy and 10 examined non-pharmacological interventions, which were analyzed only via pairwise meta-analyses due to being disconnected from the network.
What was found
The abstract reports no numerical effect sizes, point estimates, or confidence intervals. Several benzodiazepines, antidepressants, and z-drugs performed better for total sleep time and sleep quality, but few comparisons had data from more than one trial. Limited evidence suggested acupressure, auricular acupuncture, mindfulness-based stress reduction, and tart cherry juice were better than controls. No clear safety differences were detected among interventions due to large uncertainty. Overall confidence in the evidence was very low.
Why it matters
This review demonstrates that despite numerous available insomnia treatments for older adults, the randomized evidence is currently insufficient to determine which pharmacological or non-pharmacological intervention is most efficacious or safe.
Limits
Confidence in the evidence was very low primarily due to sparse network connectedness and a small volume of data per comparison. Non-pharmacological interventions could not be integrated into the network meta-analysis, safety comparisons carried high uncertainty, and the abstract omitted quantitative numerical estimates.
Cited by
- context Tart cherry juice has moderate to strong scientific evidence supporting its ability to improve sleep.