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Frontiers in Public Health 2023There is a need for evidence-informed guidance on the use of complementary and alternative medicine (CAM) for insomnia because of its widespread utilization and a lack...
Identifying complementary and alternative medicine recommendations for insomnia treatment and care: a systematic review and critical assessment of comprehensive clinical practice guidelines.
BACKGROUND
There is a need for evidence-informed guidance on the use of complementary and alternative medicine (CAM) for insomnia because of its widespread utilization and a lack of guidance on the balance of benefits and harms. This systematic review aimed to identify and summarize the CAM recommendations associated with insomnia treatment and care from existing comprehensive clinical practice guidelines (CPGs). The quality of the eligible guidelines was appraised to assess the credibility of these recommendations.
METHODS
Formally published CPGs incorporating CAM recommendations for insomnia management were searched for in seven databases from their inception to January 2023. The NCCIH website and six websites of international guideline developing institutions were also retrieved. The methodological and reporting quality of each included guideline was appraised using the AGREE II instrument and RIGHT statement, respectively.
RESULTS
Seventeen eligible GCPs were included, and 14 were judged to be of moderate to high methodological and reporting quality. The reporting rate of eligible CPGs ranged from 42.9 to 97.1%. Twenty-two CAM modalities were implicated, involving nutritional or natural products, physical CAM, psychological CAM, homeopathy, aromatherapy, and mindful movements. Recommendations for these modalities were mostly unclear, unambiguous, uncertain, or conflicting. Logically explained graded recommendations supporting the CAM use in the treatment and/or care of insomnia were scarce, with bibliotherapy, Tai Chi, Yoga, and auriculotherapy positively recommended based on little and weak evidence. The only consensus was that four phytotherapeutics including valerian, chamomile, kava, and aromatherapy were not recommended for insomnia management because of risk profile and/or limited benefits.
CONCLUSIONS
Existing guidelines are generally limited in providing clear, evidence-informed recommendations for the use of CAM therapies for insomnia management due to a lack of high-quality evidence and multidisciplinary consultation in CPG development. More well-designed studies to provide reliable clinical evidence are therefore urgently needed. Allowing the engagement of a range of interdisciplinary stakeholders in future updates of CPGs is also warranted.
SYSTEMATIC REVIEW REGISTRATION
https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=369155, identifier: CRD42022369155.
Topics: Humans; Bibliotherapy; Complementary Therapies; Sleep Initiation and Maintenance Disorders; Yoga; Practice Guidelines as Topic
PubMed: 37397764
DOI: 10.3389/fpubh.2023.1157419 -
Medicine Jun 2023To explore the efficacy and safety of electroacupuncture (EA) for secondary insomnia through a meta-analysis and a systematic review. (Meta-Analysis)
Meta-Analysis
BACKGROUND
To explore the efficacy and safety of electroacupuncture (EA) for secondary insomnia through a meta-analysis and a systematic review.
METHODS
The CNKI, Wanfang, VIP database, Web of Science, EMBASE, PubMed, and Cochrane Library were retrieved. The retrieval date was February 28, 2023. Two independent reviewers conducted literature screening, data extraction, and risk of bias (ROB) assessment. The revised Cochrane ROB tool was used to assess the ROB in included studies. Data analysis was performed using RevMan 5.4 software and Stata 15.0.
RESULTS
Thirteen randomized controlled studies were included, involving 820 patients, including 414 patients in EA group and 406 patients in the control group. Compared with the control group, EA could improve secondary insomnia overall responses (relative risk = 3.90, 95% confidence interval [CI] [1.87, 8.13], P < .001), reduce Pittsburgh Sleep Quality Index score (mean difference [MD] = -2.26, 95% CI [-4.14, -0.37], P = .02), reduce Athens Insomnia Scale score (MD = -0.57, 95% CI [-2.70, 1.56], P = .60), prolonged total sleep time (MD = 2.63, 95% CI [-0.59, 5.86], P = .11), and not increase adverse events (relative risk = 0.50, 95% CI [0.18, 1.44], P = .20).
CONCLUSION
EA may be a promising treatment for secondary sleep disorders; however, more high-quality studies are needed to confirm our findings.
Topics: Humans; Electroacupuncture; Sleep Initiation and Maintenance Disorders; Control Groups; Data Analysis; Databases, Factual
PubMed: 37390293
DOI: 10.1097/MD.0000000000034150 -
Lipids in Health and Disease Jun 2023One of the most prevalent sleep disorders affecting the individual's daily life is obstructive sleep apnea (OSA), for which obesity is a major risk factor. Several novel... (Meta-Analysis)
Meta-Analysis
BACKGROUND
One of the most prevalent sleep disorders affecting the individual's daily life is obstructive sleep apnea (OSA), for which obesity is a major risk factor. Several novel lipid indices have been suggested to have associations with OSA, among which visceral adiposity index (VAI), atherogenic index of plasma (AIP), and lipid accumulation product (LAP) are the most important ones. Herein, the current study aimed to systematically investigate the association between these indices and OSA.
METHODS
Four international databases, including PubMed, Scopus, the Web of Science, and Embase were searched in order to find relevant studies that investigated LAP, VAI, or AIP in OSA and compared them with non-OSA cases or within different severities of OSA. Random-effect meta-analysis was used to generate the standardized mean difference (SMD) and 95% confidence interval (CI) of the difference in lipid indices between OSA and non-OSA cases. Moreover, the pooled area under the receiver operating characteristic curves (AUCs) observed in individual studies for diagnosis of OSA based on these lipid indices were calculated by random-effect meta-analysis.
RESULTS
Totally 14 original studies were included, comprised of 14,943 cases. AIP, LAP, and VAI were assessed in eight, five, and five studies, respectively. Overall, these lipid indices had acceptable diagnostic ability (AUC 0.70, 95% CI 0.67 to 073). Meta-analysis revealed that AIP was significantly higher in patients with OSA (SMD 0.71, 95% CI 0.45 to 0.97, P < 0.01). Moreover, AIP also increased in higher severities of OSA. Regarding LAP, a higher LAP was observed in OSA/patients with high risk for OSA rather than in controls/low risk for OSA (SMD 0.53, 95% CI 0.25 to 0.81, P < 0.01). VAI was also increased in OSA based on results from two studies.
CONCLUSION
These findings suggest that composite lipid indices are increased in OSA. Also, these indices can have the potential beneficiary diagnostic and prognostic ability in OSA. Future studies can confirm these findings and enlighten the role of lipid indices in OSA.
Topics: Humans; Area Under Curve; Databases, Factual; Lipid Accumulation Product; Sleep Apnea, Obstructive; Lipids
PubMed: 37386562
DOI: 10.1186/s12944-023-01859-3 -
Sleep & Breathing = Schlaf & Atmung Dec 2023Obstructive sleep apnea (OSA) is frequently treated with continuous positive airway pressure (CPAP) or mandibular advancement devices (MADs). For various reasons, both... (Review)
Review
PURPOSE
Obstructive sleep apnea (OSA) is frequently treated with continuous positive airway pressure (CPAP) or mandibular advancement devices (MADs). For various reasons, both treatment options are often affected by low adherence. While factors associated with low CPAP adherence are described in the literature extensively, less is known about adherence to MAD therapy. This scoping review aimed to synthesize the body of literature on the factors associated with adherence to MAD treatment.
METHODS
A systematic literature search was conducted using bibliographic databases PubMed, Embase.com , Web of Science, and the Cochrane Library (Wiley) to identify relevant studies that described factors associated with adherence to MAD in the treatment of OSA or snoring combined with OSA in adults.
RESULTS
The literature search yielded a total of 694 references. Forty studies were found eligible for inclusion. The literature showed that factors with a possible negative influence on the adherence to MAD treatment are personality aspects; failing effectiveness of MAD; side effects during MAD therapy; using a thermoplastic MAD; dental treatments during MAD therapy; and a poor first experience with the MAD with inadequate guidance by professionals. Factors that may have a positive effect on MAD adherence include effectiveness of therapy, custom-made MAD, good communication skills of the practitioner, early recognition of side effects, stepwise titration of the MAD, and positive first experience with MAD.
CONCLUSIONS
The knowledge of factors associated with MAD adherence can be used to provide further insight into individual adherence to OSA treatments.
Topics: Adult; Humans; Continuous Positive Airway Pressure; Mandibular Advancement; Occlusal Splints; Sleep Apnea, Obstructive; Treatment Adherence and Compliance; Treatment Outcome
PubMed: 37386300
DOI: 10.1007/s11325-023-02862-9 -
Medicina (Kaunas, Lithuania) Jun 2023In recent years, surgical interventions for obstructive sleep apnea (OSA) have evolved rapidly, with numerous techniques described in the literature. The approach to... (Review)
Review
In recent years, surgical interventions for obstructive sleep apnea (OSA) have evolved rapidly, with numerous techniques described in the literature. The approach to velopharyngeal surgery for obstructive sleep apnea has transformed over time, shifting from an aggressive removal of redundant excess soft tissue to less invasive reconstruction techniques that aim to preserve pharyngeal function while effectively managing sleep apnea. This review aims to evaluate and compare the efficacy of the surgical techniques utilized for OSA at the level of the palate and pharynx. It will cover both traditional and novel procedures. A comprehensive search of the major databases, such as PubMed/MEDLINE, Web of Science, and Scopus, was conducted to identify the relevant literature. We included articles written in English that analyzed the outcomes of adult patients who received velopharyngeal surgery for sleep apnea. Only comparative studies that examined at least two techniques were considered. In all of the studies combined, the total number of patients who underwent velopharyngeal surgery was 614 in eight studies. All surgical procedures resulted in improvements in the apnea-hypopnea index (AHI). The highest success rates and best outcomes were achieved by barbed reposition pharyngoplasty (BRP) in most studies, ranging from 64.29% to 86.6%. BRP also demonstrated the most significant improvements in both objective and subjective parameters closely followed by ESP that obtained similar efficiency in some studies, especially when combined with anterior palatoplasty (AP), but with a higher incidence of complications. While LP showed moderate efficiency compared with BRP or ESP, the UPPP techniques exhibited greater outcome variability among studies, with a success rate ranging from 38.71% to 59.26%, and the best results observed in a multilevel context. In our review, BRP was the most preferred, effective, and safe among all velopharyngeal techniques, closely followed by ESP. However, older described techniques also showed good results in well-selected patients. Larger-scale studies, preferably prospective, that rigorously incorporate DISE-based strict inclusion criteria might be needed to assess the efficacy of different techniques and generalize the findings.
Topics: Adult; Humans; Prospective Studies; Polysomnography; Treatment Outcome; Pharynx; Sleep Apnea, Obstructive; Sleep Apnea Syndromes
PubMed: 37374351
DOI: 10.3390/medicina59061147 -
International Journal of Environmental... Jun 2023Irish dance is growing in popularity, evolving to a more athletic and demanding dance style. The aim of this study is to conduct a systematic review, previously... (Review)
Review
Irish dance is growing in popularity, evolving to a more athletic and demanding dance style. The aim of this study is to conduct a systematic review, previously registered with PROSPERO, to identify the prevalence, incidence, and the injury pattern among Irish dancers and analyse the associated risk factors. Six online databases and two dance-specific science publications were searched systematically. Studies were included if the patterns of injuries among Irish dancers were evaluated or the factors associated with injury were analysed, published in English or Portuguese, in peer-reviewed scientific journals. Four reviewers assessed the quality and level of evidence using the Downs and Black criteria and a modified Oxford Centre of Evidence-Based Medicine 2009 model, respectively. Eleven articles were included, eight of Level 3c (cross-sectional) and three of Level 3b (prospective). Mean DB percentage score was 63% ± 7.2%. Prevalence ranged from 72.2% to 92.6%, affecting mostly the foot/ankle complex. Only two articles reported incidence, which ranged from 3.4 to 10.6 injuries/1000 h danced depending on injury definition. Psychological factors, elite level, and insufficient/poor sleep were associated with musculoskeletal injury. Injury prevalence and incidence is high in Irish dancers, with the foot and ankle being more affected. Due to heterogeneity in injury definitions, methods, and populations, along with the need for improvement in studies quality, recommendations were made for future research.
Topics: Humans; Dancing; Prospective Studies; Cross-Sectional Studies; Musculoskeletal Diseases; Sleep Deprivation; Risk Factors; Athletic Injuries
PubMed: 37372775
DOI: 10.3390/ijerph20126190 -
Journal of Sleep Research Dec 2023Cognition is central to the experience of insomnia. Although unhelpful thoughts about and around insomnia are a primary treatment target of cognitive behaviour therapy... (Review)
Review
Cognition is central to the experience of insomnia. Although unhelpful thoughts about and around insomnia are a primary treatment target of cognitive behaviour therapy for insomnia, cognitive constructs are termed and conceptualised differently in different theories of insomnia proposed over the past decades. In search of consensus in thinking, the current systematic review identified cognitive factors and processes featured in theoretical models of insomnia and mapped any commonality between models. We systematically searched PsycINFO and PubMed for published theoretical articles on the development, maintenance and remission of insomnia, from inception of databases to February, 2023. A total of 2458 records were identified for title and abstract screening. Of these, 34 were selected for full-text assessment and 12 included for analysis and data synthesis following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We identified nine distinguishable models of insomnia published between 1982 and 2023 and extracted 20 cognitive factors and processes featured in these models; 39 if sub-factors were counted. After assigning similarity ratings, we observed a high degree of overlap between constructs despite apparent differences in terminologies and measurement methods. As a result, we highlight shifts in thinking around cognitions associated with insomnia and discuss future directions.
Topics: Humans; Sleep Initiation and Maintenance Disorders; Cognitive Behavioral Therapy
PubMed: 37364869
DOI: 10.1111/jsr.13923 -
European Archives of... Oct 2023Hypoglossal nerve stimulation (HNS) has recently been introduced as an alternative treatment for patients with OSA. A large number of studies have demonstrated... (Meta-Analysis)
Meta-Analysis
INTRODUCTION
Hypoglossal nerve stimulation (HNS) has recently been introduced as an alternative treatment for patients with OSA. A large number of studies have demonstrated substantial changes in OSA with this therapy by reducing respiratory events and improving symptoms such as daytime sleepiness and quality of life. The objective of this review was to conduct a systematic review and meta-analysis to evaluate patient-reported outcomes and experience with HNS therapy.
METHODS
A systematic literature search of MEDLINE, Cochrane, and Web of Science was performed to identify randomized controlled and observational studies reporting subjective outcomes with different HNS systems in patients with OSA. Abstracts of 406 articles were screened and a subset of 55 articles were reviewed for eligibility. Risk of bias was assessed using the ROBINS-I tool. Meta-analysis using RevMan was performed when > 2 studies were identified that reported data on a specific outcome.
RESULTS
Thirty-four publications reporting data on 3785 patients with a mean follow-up of 11.8 ± 12.2 months were identified and included in the meta-analysis. The analysis revealed a pooled effect of 4.59 points improvement in daytime sleepiness as measured by the ESS questionnaire (Z = 42.82, p < .001), 2.84 points improvement in daytime functioning as measured by the FOSQ score (Z = 28.38, p < .001), and 1.77 points improvement in sleep quality as measured by the PSQI questionnaire (Z = 2.53, p = .010). Patient-reported experience was consistently positive and revealed additional relevant aspects from this perspective.
CONCLUSION
HNS therapy significantly improves quality of life in patients with OSA and reliably produces clinically meaningful effects on daytime sleepiness, daytime functioning, and sleep quality. Treatment regularly meets or exceeds the minimum clinically important differences defined for the respective instruments. Additional research is needed to further investigate effects on quality of life beyond improvements in daytime sleepiness and daytime functioning.
Topics: Humans; Hypoglossal Nerve; Sleep Apnea, Obstructive; Patient Reported Outcome Measures; Quality of Life; Electric Stimulation Therapy
PubMed: 37354340
DOI: 10.1007/s00405-023-08062-1 -
Thorax Nov 2023Vibrotactile positional therapy (PT) devices are a new treatment modality for positional obstructive sleep apnoea (POSA). This review aimed to determine the effect of... (Meta-Analysis)
Meta-Analysis
INTRODUCTION
Vibrotactile positional therapy (PT) devices are a new treatment modality for positional obstructive sleep apnoea (POSA). This review aimed to determine the effect of vibrotactile PT on the Apnoea Hypopnoea Index (AHI) and the percentage of time spent in the supine position (%Tsupine) in patients with POSA, compared with baseline. Secondary aims were to investigate the effect on daytime sleepiness, quality of life and sleep quality.
METHODS
A systematic review and meta-analysis was performed of randomised controlled trials (RCTs) and cohort studies that investigated the effect of vibrotactile PT in POSA patients. Searches were performed via MEDLINE, CENTRAL and Embase up to 29 October 2022.
RESULTS
1119 studies were identified, 18 studies met the inclusion criteria (10 RCTs, 8 cohort studies). The use of vibrotactile PT significantly reduced the AHI at follow-up compared with baseline (mean difference (95% CI) -9.19 events/hour (-11.68 to -6.70); p<0.00001). The mean %Tsupine was also significantly reduced (mean difference (95% CI) -32.79% (-38.75% to -26.83%); p<0.00001). The percentage changes in the AHI and %Tsupine were 43% and 70%, respectively. Secondary outcomes were daytime sleepiness, quality of life and sleep indices. These showed minimal change, although follow-up was short.
CONCLUSION
Vibrotactile PT devices are effective in treating POSA; reducing both AHI and %Tsupine. The effect on sleep quality, daytime sleepiness and disease-specific quality of life was minimal. However, there were limited data and follow-up was often brief, meaning that further research is needed to determine the effect of vibrotactile PT on patient-centred outcomes.
PROSPERO REGISTRATION NUMBER
CRD42020188617.
Topics: Humans; Outcome Assessment, Health Care; Cohort Studies; Continuous Positive Airway Pressure; Sleep Apnea, Obstructive; Disorders of Excessive Somnolence
PubMed: 37344178
DOI: 10.1136/thorax-2021-218402 -
Medicine May 2023Sleep-related problems are debilitating and long-lasting conditions in individuals with stroke. We aimed to estimate the prevalence of poor sleep quality after stroke by... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Sleep-related problems are debilitating and long-lasting conditions in individuals with stroke. We aimed to estimate the prevalence of poor sleep quality after stroke by conducting a systematic review and meta-analysis.
METHODS
Five databases (PubMed, Embase, Web of Science, Scopus, and CINHAL) were searched for literature published before November 2022. Studies recruiting participants with stroke, using a validated scale to measure sleep quality and in English were included. We used the Agency for Healthcare Research and Quality Scale and Newcastle-Ottawa Scale to assess the quality of eligible studies. Pooled prevalence and subgroup analyses were performed to understand the variation in sleep quality among studies. We followed the PRISMA checklist to report the study.
RESULTS
Thirteen studies were included for analysis (n = 3886). The pooled prevalence of poor sleep quality was 53% (95% CI 41-65%). Studies using PSQI with a cutoff point of 7 had a prevalence of 49% (95% CI 26-71%), whereas those with a cutoff point of 5 had a higher prevalence of 66% (95% CI 63-69%) (P = .13). Geographical location could explain the prevalence variation between studies. The majority of included studies had a medium level quality of evidence (10/13).
CONCLUSION
Poor sleep quality appears to be common in patients with stroke. Considering its negative impact on health, effective measures should be taken to improve their quality of sleep. Longitudinal studies should be conducted to examine the contributing factors and investigate the mechanisms that lead to poor sleep quality.
Topics: Humans; Sleep Quality; Stroke; Sleep; Sleep Initiation and Maintenance Disorders; Prevalence
PubMed: 37335687
DOI: 10.1097/MD.0000000000033777