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

Chan-Young Kwon; Boram Lee; Moon Joo Cheong; Tae-Hun Kim; Bo-Hyoung Jang; Sun Yong Chung; Jong Woo Kim

doi:10.3389/fpsyt.2020.608896

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

Front Psychiatry. 2021 Jan 28:11:608896. doi: 10.3389/fpsyt.2020.608896. eCollection 2020.

Authors

Chan-Young Kwon¹, Boram Lee², Moon Joo Cheong³, Tae-Hun Kim⁴, Bo-Hyoung Jang⁵, Sun Yong Chung⁶, Jong Woo Kim⁶

Affiliations

¹ Department of Oriental Neuropsychiatry, Dong-eui University College of Korean Medicine, Busan, South Korea.
² Clinical Medicine Division, Korea Institute of Oriental Medicine, Daejeon, South Korea.
³ Education Graduate of Wonkwang University, Iksan-si, South Korea.
⁴ Korean Medicine Clinical Trial Center, Korean Medicine Hospital, Kyung Hee University, Seoul, South Korea.
⁵ Department of Preventive Medicine, College of Korean Medicine, Kyung Hee University, Seoul, South Korea.
⁶ Department of Neuropsychiatry, Kyung Hee University Korean Medicine Hospital at Gangdong, Seoul, South Korea.

Abstract

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.

Keywords: aged; elderly; insomnia; network meta-analysis; systematic review.

Publication types

Systematic Review