Efficacy, acceptability and tolerability of all available treatments for insomnia in the elderly: a systematic review and network meta-analysis.

Myrto, Samara T; Huhn, Maximilian; Chiocchia, Virginia; Schneider-Thoma, Johannes; Wiegand, Michael; Salanti, Georgia; Leucht, Stefan (2020). Efficacy, acceptability and tolerability of all available treatments for insomnia in the elderly: a systematic review and network meta-analysis. Acta psychiatrica Scandinavica, 142(1), pp. 6-17. Wiley-Blackwell 10.1111/acps.13201

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OBJECTIVES

Symptoms of insomnia are highly prevalent in the elderly. A significant number of pharmacological and non-pharmacological interventions exists, but, up-to-date, their comparative efficacy and safety has not been sufficiently assessed.

METHODS

We integrated the randomized evidence from every available treatment for insomnia in the elderly (>65 years) by performing a network meta-analysis. Several electronic databases were searched up to May 25, 2019. The two primary outcomes were total sleep time and sleep quality. Data for other 6 efficacy and 8 safety outcomes were also analyzed.

RESULTS

53 RCTs with 6832 participants (75 years old on average) were included, 43 of which examined the efficacy of one or more drugs. Ten RCTs examined the efficacy of non-pharmacological interventions and were evaluated only with pairwise meta-analyses because they were disconnected from the network. The overall confidence in the evidence was very low primarily due to the small amount of data per comparison and their sparse connectedness. Several benzodiazepines, antidepressants and z-drugs performed better in both primary outcomes, but few comparisons had data from more than one trial. The limited evidence on non-pharmacological interventions suggested that acupressure, auricular acupuncture, mindfulness-based stress reduction program, and tart cherry juice were better than their control interventions. Regarding safety, no clear differences were detected among interventions due to large uncertainty.

CONCLUSIONS

Insufficient evidence exists on which intervention is more efficacious for elderly patients with insomnia. More RCTs, with longer duration, making more direct interventions among active treatments and presenting more outcomes are urgently needed.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Pre-clinic Human Medicine > Institute of Social and Preventive Medicine (ISPM)

UniBE Contributor:

Chiocchia, Virginia and Salanti, Georgia

Subjects:

600 Technology > 610 Medicine & health
300 Social sciences, sociology & anthropology > 360 Social problems & social services

ISSN:

0001-690X

Publisher:

Wiley-Blackwell

Language:

English

Submitter:

Andrea Flükiger-Flückiger

Date Deposited:

18 Jun 2020 10:20

Last Modified:

13 Aug 2020 14:38

Publisher DOI:

10.1111/acps.13201

PubMed ID:

32521042

Uncontrolled Keywords:

meta-analysis old age psychopharmacology sleep treatment

BORIS DOI:

10.7892/boris.144721

URI:

https://boris.unibe.ch/id/eprint/144721

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