Effects of non-pharmacological interventions on insomnia in patients with tinnitus: a systematic review & meta-analysis.
Despina LaparidouFfion CurtisAlina RodriguezGraham LawSimon DurrantRobert H. PierzyckiA Niroshan Siriwardena
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Abstract:
Introduction
Tinnitus is the perception of sound (ringing or buzzing) in the absence of external/electrical stimulation. It affects about 10% of people in the United Kingdom, with rates of comorbid sleep problems ranging from 50 to 77%. Our aim was to systematically review the literature relating to the effectiveness of cognitive behavioural therapy (CBT) interventions on insomnia in patients with tinnitus.
Methods
A systematic literature search of seven scientific databases (Cochrane Library/CENTRAL, PROSPERO, HTA/DARE, Medline, CINAHL, Web of science, ClinicalTrials.gov) was performed, covering literature published up to August 2018. Database searching was supplemented with internet searching and forward/backward citation tracking from systematic reviews and included studies. Studies were considered eligible for inclusion if they involved: adult patients (living at home or in a care setting) with tinnitus; CBT interventions for tinnitus and/or insomnia; any comparator (i.e. usual care, alternative intervention); randomised controlled trials or quasi-randomised controlled trials that reported sleep outcomes. The primary outcome was a mean difference in sleep. The quality of the included studies was assessed according to the Cochrane Risk of Bias assessment tool. Two reviewers independently reviewed title/abstracts initially and then full-text papers, before proceeding with data extractions. Any discrepancies were resolved through discussion, or where required a third reviewer.
Results
Four studies (427 participants) were included in the meta-analysis. The majority of the interventions were internet-based and targeted tinnitus distress with insomnia reported as a secondary outcome. Sleep management and/or guidance was an additional optional module in three studies. Results demonstrated a significant reduction in insomnia as measured by the insomnia severity index [-3.28; 95% CI=-4.51,-2.05; I2=0%]), which equates to a moderate effect size (0.05). Risk of bias was considered low in all categories except blinding (participants and personnel and/or outcome assessment), which was not always possible due to study design.
Conclusion
This systematic review and meta-analysis showed that CBT-based interventions can improve insomnia in people diagnosed with tinnitus. Further research into interventions specifically targeting sleep problems would be advantageous, especially exploring which components of CBT are the most effective for alleviating sleep problems in patients with tinnitus.Keywords:
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Background. Insomnia is a prominent complaint of cancer patients that can significantly affect their quality of life and symptoms related to sleep quality. Conventional drug approaches have a low rate of success in alleviating those suffering insomnia. The aim of this systematic review was to assess the efficacy of acupuncture in the management of cancer-related insomnia. Methods. A total of 12 databases were searched from their inception through January 2016 without language restriction. Randomized controlled trials (RCTs) and quasi-RCTs were included if acupuncture was used as the sole intervention or as an adjunct to another standard treatment for any cancer-related insomnia. The data extraction and the risk of bias assessments were performed by 2 independent reviewers. Results. Of the 90 studies screened, 6 RCTs were included. The risk of bias was generally unclear or low. Three RCTs showed equivalent effects on the Pittsburgh Sleep Quality Index and 2 RCTs showed the similar effects on response rate to those of conventional drugs at the end of treatment. The other RCT showed acupuncture was better than hormone therapy in the numbers of hours slept each night and number of times woken up each night. The 3 weeks of follow-up in 2 RCTs showed superior effects of acupuncture compared with conventional drugs, and a meta-analysis showed significant effects of acupuncture. Two RCTs tested the effects of acupuncture on cancer-related insomnia compared with sham acupuncture. One RCT showed favourable effects, while the other trial failed to do so. Conclusion. There is a low level of evidence that acupuncture may be superior to sham acupuncture, drugs or hormones therapy. However, the number of studies and effect size are small for clinical significance. Further clinical trials are warranted.
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Background . Insomnia and depression often co‐occurr. However, there is lack of effective treatment for such comorbidity. CBT‐I has been recommended as the first‐line treatment for insomnia; whether it is also effective for comorbidity of insomnia and depression is still unknown. Therefore, we conducted this meta‐analysis of randomized controlled trials to assess the clinical effectiveness and safety of CBT‐I for insomnia comorbid with depression. Data Sources. Seven electronic databases, including China National Knowledge Infrastructure (CNKI), Wanfang Database, China Science Technology Journal Database, SinoMed Database, PubMed, the Cochrane Library, and EMBASE, as well as grey literature, were searched from the beginning of each database to July 1, 2019. Study Eligibility Criteria. Randomized controlled trials that compared CBT‐I to no treatment or hypnotics (zopiclone, estazolam, and benzodiazepine agonist) for insomnia comorbid with depression and reported both insomnia scales and depression scales. Study Assessment and Synthesis Methods. Cochrane Reviewer’s Handbook was used for evaluating the risk of bias of included studies. Review Manager 5.3 software was used for meta‐analysis. Online GRADEpro was used to assess the quality of evidence. Results . The pooled data showed that CBT‐I was superior to no treatment for insomnia, while it was unsure whether CBT‐I was better than no treatment for depression. And the effectiveness of CBT‐I was comparable to hypnotics for both insomnia and depression. CBT‐I was likely to be safe due to its noninvasive nature. The methodological quality varied across these trials. The evidence quality varied from moderate to very low, and the recommendation level was low. Conclusions . Currently, findings support that CBT‐I seems to be effective and safe for insomnia comorbid with depression to improve the insomnia condition, while it is unsure whether CBT‐I could improve depression condition. More rigorous trials are needed to confirm our findings.
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Objectives: To systematically review studies on the effect of treatment of subjective tinnitus in children. Data Sources: We searched for studies in MEDLINE and EMBASE databases, after which additional studies were hand searched using Scopus databases. The methods are described in the study protocol, which has been registered in the PROSPERO register. PRISMA guidelines were followed in the reporting of this study. Eligibility Criteria: We considered for inclusion randomized controlled trials (RCTs), observational studies, case reports, and case series, with tinnitus as primary outcome in children (0–18 years old) with acute or chronic subjective tinnitus. We excluded studies in which both children and adults participated but outcomes were not specifically reported for children, as well as animal studies, studies with a non-original study design and studies about children with pulsatile or objective tinnitus. Data Selection: Two reviewers independently assessed studies for eligibility and quality, collected and extracted data. Statistical analyses were performed in case of homogeneous outcomes. Results: The search yielded a total of 4,447 studies. Of these, 147 eligible studies were selected. One case report and five observational studies met the eligibility criteria. Three studies applied counseling and (simplified-)TRT and reported improvement in tinnitus outcome in 68 out of 82 children after 3–6 months of treatment. Two studies used pharmacological treatments and reported improvement in 74 out of 86 patients after 10 days to 3 months of treatment. One study reported the outcome of biofeedback therapy, describing an improvement in tinnitus loudness and annoyance after 2 months of treatment. Conclusion: Due to the high risk of bias of the included studies, we cannot determine the effectiveness of the treatment of subjective tinnitus in children. Also, owing to brief follow-up periods, it is not possible to draw conclusions regarding long-term effects. Randomized controlled trials with longer follow-up periods are necessary to provide substantial evidence of the effects of therapies for children affected by tinnitus. https://www.crd.york.ac.uk/prospero/ Systematic Review Registration: https://www.crd.york.ac.uk/prospero/ , identifier [CRD42020178134].
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Background Insomnia is common in primary care, can persist after co-morbid conditions are treated, and may require long-term medication treatment. A potential alternative to medications is cognitive behavioral therapy for insomnia (CBT-I). Methods In accordance with PRISMA guidelines, we systematically reviewed MEDLINE, EMBASE, the Cochrane Central Register, and PsycINFO for randomized controlled trials (RCTs) comparing CBT-I to any prescription or non-prescription medication in patients with primary or comorbid insomnia. Trials had to report quantitative sleep outcomes (e.g. sleep latency) in order to be included in the analysis. Extracted results included quantitative sleep outcomes, as well as psychological outcomes and adverse effects when available. Evidence base quality was assessed using GRADE. Results Five studies met criteria for analysis. Low to moderate grade evidence suggests CBT-I has superior effectiveness to benzodiazepine and non-benzodiazepine drugs in the long term, while very low grade evidence suggests benzodiazepines are more effective in the short term. Very low grade evidence supports use of CBT-I to improve psychological outcomes. Conclusions CBT-I is effective for treating insomnia when compared with medications, and its effects may be more durable than medications. Primary care providers should consider CBT-I as a first-line treatment option for insomnia. (Reprinted with permission from BMC Family Practice 2012;13:40:1–11)
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Insomnia with high incidence is usually accompanied by many other diseases, especially mental disorders with the under-diagnosis and under-treatment. Some studies demonstrated that acupuncture may be effective for emotional disorders accompanied by insomnia. The systematic review protocol is designed to guiding analysis the effectiveness and safety of acupuncture for emotional disorders in patients with insomnia.Seven databases, Cochrane central register of controlled trials, Medline, Embase, China National Knowledge Infrastructure, Chinese Biomedical Literature database, VIP database and Wanfang database, will be searched from initial to December 2020. Randomized controlled trials (RCTs) of acupuncture for insomnia with emotional disorders (depression and anxiety) outcomes, which were reported in Chinese or English, will be included. The primary outcome is the change of degree of anxiety and depression. Study selection, data extraction and assessment of the risk of bias will be performed independently by 2 or more reviewers. Available data will be synthesized and statistically analyzed in RevMan V.5.3. The model of fixed effects will be used for the pooled data when the heterogeneity tests show little or no statistical heterogeneity (I2 < 50%). The random-effects model will be taken with heterogeneous data (50% ≤ I2 < 75%).The effect of acupuncture on emotional disorders in patients with insomnia will be assessed on Hamilton anxiety Scale, Hamilton anxiety Scale, Pittsburgh Sleep Quality Index, Insomnia Severity Index, Self-rating Anxiety Scale, Self-rating Depressive Scale and the number of participants secede and the number of patients reported adverse events.the emotional disorders interaction with insomnia and the increase of risk on disease evolving and insomnia-related burden, it is so momentous to know that the role of insomnia treatment on comorbidities. We should concern about the management of emotional disorders when treat insomnia, and acupuncture treatment anxiety and depression caused by insomnia may be effective.Ethics approval is not be needed because the data will not contain individual patient data, and there are no concerns about privacy. The results of this meta-analysis will be disseminated through publication in a peer-reviewed academic journal or relevant conference.INPLASY2020100115.
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