ReviewMusic therapy improves sleep quality in acute and chronic sleep disorders: A meta-analysis of 10 randomized studies
Introduction
Sleep is a primitive behavior of humans. Unfortunately, according to epidemiological studies, about one third of adults reported sleep disorders (Krueger and Friedman, 2009), especially in older and shift-workers (Kronholm et al., 2008, Rowshan Ravan et al., 2010). As to in-hospital patients, duo to the change of environments and the noise of medical equipments, acute sleep deprivation is common, especially in peri-operative patients or patients in intensive care unit (Hardin, 2009, Kamdar et al., 2012).
Chronic sleep disorders have proved to be associated with adverse health outcomes, including cardiovascular disorders (Cappuccio et al., 2011, Chien et al., 2010), total mortality (Cappuccio et al., 2010a, Cappuccio et al., 2010b, Castro-Costa et al., 2011, Kronholm et al., 2011), type 2 diabetes (Cappuccio et al., 2010a, Cappuccio et al., 2010b), respiratory disorders (Penzel et al., 2007), and obesity (Cappuccio et al., 2008). In addition, acute sleep deprivation can also worsen the prognosis.
Pharmacological therapy has been wildly used to treat sleep disorders, but the potential side effects limit a long-term intervention. Realizing that sleep is affected by both physiological and psychological factors, people resorted to kinds of mind-body interventions such as music therapy, which indeed have been used from a very ancient time (Cervellin and Lippi, 2011). In fact, music is the most welcomed method used by nurses to improve the patients’ sleep quality (Bouhairie et al., 2006).
Some earlier studies succeeded to prove the efficacy of music in improving sleep quality (Kullich et al., 2003, Lai and Good, 2005, Renzi et al., 2000, Zimmerman et al., 1996). Although a previous meta-analysis (de Niet et al., 2009) recommended the music-assisted relaxation to patients with sleep disorders, the evidence was limited because only 5 studies were available at that time. The result was challenged by several recent studies with negative results (Chan et al., 2010, Chang et al., 2012), and we noticed that only one study included in that mate-analysis showed negative result (Hernandez-Ruiz, 2005). With accumulating evidence, our goal was to evaluate the efficacy of music for sleep disorders by conducting a meta-analysis of prospective cohort studies.
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Search strategy and study selection
We attempted to follow the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) guideline to report the present meta-analysis (Moher et al., 2009). We systematically searched the electronic databases PubMed, Embase, and the Cochrane Library without language restriction. The following search terms were used: sleep, sleep quality, insomnia, music, music intervention, music relaxation, music therapy. The reference lists of original and review articles were reviewed to
Main features of included studies
Two hundred and twenty-seven articles were obtained from the initial search. Ten studies involving 557 participants were identified based on our criteria (Chan et al., 2010, Chang et al., 2012, Harmat et al., 2008, Hernandez-Ruiz, 2005, Kullich et al., 2003, Lai and Good, 2005, Renzi et al., 2000, Richards, 1998, Ryu et al., 2012, Zimmerman et al., 1996) (Fig. 1). The excluded studies are listed in the Appendix. All articles were in English except one in German. Two studies were found to be
Discussion
This study shows music can help to improve the quality of sleep in a wild range of populations, including patients after operation with acute sleep disorders, as well as students in university and elders in community with chronic sleep disorders. Similar results were shown in subgroups with different ages or geographical locations.
Substantial heterogeneity was observed among all studies. Subgroup analysis found heterogeneity between subgroups with objective or subjective methods, and with
Conclusion
Music appears to be effective in treating acute and chronic sleep disorders. It is low cost and safe, and could be used to improve sleep quality in various populations with different ages and culture backgrounds, in hospital or in community. Our study also gives an indication that music shows a cumulative dose effect for chronic sleep disorders. A follow-up duration more than three weeks is necessary for assessing the efficacy of music, which have an implication for the design of trial
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