Can music improve sleep quality in adults with primary insomnia? A systematic review and network meta-analysis
Introduction
One third of one’s lifetime is expended in sleep, and sleep is an important and indispensable part of health. Sleep disturbance has been identified as a significant and growing cause of concern for public health (Nomura et al., 2010). Characteristic of insomnia, one of the foremost sleep disturbances, as described by sleep experts, often features difficulty in initiating or maintaining sleep, early morning waking, and nonrestorative sleep (Schutte-Rodin et al., 2008). Insomnia may also be considered as a kind of sub-health state, as it causes much harm to the body, often characterized by hypertension, diabetes, or depression. Insomnia also affects the next day's work and study; in severe cases, it will lead to a decline in attention for a long time, accompanied by a reduction of the individual’s immunity and quality of life, even becoming life-threatening (Dam et al., 2008, Komada et al., 2012). Insomnia has become the second major cause of individuals’ visits to neurological clinics, ranking after headaches, and it is severe enough to become an economic burden to individuals and society, simultaneously increasing accident rates and decreasing productivity (Wade, 2011). The prevalence of insomnia worldwide is 30–35% (Roth, 2007, Yeung et al., 2004), involving up to 50% of older adults (Zahran et al., 2005). Therefore, the treatment of insomnia, especially the treatment of insomnia for elderly individuals, has attracted more and more public attention.
At present, the treatment of insomnia is still mainly drug-based therapy; however, the long-term side effects of sedative, hypnotic drug use are obvious, causing drug dependence or drug tolerance, which may also affect the hypnotic effect (DeMartinis et al., 2009). Current research shows that clinically-used, sedative, hypnotic drugs do not really improve sleep quality (Buscemi et al., 2007). As a result, the non-pharmacological management of sleep problems has become a crucial issue (Mercier et al., 2016, van Straten et al., 2017). The power of music and its nonverbal nature provides a prime communication medium in which language is diminished or abolished; furthermore, music easily elicits movements that stimulate interactions between the perception and action systems (Zhang et al., 2016, Zhang et al., 2017). As a result, music intervention has been identified by researchers as a key area of interest as it is relatively inexpensive, readily available, and can be easily implemented. Recipients can be actively engaged in a relaxation-improving intervention in which music is the key ingredient, termed “music-assisted relaxation” method, or they can passively listen to music that a therapist plays or sings or to a CD player before bedtime, considered as a “listening to music” method. Insomnia patients may sensitive to the music, and listening to music has been considered as a therapeutic strategy for insomnia patients' treatment.
Due to numerous means of classifying music intervention and small sample sizes, the effects of music are still inconclusive. To further explore this subject, we performed a network meta-analysis of all available clinical trials of the effects of music on adults with primary insomnia. Network meta-analysis is an extension of pairwise meta-analysis (head-to-head meta-analysis which only considers direct evidences) which intervention aims to combine direct and indirect evidences into a single effect size and rank all available arms, calculating estimates for interventions even if they have not been compared directly in current studies, provided that a common comparator exists (Salanti, 2012). A few pairwise meta-analyses (De Niet et al., 2009, Kligler et al., 2016, Wang et al., 2014a) have analyzed the effects of music therapy, but these analyses only considered direct evidence and did not rank which intervention arm is best. No previous reviews have provided a comprehensive overview of this subject, using network meta-analysis.
Section snippets
Search strategy and selection criteria
This systematic review was performed with an a priori established protocol (PROSPERO CRD42017064750) (PROSPERO, 2009 http://www.cdr.york.ac.uk/prospero), and the meta-analysis was performed in agreement with the preferred reporting items for the systematic reviews and meta-analyses (PRISMA) statement, the PRISMA network statement, and the Cochrane Collaboration recommendations (Cochrane handbook for systematic reviews of interventions, 2011; Hutton et al., 2015; Moher et al., 2009). Clinical
Systematic review and qualitative assessment
Overall, 214 unique citations were identified using our search strategy. A total of 20 trials (n = 1339) (Chan et al., 2010, Chan, 2011, Chang et al., 2012, de Niet et al., 2010, Feng and Wang, 2013a, Feng and Wang, 2013b, Huang et al., 2016, Lai and Good, 2005, Lai et al., 2015, Levin, 1998, Lin et al., 2016, Min et al., 2013, Shi, 2014, Shum et al., 2014, Su et al., 2013, Wang and Cheng, 2014, Wang et al., 2014b, Wang et al., 2016, Yin et al., 2015, Ziv et al., 2008) and 12 interventions
Discussion
The network meta-analysis represents the most comprehensive synthesis of data for currently available music intervention studies on adults with primary insomnia. We combined direct and indirect trials, comparing 12 different interventions and reporting on 1339 patients. First, we found that all interventions with music were significantly more effective than usual care, in reference to PSQI scores, to be the primary outcome. Listening to music before bedtime lead to superior efficacy in terms of
Conflicts of interest
The authors do not have any conflicts of interest to disclose.
Funding
The work were supported by Special project for capital health development research(No. 2014-2-5031)and Dean Innovation Fund (YNKT2014039) from the 302nd Hospital of Chinese PLA, Beijing 100039, PR China. Ethical approval
Ethical approval
The systematic review was not subject to ethical review.
References (66)
- et al.
Associations between specific technologies and adolescent sleep quantity, sleep quality, and parasomnias
Sleep Med.
(2014) - et al.
The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research
Psychiatry Res.
(1989) - et al.
Effects of music on depression and sleep quality in elderly people: a randomised controlled trial
Complement. Ther. Med.
(2010) - et al.
The effects of music on the sleep quality of adults with chronic insomnia using evidence from polysomnographic and self-reported analysis: a randomized control trial
Int. J. Nurs. Stud.
(2012) - et al.
New approaches for the treatment of sleep disorders
Adv. Pharmacol.
(2009) - et al.
Comparing the effects of music and exercise with music for older adults with insomnia
Appl. Nurs. Res.
(2016) - et al.
A two-year follow-up study on the symptoms of sleep disturbances/insomnia and their effects on daytime functioning
Sleep Med.
(2012) - et al.
Social determinants of self-reported sleep problems in South Korea and Taiwan
J. Psychosom. Res.
(2010) - et al.
Graphical methods and numerical summaries for presenting results from multiple-treatment meta-analysis: an overview and tutorial
J. Clin. Epidemiol.
(2011) - et al.
The effects of sedative music on sleep quality of older community-dwelling adults in Singapore
Complement. Ther. Med.
(2014)
Music therapy improves sleep quality in acute and chronic sleep disorders: a meta-analysis of 10 randomized studies
Int. J. Nurs. Stud.
Does music therapy enhance behavioral and cognitive function in elderly dementia patients? A systematic review and meta-analysis
Ageing Res. Rev.
Crossmodal effects of Guqin and piano music on selective attention: an event-related potential study
Neurosci. Lett.
Cochrane Handbook for Systematic Reviews of Interventions
The efficacy and safety of drug treatments for chronic insomnia in adults: a meta-analysis of RCTs
J. Gen. Intern. Med.
CRD’s Guidance for Undertaking Reviews in Health Care (Internet)
Graphical tools for network meta-analysis in STATA
PLoS One
Sleep Behaviour Among Elderly in Hong Kong
Retracted: a randomised controlled study of the effects of music on sleep quality in older people
J. Clin. Nurs.
Association between sleep and physical function in older men: the osteoporotic fractures in men sleep study
J. Am. Geriatr. Soc.
Music-assisted relaxation to improve sleep quality: meta-analysis
J. Adv. Nurs.
Evidence synthesis for decision making 4: inconsistency in networks of evidence based on randomized controlled trials
Med. Decis. Making
Experimental pain thresholds and plasma beta-endorphin levels during exercise
Med. Sci. Sports Exercise
The efficacy and mechanism of Chinese Guqin music intervention for patients with primary insomnia. International
J. Tradit. Chin. Med.
Hypnotic suggestion combined with Guqin music in the treatment of primary insomnia-a 8-week randomized controlled trial
Int. J. Tradit. Chin. Med.
Users’ guides to the medical literature: II. How to use an article about therapy or prevention A. Are the results of the study valid?
JAMA
Measuring inconsistency in meta-analyses [journal article as teaching resource, deposited by John Flynn]
Br. Med. J.
Acupuncture and reflexology for insomnia: a feasibility study
Acupunct. Med.
The PRISMA extension statement for reporting of systematic reviews incorporating network meta-analyses of health care interventions: checklist and explanations
Ann. Intern. Med.
The effect of relaxation music listening on sleep quality in traumatized refugees: a pilot study
J. Music Ther.
Complementary/Integrative therapies that work: a review of the evidence
Am. Fam. Physician
Musiktherapie—Wirkung auf Schmerz, Schlaf und Lebensqualität bei low back pain
Wien. Med. Wochenschr.
Music improves sleep quality in older adults
J. Adv. Nurs.
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These authors contributed equally to this work.