Department of Soldier Performance, Defence Institute of Physiology and Allied Sciences, Defence Research and Development Organization, Delhi, India.
Chronobiol Int. 2023 Oct 3;40(10):1333-1353. doi: 10.1080/07420528.2023.2262567. Epub 2023 Nov 3.
Sleep is the elixir of life. Both healthy populations and patients with chronic diseases experience sleep disturbances in their lifetime. Pharmacological agents to induce sleep in individuals with sleep disturbances pose side effects like tolerance and dependence, warranting the development of alternative non-pharmacological interventions with less or no adverse effects. However, deciphering comprehensive evidence on the translational potential of these alternative therapies remains difficult. In the current paper, we systematically reviewed the recent literature on the effect of non-pharmacological interventions (NPIs) on improving sleep quality in both healthy and diseased populations experiencing sleep disturbances. We searched PubMed, Science Direct, Cochrane Controlled Trials, and Web of Science databases from inception to June 2022 for randomized controlled trials and cohort studies evaluating the sleep quality of individuals. We performed a meta-analysis using the random effects model with Pittsburgh Sleep Quality Index (PSQI) as an outcome measure to evaluate the effect of five distinct NPIs on sleep quality in normal and people with different medical conditions. Subgroup analyses and sensitivity analyses were done for heterogeneity analysis and to check the consistency of results, respectively. In 16 trials reporting on 1885 subjects, that all NPIs like Resistance Training (SMD -0.29, 95% CI -0.64 to 0.05; = 0.09); Yoga (SMD -0.48, 95% CI -0.72 to -0.25; < 0.0001); Cognitive Behavioral Therapy (SMD -1.69, 95% CI -2.70 to -0.68; = 0.001); Music (SMD -1.42, 95% CI -1.99 to -0.85; < 0.00001); Light (SMD -0.43, 95% CI -0.77 to -0.09; = 0.01) have substantially decreased the global PSQI scores. The findings of the randomized studies and a cohort study included in qualitative synthesis demonstrated that the global PSQI scores improved significantly as compared to the placebo groups. Despite the limitations of clinical heterogeneity in subjects, our results demonstrate a positive impact of the studied NPIs on sleep quality in individuals experiencing sleep disturbances. However, comprehensive double-blinded controlled trials are indispensable in the future, emphasizing the objective sleep quality and inter-individual differences in response to the intervention.
睡眠是生命的灵药。无论是健康人群还是患有慢性疾病的患者，一生中都会经历睡眠障碍。用于诱导睡眠障碍患者入睡的药物会产生耐受性和依赖性等副作用，因此需要开发副作用较小或没有副作用的替代非药物干预措施。然而，破译这些替代疗法的转化潜力的综合证据仍然很困难。在本文中，我们系统地回顾了最近关于非药物干预措施（NPIs）改善健康人群和患有睡眠障碍的疾病人群睡眠质量的文献。我们从建库至 2022 年 6 月在 PubMed、Science Direct、Cochrane 对照试验和 Web of Science 数据库中检索了评估个体睡眠质量的随机对照试验和队列研究。我们使用匹兹堡睡眠质量指数（PSQI）作为结局指标，采用随机效应模型进行荟萃分析，以评估五种不同的 NPIs 对正常人群和不同医疗条件人群睡眠质量的影响。分别进行了亚组分析和敏感性分析，以进行异质性分析和检查结果的一致性。在 16 项涉及 1885 名受试者的试验中，所有的 NPIs 均显示出改善睡眠质量的效果，包括阻力训练（SMD-0.29，95%CI-0.64 至 0.05；=0.09）；瑜伽（SMD-0.48，95%CI-0.72 至-0.25；<0.0001）；认知行为疗法（SMD-1.69，95%CI-2.70 至-0.68；=0.001）；音乐（SMD-1.42，95%CI-1.99 至-0.85；<0.00001）；光照（SMD-0.43，95%CI-0.77 至-0.09；=0.01），均显著降低了全球 PSQI 评分。纳入定性综合分析的随机研究和队列研究的结果表明，与安慰剂组相比，全球 PSQI 评分显著改善。尽管受试者的临床异质性存在局限性，但我们的结果表明，所研究的 NPIs 对睡眠障碍患者的睡眠质量有积极影响。然而，未来仍需要进行全面的双盲对照试验，强调干预措施对客观睡眠质量和个体间差异的影响。
