Comparative effectiveness and safety of pharmacological and non-pharmacological interventions for insomnia: an overview of reviews

Rios, Patricia; Cardoso, Roberta; Morra, Deanna; Nincic, Vera; Goodarzi, Zahra; Farah, Bechara; Harricharan, Sharada; Morin, Charles M.; Leech, Judith; Straus, Sharon E.; Tricco, Andrea C.

doi:10.1186/s13643-019-1163-9

Systematic Reviews

Table 3 Summary of evidence across outcomes from SR + MAs and SRs

From: Comparative effectiveness and safety of pharmacological and non-pharmacological interventions for insomnia: an overview of reviews

Intervention and comparator	Number of primary studies	Type of publication	Findings^a and certainty of evidence (GRADE)
Intervention and comparator	Number of primary studies	Type of publication	High^b	Medium^c	Low^d	Very low^e
Outcome: sleep onset latency (SOL)
Benzodiazepines vs inactive controls	54	SR + MA		+ 1	+ 1	+ 1
Non-benzodiazepines vs inactive controls	59	SR + MA		+ 2	+ 2
Non-benzodiazepines vs inactive controls	59	SR			+ 2	− 1
Non-benzodiazepines vs active controls	1	SR				− 1
Suvorexant vs inactive controls	3	SR + MA		+ 3
Suvorexant vs inactive controls	3	SR			+ 1
Antidepressants vs inactive controls	21	SR + MA		+/− 2	+ 1
Antidepressants vs inactive controls	21	SR		+/− 1	+/− 2	+/− 1
Antidepressants vs active controls	1	SR			+ 3
Antipsychotics vs inactive controls	5	SR + MA
Antipsychotics vs inactive controls	5	SR			+ 1	+ 2
Melatonin vs inactive controls	24	SR + MA		+ 3		+ 1
Melatonin vs inactive controls	24	SR			+ 1/− 1	+/− 1
Diphenhydramine vs inactive controls	5	SR + MA			+/− 1
Diphenhydramine vs inactive controls	5	SR			+/− 2
Cognitive behavioral therapy vs inactive controls	89	SR + MA	+ 3	+ 6	+ 6	− 2
Cognitive behavioral therapy vs inactive controls	89	SR		+ 5	+ 2	+ 1
Cognitive behavioral therapy vs active controls	7	SR + MA			+ 1/− 1
Cognitive behavioral therapy vs active controls	7	SR
Behavioral Interventions vs inactive controls	22	SR + MA			− 2
Behavioral Interventions vs inactive controls	22	SR		+ 1	+ 1
Mindfulness-based Interventions vs inactive controls	2	SR + MA		+ 1
Combination Therapies vs inactive controls	1	SR			+ 1
Outcome: total sleep time (TST)
Benzodiazepines vs inactive controls	33	SR + MA			+ 1	+ 1
Benzodiazepines vs inactive controls	33	SR				+ 1
Non-benzodiazepines vs inactive controls	41	SR + MA		+ 2	+ 1
Non-benzodiazepines vs inactive controls	41	SR			+ 1	+ 1
Non-benzodiazepines vs active controls	1	SR				+ 1
Suvorexant vs inactive controls	3	SR + MA		+ 2	+ 1
Suvorexant vs inactive controls	3	SR			+ 1
Antidepressants vs inactive controls	24	SR + MA		+ 4
Antidepressants vs inactive controls	24	SR		+/− 1	+/− 2	+/− 1
Antidepressants vs active controls	1	SR			− 2
Antipsychotics vs inactive controls	4	SR				+/− 3
Melatonin vs inactive controls	30	SR + MA	− 1	+ 2/− 1	− 1	− 1
Melatonin vs inactive controls	30	SR		+ 1	+/− 1	+/− 2
Diphenhydramine vs inactive controls	4	SR + MA			− 1
Diphenhydramine vs inactive controls	4	SR			+/− 2
Cognitive behavioral therapy vs inactive controls	72	SR + MA	+ 1/− 1	+ 4/− 2	+ 1/− 4	+ 1/− 1
Cognitive behavioral therapy vs inactive controls	72	SR		+/− 2	+/− 1
Cognitive behavioral therapy vs active controls	2	SR + MA			− 2
Cognitive behavioral therapy vs active controls	2	SR		− 1
Behavioral Interventions vs inactive controls	7	SR + MA			− 1
Behavioral Interventions vs inactive controls	7	SR			− 1	− 1
Mindfulness-based Interventions vs inactive controls	2	SR + MA		− 1
Combination therapies vs inactive controls	4	SR + MA			− 1
Combination therapies vs inactive controls	4	SR			+ 1
Outcome: wake after sleep onset (WASO)
Benzodiazepines vs inactive controls	4	SR + MA			+ 1
Non-benzodiazepines vs inactive controls	16	SR + MA		− 1	+ 1
Non-benzodiazepines vs inactive controls	16	SR			+ 2	+ 1
Non-benzodiazepines vs active controls	3	SR + MA
Non-benzodiazepines vs active controls	3	SR			+ 1
Suvorexant vs inactive controls	3	SR + MA		+ 1	+ 1
Suvorexant vs inactive controls	3	SR			+ 1
Antidepressants vs inactive controls	13	SR + MA		+ 2
Antidepressants vs inactive controls	13	SR		+ 1	+ 2	+ 2
Antidepressants vs active controls	1	SR			+ 2
Melatonin vs inactive controls	13	SR + MA		− 1	− 2
Melatonin vs inactive controls	13	SR				+ 2
Diphenhydramine vs inactive controls	1	SR				− 1
Cognitive behavioral therapy vs inactive controls	70	SR + MA	+ 1/− 1	+ 5	+ 7/− 2	+ 1
Cognitive behavioral therapy vs inactive controls	70	SR		+ 3	+ 3
Cognitive behavioral therapy vs active controls	17	SR + MA			− 2
Cognitive behavioral therapy vs active controls	17	SR		+ 1		+ 1
Behavioral Interventions vs inactive controls	9	SR + MA		+/− 1	+/− 1
Behavioral Interventions vs inactive controls	9	SR			+ 1
Outcome: sleep quality
Benzodiazepines vs inactive controls	2	SR + MA			− 1
Non-benzodiazepines vs inactive controls	9	SR + MA		+ 1	+ 1
Non-benzodiazepines vs inactive controls	9	SR			+ 2
Suvorexant vs inactive controls	3	SR + MA		+ 1
Antidepressants vs inactive controls	13	SR + MA		+ 1
Antidepressants vs inactive controls	13	SR			+ 3
Antidepressants vs active controls	1	SR			− 1
Antipsychotics vs inactive controls	8	SR			+ 2	+ 2
Melatonin vs inactive controls	23	SR + MA		− 3	+ 1/− 1
Melatonin vs inactive controls	23	SR			+/− 3	+ 2
Diphenhydramine vs inactive controls	1	SR				− 1
Cognitive behavioral therapy vs inactive controls	47	SR + MA		+ 5/− 1	+ 5/− 2	+ 1
Cognitive behavioral therapy vs inactive controls	47	SR		+ 1	+ 2/− 1
Cognitive behavioral therapy vs active controls	4	SR			− 2
Behavioral Interventions vs inactive controls	12	SR + MA			+ 1
Behavioral Interventions vs inactive controls	12	SR		+ 1/− 1	+ 3/− 1
Behavioral Interventions vs active controls	8	SR + MA			+ 1
Mindfulness-based Interventions vs inactive controls	4	SR + MA		+ 1
Mindfulness-based Interventions vs inactive controls	4	SR				+ 1
Combination Therapies vs inactive controls	1	SR			+ 1
Outcome: sleep satisfaction
Antipsychotics vs inactive controls	1	SR				− 1
Melatonin vs inactive controls	1	SR			+ 1
Cognitive behavioral therapy vs inactive controls	2	SR		+ 1
Behavioral Interventions vs inactive controls	1	SR			+ 1
Outcome: sleep efficiency
Non-benzodiazepines vs inactive controls	4	SR + MA		+ 1
Non-benzodiazepines vs inactive controls	4	SR				+/− 1
Non-benzodiazepines vs active controls	2	SR				+/− 1
Antidepressants vs inactive controls	15	SR + MA		+ 2
Antidepressants vs inactive controls	15	SR		+ 1	+ 1	+/− 2
Antipsychotics vs inactive controls	2	SR				+ 3
Melatonin vs inactive controls	19	SR + MA	− 1	+ 1/− 2	− 1
Melatonin vs inactive controls	19	SR			+/− 1	+ 1/− 1
Diphenhydramine vs inactive controls	2	SR			+/− 1
Cognitive behavioral therapy vs inactive controls	83	SR + MA	+ 1	+ 7/− 1	+ 5	+ 1
Cognitive behavioral therapy vs inactive controls	83	SR		+ 4	+ 5
Cognitive behavioral therapy vs active controls	4	SR + MA			− 2
Cognitive behavioral therapy vs active controls	4	SR		+ 1	+ 1
Behavioral Interventions vs inactive controls	4	SR			+ 2
Mindfulness-based Interventions vs inactive controls	5	SR + MA		− 1
Mindfulness-based Interventions vs inactive controls	5	SR			+/− 1
Outcome: Insomnia Severity Index (ISI)
Suvorexant vs inactive controls	3	SR + MA		+ 1	+ 1
Suvorexant vs inactive controls	3	SR			+ 1
Antidepressants vs inactive controls	2	SR + MA		+ 1
Antipsychotics vs inactive controls	1	SR				+ 1
Diphenhydramine vs inactive controls	1	SR			+ 1
Cognitive behavioral therapy vs inactive controls	46	SR + MA		+ 4/− 1	+ 5
Cognitive behavioral therapy vs inactive controls	46	SR		+ 3	+ 2
Cognitive behavioral therapy vs active controls	2	SR + MA			− 1
Outcome: fatigue severity
Cognitive behavioral therapy vs inactive controls	26	SR + MA	+/− 1	+/− 2
Cognitive behavioral therapy vs inactive controls	26	SR		+ 2
Behavioral Interventions vs inactive controls	2	SR			− 1
Outcome: health-related quality of life
Non-benzodiazepines vs inactive controls	4	SR		+/− 1
Melatonin vs inactive controls	1	SR				+ 1
Cognitive behavioral therapy vs inactive controls	7	SR		+ 2	+ 2
Cognitive behavioral therapy vs active controls	1	SR			+ 1
Outcome: hangover/morning sedation
Non-benzodiazepines vs inactive controls	1	SR				− 1
Non-benzodiazepines vs active controls	1	SR				− 1
Suvorexant vs inactive controls	3	SR + MA		+ 2
Antipsychotics vs inactive controls	2	SR				+ 1
Outcome: accidental injury
Suvorexant vs inactive controls	3	SR + MA		+ 2
Outcome: addiction, dependence, or diversion
Non-benzodiazepines vs inactive controls	3	SR			+/− 1
Non-benzodiazepines vs active controls	3	SR			+/− 1
Suvorexant vs inactive controls	3	SR + MA		+ 2

Abbreviations: SR systematic review, SR + MA systematic review and meta-analysis, GRADE Grading of Recommendations Assessment, Development and Evaluation
^aThe number indicates how many SR + MAs or SRs contributed to that result
^bReviews that received no downgrades
^cReviews that received 1 or 2 downgrades
^dReviews that received 3 or 4 downgrades
^eReviews that received 5 or 6 downgrades
⁺Signifies statistically significant improvement in effectiveness outcomes or significantly increased risk of harms for safety outcomes
⁻Signifies non-statistically significant change
^+/−Signifies mixed or discordant results within SR + MAs and SRs

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ISSN: 2046-4053

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