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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 comparatorNumber of primary studiesType of publicationFindingsa and certainty of evidence (GRADE)
HighbMediumcLowdVery lowe
Outcome: sleep onset latency (SOL)
 Benzodiazepines vs inactive controls54SR + MA + 1+ 1+ 1
 Non-benzodiazepines vs inactive controls59SR + MA + 2+ 2 
SR  + 2− 1
 Non-benzodiazepines vs active controls1SR   − 1
 Suvorexant vs inactive controls3SR + MA + 3  
SR  + 1 
 Antidepressants vs inactive controls21SR + MA +/− 2+ 1 
SR +/− 1+/− 2+/− 1
 Antidepressants vs active controls1SR  + 3 
 Antipsychotics vs inactive controls5SR + MA    
SR  + 1+ 2
 Melatonin vs inactive controls24SR + MA + 3 + 1
SR  + 1/− 1+/− 1
 Diphenhydramine vs inactive controls5SR + MA  +/− 1 
SR  +/− 2 
 Cognitive behavioral therapy vs inactive controls89SR + MA+ 3+ 6+ 6− 2
SR + 5+ 2+ 1
 Cognitive behavioral therapy vs active controls7SR + MA  + 1/− 1 
SR    
 Behavioral Interventions vs inactive controls22SR + MA  − 2 
SR + 1+ 1 
 Mindfulness-based Interventions vs inactive controls2SR + MA + 1  
 Combination Therapies vs inactive controls1SR  + 1 
Outcome: total sleep time (TST)
 Benzodiazepines vs inactive controls33SR + MA  + 1+ 1
SR   + 1
 Non-benzodiazepines vs inactive controls41SR + MA + 2+ 1 
SR  + 1+ 1
 Non-benzodiazepines vs active controls1SR   + 1
 Suvorexant vs inactive controls3SR + MA + 2+ 1 
SR  + 1 
 Antidepressants vs inactive controls24SR + MA + 4  
SR +/− 1+/− 2+/− 1
 Antidepressants vs active controls1SR  − 2 
 Antipsychotics vs inactive controls4SR   +/− 3
 Melatonin vs inactive controls30SR + MA− 1+ 2/− 1− 1− 1
SR + 1+/− 1+/− 2
 Diphenhydramine vs inactive controls4SR + MA  − 1 
SR  +/− 2 
 Cognitive behavioral therapy vs inactive controls72SR + MA+ 1/− 1+ 4/− 2+ 1/− 4+ 1/− 1
SR +/− 2+/− 1 
 Cognitive behavioral therapy vs active controls2SR + MA  − 2 
SR − 1  
 Behavioral Interventions vs inactive controls7SR + MA  − 1 
SR  − 1− 1
 Mindfulness-based Interventions vs inactive controls2SR + MA − 1  
 Combination therapies vs inactive controls4SR + MA  − 1 
SR  + 1 
Outcome: wake after sleep onset (WASO)
 Benzodiazepines vs inactive controls4SR + MA  + 1 
 Non-benzodiazepines vs inactive controls16SR + MA − 1+ 1 
SR  + 2+ 1
 Non-benzodiazepines vs active controls3SR + MA    
SR  + 1 
 Suvorexant vs inactive controls3SR + MA + 1+ 1 
SR  + 1 
 Antidepressants vs inactive controls13SR + MA + 2  
SR + 1+ 2+ 2
 Antidepressants vs active controls1SR  + 2 
 Melatonin vs inactive controls13SR + MA − 1− 2 
SR   + 2
 Diphenhydramine vs inactive controls1SR   − 1
 Cognitive behavioral therapy vs inactive controls70SR + MA+ 1/− 1+ 5+ 7/− 2+ 1
SR + 3+ 3 
 Cognitive behavioral therapy vs active controls17SR + MA  − 2 
SR + 1 + 1
 Behavioral Interventions vs inactive controls9SR + MA +/− 1+/− 1 
SR  + 1 
Outcome: sleep quality
 Benzodiazepines vs inactive controls2SR + MA  − 1 
 Non-benzodiazepines vs inactive controls9SR + MA + 1+ 1 
SR  + 2 
 Suvorexant vs inactive controls3SR + MA + 1  
 Antidepressants vs inactive controls13SR + MA + 1  
SR  + 3 
 Antidepressants vs active controls1SR  − 1 
 Antipsychotics vs inactive controls8SR  + 2+ 2
 Melatonin vs inactive controls23SR + MA − 3+ 1/− 1 
SR  +/− 3+ 2
 Diphenhydramine vs inactive controls1SR   − 1
 Cognitive behavioral therapy vs inactive controls47SR + MA + 5/− 1+ 5/− 2+ 1
SR + 1+ 2/− 1 
 Cognitive behavioral therapy vs active controls4SR  − 2 
 Behavioral Interventions vs inactive controls12SR + MA  + 1 
SR + 1/− 1+ 3/− 1 
 Behavioral Interventions vs active controls8SR + MA  + 1 
 Mindfulness-based Interventions vs inactive controls4SR + MA + 1  
SR   + 1
 Combination Therapies vs inactive controls1SR  + 1 
Outcome: sleep satisfaction
 Antipsychotics vs inactive controls1SR   − 1
 Melatonin vs inactive controls1SR  + 1 
 Cognitive behavioral therapy vs inactive controls2SR + 1  
 Behavioral Interventions vs inactive controls1SR  + 1 
Outcome: sleep efficiency
 Non-benzodiazepines vs inactive controls4SR + MA + 1  
SR   +/− 1
 Non-benzodiazepines vs active controls2SR   +/− 1
 Antidepressants vs inactive controls15SR + MA + 2  
SR + 1+ 1+/− 2
 Antipsychotics vs inactive controls2SR   + 3
 Melatonin vs inactive controls19SR + MA− 1+ 1/− 2− 1 
SR  +/− 1+ 1/− 1
 Diphenhydramine vs inactive controls2SR  +/− 1 
 Cognitive behavioral therapy vs inactive controls83SR + MA+ 1+ 7/− 1+ 5+ 1
SR + 4+ 5 
 Cognitive behavioral therapy vs active controls4SR + MA  − 2 
SR + 1+ 1 
 Behavioral Interventions vs inactive controls4SR  + 2 
 Mindfulness-based Interventions vs inactive controls5SR + MA − 1  
SR  +/− 1 
Outcome: Insomnia Severity Index (ISI)
 Suvorexant vs inactive controls3SR + MA + 1+ 1 
SR  + 1 
 Antidepressants vs inactive controls2SR + MA + 1  
 Antipsychotics vs inactive controls1SR   + 1
 Diphenhydramine vs inactive controls1SR  + 1 
 Cognitive behavioral therapy vs inactive controls46SR + MA + 4/− 1+ 5 
SR + 3+ 2 
 Cognitive behavioral therapy vs active controls2SR + MA  − 1 
Outcome: fatigue severity
 Cognitive behavioral therapy vs inactive controls26SR + MA+/− 1+/− 2  
SR + 2  
 Behavioral Interventions vs inactive controls2SR  − 1 
Outcome: health-related quality of life
 Non-benzodiazepines vs inactive controls4SR +/− 1  
 Melatonin vs inactive controls1SR   + 1
 Cognitive behavioral therapy vs inactive controls7SR + 2+ 2 
 Cognitive behavioral therapy vs active controls1SR  + 1 
Outcome: hangover/morning sedation
 Non-benzodiazepines vs inactive controls1SR   − 1
 Non-benzodiazepines vs active controls1SR   − 1
 Suvorexant vs inactive controls3SR + MA + 2  
 Antipsychotics vs inactive controls2SR   + 1
Outcome: accidental injury
 Suvorexant vs inactive controls3SR + MA + 2  
Outcome: addiction, dependence, or diversion
 Non-benzodiazepines vs inactive controls3SR  +/− 1 
 Non-benzodiazepines vs active controls3SR  +/− 1 
 Suvorexant vs inactive controls3SR + MA + 2  
  1. Abbreviations: SR systematic review, SR + MA systematic review and meta-analysis, GRADE Grading of Recommendations Assessment, Development and Evaluation
  2. aThe number indicates how many SR + MAs or SRs contributed to that result
  3. bReviews that received no downgrades
  4. cReviews that received 1 or 2 downgrades
  5. dReviews that received 3 or 4 downgrades
  6. eReviews that received 5 or 6 downgrades
  7. +Signifies statistically significant improvement in effectiveness outcomes or significantly increased risk of harms for safety outcomes
  8. Signifies non-statistically significant change
  9. +/−Signifies mixed or discordant results within SR + MAs and SRs