Identifying complementary and alternative medicine recommendations for insomnia treatment and care: a systematic review and critical assessment of comprehensive clinical practice guidelines.
Fei-Yi Zhao,
Peijie Xu,
Gerard A Kennedy,
Russell Conduit,
Wen-Jing Zhang
et al.
Systematic Review
Frontiers in public health
2023
13 sitasi
PubMed
DOI
CC-BY
PDF
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Study Design
- Jenis Studi
- systematic review
- Ukuran Sampel
- 17
- Intervensi
- Identifying complementary and alternative medicine recommendations for insomnia treatment and care: a systematic review and critical assessment of comprehensive clinical practice guidelines. various
- Pembanding
- Placebo
- Arah Efek
- Mixed
- Risiko Bias
- Moderate
Abstract
BACKGROUND: There is a need for evidence-informed guidance on the use of complementary and alternative medicine (CAM) for insomnia because of its widespread utilization and a lack of guidance on the balance of benefits and harms. This systematic review aimed to identify and summarize the CAM recommendations associated with insomnia treatment and care from existing comprehensive clinical practice guidelines (CPGs). The quality of the eligible guidelines was appraised to assess the credibility of these recommendations. METHODS: Formally published CPGs incorporating CAM recommendations for insomnia management were searched for in seven databases from their inception to January 2023. The NCCIH website and six websites of international guideline developing institutions were also retrieved. The methodological and reporting quality of each included guideline was appraised using the AGREE II instrument and RIGHT statement, respectively. RESULTS: Seventeen eligible GCPs were included, and 14 were judged to be of moderate to high methodological and reporting quality. The reporting rate of eligible CPGs ranged from 42.9 to 97.1%. Twenty-two CAM modalities were implicated, involving nutritional or natural products, physical CAM, psychological CAM, homeopathy, aromatherapy, and mindful movements. Recommendations for these modalities were mostly unclear, unambiguous, uncertain, or conflicting. Logically explained graded recommendations supporting the CAM use in the treatment and/or care of insomnia were scarce, with bibliotherapy, Tai Chi, Yoga, and auriculotherapy positively recommended based on little and weak evidence. The only consensus was that four phytotherapeutics including valerian, chamomile, kava, and aromatherapy were not recommended for insomnia management because of risk profile and/or limited benefits. CONCLUSIONS: Existing guidelines are generally limited in providing clear, evidence-informed recommendations for the use of CAM therapies for insomnia management due to a lack of high-quality evidence and multidisciplinary consultation in CPG development. More well-designed studies to provide reliable clinical evidence are therefore urgently needed. Allowing the engagement of a range of interdisciplinary stakeholders in future updates of CPGs is also warranted. SYSTEMATIC REVIEW REGISTRATION: https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=369155, identifier: CRD42022369155.
Full Text
Figures
Figure 1
PRISMA flow diagram or study selection process for a systematic review identifying complementary and alternative medicine recommendations for insomnia treatment. The review addresses widespread CAM utilization for sleep disorders.
flowchart
Figure 2
Summary of clinical practice guideline recommendations for complementary and alternative medicine approaches to insomnia management. The review critically assesses the evidence base behind each recommendation.
chart
Figure 3
Evidence quality assessment for CAM interventions in insomnia care, evaluating the strength of recommendations across different complementary therapies including herbal medicines and mind-body practices.
chart
Figure 4
Comparison of CAM modalities recommended for insomnia across different clinical guidelines. The analysis reveals inconsistencies in guidance, reflecting the need for better evidence-informed recommendations.
chart
Figure 5
Guideline concordance analysis showing areas of agreement and disagreement among clinical practice guidelines regarding CAM use for insomnia treatment and care.
chartTables
Table 1
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| Artiach et al. ( | Both EB and CB | General | DSM-IV-TR | Spain | NHSIC | Original | Yes | Medline, Embase, PsycINFO, CINAHL, Cochrane Plus, DARE, HTA, Clinical Evidence, INAHTA, NHS EED, CINDOC in Spanish, English and French | Yes | NR | Carlos III, HTAULEA | Melatonin, valerian, acupuncture, and bibliotherapy |
| Baker et al. ( | EB | Middle-aged to older adults (≥45) | NR | USA | SN-UTA | Original | Yes | Medline, PubMed, CINAHL Plus, Cochrane, PsycINFO, and PsycARTICLES | Yes | 2000–2014 | Family Nurse Practitioner Program (SN-UTA) | Melatonin, valerian, Tai Chi, acupuncture, acupressure, light therapy, massage, yoga, and tart cherry juice |
| Bloom et al. ( | EB | Elderly (≥65) | Have difficulty falling asleep/staying asleep ≥ 1 month + causes impairment in daytime functioning | USA | Third conference of ILC | Original | Yes | PubMed, CDSR, NGC, CRD/HTAD | NR | NR | NR | Tai Chi, acupressure |
| Choi et al. ( | Both EB and CB | General | ICSD and DSM-V | Korea | KNA | Original | Yes | PubMed, EMBASE + various medical guideline website (e.g., NGC, NICE, GIN, etc.) | NR | 2015–2020 | KNA | Valerian and melatonin |
| Denlinger et al. ( | Both EB and CB | Cancer survivors | [Have difficulty in falling asleep and/or maintaining sleep ≥ 3 times per week] ≥ 4 weeks, accompanied by distress | USA | NCCN | Updated | Yes | NR | NR | NR | NCCN | Valerian and melatonin |
| Devlin et al. ( | Both EB and CB | ICU patients | NR | USA | ACCM | Updated | Yes | PubMed, EMBASE, Cochrane, CINAHL, and WOS | Yes | 1990–Oct 2015 | NIA, NHLBI, AZP | Melatonin, music therapy, aromatherapy, and acupressure |
| Edinger et al. ( | Both EB and CB | General | ICSD-3 and DSM-V | USA | AASM | Updated | Yes | PubMed, PsycINFO | Yes | - Jan 2017 | AASM | Biofeedback and mindfulness |
| Han et al. ( | Both EB and CB | General | ICSD-3 | China | CSRS | Original | Yes | PubMed, EMBASE, Cochrane, CNKI, and WanFang | NR | July 1999–Dec 2015 | NR | Melatonin, light therapy, biofeedback, music therapy, CHM, and acupuncture |
| Howell et al. ( | Both EB and CB | Cancer survivors | ICSD and DSM-IV | Canada | CAPO and CPAC | Original | Yes | MEDLINE, EMBASE, PsycINFO, HealthStar, Cochrane, CPACICG, GIN, AASM, NGC, NICE, SIGN, NCCN, and PGOs | Yes | 2004–June 2012 | Health Canada | Melatonin, valerian, massage, yoga, aromatherapy, music therapy, acupuncture, and homeopathy |
| Leopando et al. ( | EB | General | DSM-IV | Philippines | M-UP | Original | Yes | MEDLINE, OVID, and internet resources | NR | 1966–2002 | NR | Melatonin |
| Mysliwiec et al. ( | EB | VA and DoD patients | DSM-IV | USA | V/DEBP | Original | Yes | PubMed, MEDLINE, CDSR, EMBASE (Excerpta Medica), PsycINFO, and DARE | Yes | Jan 2008–May 2018 | DCI-ADATP | Mindfulness meditation, auriculotherapy, acupuncture, Tai Chi, yoga, Qigong, valerian, chamomile, kava, and melatonin |
| Pinto et al. ( | EB | General | ICSD-2 and DSM-IV | Brazil | BSA | Original | Yes | NR | NR | NR | NR | Valerian |
| Qaseem et al. ( | EB | General | ICSD-3 and DSM-V | USA | ACP | Original | Yes | MEDLINE, EMBASE, CENTRAL, PsycINFO bibliographic databases | NR | 2004–Sept 2015 | ACP operating budget | Melatonin, acupuncture, and CHM |
| Riemann et al. ( | Both EB and CB | General | ICSD-3 and ICD-10 | Germany | ESRS | Original | Yes | PubMed, Cochrane, journal (Sleep Medicine Reviews) | Yes | Jan 1966–June 2016 | ESRS | Melatonin, valerian, chamomile, kava, hops, melissa, passiflora, acupuncture, moxibustion, aromatherapy, foot reflexology, homeopathy, yoga, light therapy, and mindfulness |
| Sateia et al. ( | Both EB and CB | General | ICSD-3 | USA | AASM | Updated | yes | PubMed | yes | - Jan 25th, 2016 | AASM | valerian, melatonin |
| Schutte-Rodin et al. ( | Both EB and CB | General | ICSD-2 | USA | AASM | Original | Yes | MEDLINE | NR | 1999–Oct 2006 | No industry support | Valerian, melatonin, and biofeedback |
| Zhang et al. ( | Both EB and CB | General | ICSD-3 and DSM-V | China | CMA | Updated | Yes | NR | NR | Jan 2012–Aug 2017 | NR | Melatonin, light therapy, biofeedback, aromatherapy, massage, homeopathy, and CHM |
Table 2
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| GRADE | High, Moderate, Low, and Very low | Strong, Weak | 7 | ( |
| AASM | 1, 2, 3 | Standard, Guideline, Option, Consensus | 2 | ( |
| Modified AASM | I, II, III, IV, V | Standard, Guideline, Option, not recommended | 1 | ( |
| SIGN | 1 ++, 1 +, 1 -, 2 ++, 2 +, 2 -, 3, 4 | A, B, C, D (+ √2, Q) | 1 | ( |
| NCCN | Poor, Low, Average, Good, and High | 1, 2A, 2B, 3 | 1 | ( |
| AGS Panel | I, II, III | A, B, C, D, E | 1 | ( |
| Canadian Medical Association systema | Good, Fair, Poor | A, B, C, D, E | 1 | ( |
| NGC | N/A | A, B, C | 1 | ( |
| CMAb | 1, 2, 3, 4 | I, II, III, IV | 1 | ( |
| USPSTF ratings | High, Moderate, Low | A, B, C, D, I | 1 | ( |
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