Table.
GRADE evaluation of interventions for insomnia
| Important outcomes | Sleep improvement, quality of life, adverse effects | ||||||||
| Number of studies (participants) | Outcome | Comparison | Type of evidence | Quality | Consistency | Directness | Effect size | GRADE | Comment |
| What are the effects of non-drug treatments for insomnia in elderly people? | |||||||||
| 1 (36) | Symptom improvement | CBT v no treatment | 4 | –1 | –1 | 0 | 0 | Low | Quality point deducted for sparse data. Consistency point deducted for conflicting results |
| 1 (43) | Symptom improvement | Exercise v no treatment | 4 | –1 | 0 | 0 | 0 | Moderate | Quality point deducted for sparse data |
| What are the effects of drug treatments for insomnia in elderly people? | |||||||||
| 14 (830) | Symptom improvement | Benzodiazepine v placebo | 4 | 0 | 0 | 0 | 0 | High | |
| 3 (339) | Symptom improvement | Benzodiazepine v benzodiazepine receptor agonists | 4 | –1 | 0 | 0 | 0 | Moderate | Quality point deducted for incomplete reporting of results |
| 3 (1019) | Symptom improvement | Zaleplon v placebo | 4 | –1 | –1 | 0 | 0 | Low | Quality point deducted for incomplete reporting of results. Consistency point deducted for conflicting results |
| 2 (815) | Adverse effects | Zaleplon v placebo | 4 | –1 | 0 | 0 | 0 | Moderate | Quality point deducted for incomplete reporting of results |
| 5 (1667) | Symptom improvement | Zolpidem v placebo | 4 | –1 | –1 | 0 | 0 | Low | Quality point deducted for incomplete reporting of results. Consistency point deducted for conflicting results |
| 3 (1031) | Symptom improvement | Zolpidem v benzodiazepines | 4 | –1 | –1 | 0 | 0 | Low | Quality point deducted for incomplete reporting of results. Consistency point deducted for conflicting results |
| 2 (144) | Symptom improvement | Different doses of zolpidem compared with each other | 4 | –2 | 0 | 0 | 0 | Low | Quality points deducted for sparse data and incomplete reporting of results |
| 16 (1541) | Adverse effects | Benzodiazepine receptor agonists v benzodiazepines | 4 | –2 | 0 | 0 | 0 | Low | Quality point deducted for incomplete reporting of results, and for not reporting results separately for comparator |
| 2 (495) | Symptom improvement | Zopiclone v placebo | 4 | –1 | +1 | 0 | 0 | High | Quality point deducted for incomplete reporting of results. Consistency point added for dose response |
Type of evidence: 4 = RCT; 2 = Observational; 1 = Non-analytical/expert opinion. Consistency: similarity of results across studies.Directness: generalisability of population or outcomes.Effect size: based on relative risk or odds ratio.