Summary of findings 1. Listening to music compared to no treatment or treatment as usual for adults with insomnia.
| Listening to music compared to no treatment or treatment as usual for adults with insomnia | ||||||
| Patient or population: adults with insomnia Settings: home, sleep laboratory or rehabilitation centre Intervention: listening to music Comparison: no treatment (including waitlist controls) or TAU (i.e. sleep hygiene education or standard care for participants with insomnia related to chronic medical conditions) | ||||||
| Outcomes | Illustrative comparative risks* (95% CI) | Relative effect (95% CI) | Number of participants (studies) | Certainty of the evidence (GRADE) | Comments | |
| Assumed risk | Corresponding risk | |||||
| No treatment or TAU | Listening to music | |||||
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Sleep quality – immediately post‐treatment
Assessed with: PSQIa Follow‐up: 14–90 days |
The mean score in the control groups ranged from 4.8 to 14.22 | The mean score in the intervention groups was 2.79 lower (3.86 lower to 1.72 lower) | — | 708 (10 RCTs) | ⊕⊕⊕⊝ Moderateb | A lower score indicates better sleep quality (i.e. fewer sleep problems). The change is approaching the size of 1 standard deviation (SMD −0.86, CI −0.54 to −1.19), which is considered a clinically relevant change. |
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Insomnia severity – immediately post‐treatment Assessed with: ISIc Follow‐up: 21–42 days |
The mean score in the control groups ranged from 16.5 to 19.9 | The mean score in the intervention groups was 6.96 lower (15.21 lower to 1.28 higher) | — | 63 (2 RCTs) |
⊕⊝⊝⊝
Very lowb,d,e |
A lower score indicates less severe insomnia. |
|
SOL – immediately post‐treatment
Assessed with: PSG and PSQIa subscale Follow‐up: 3–21 days for PSG measures and 21–90 days for PSQI subscale |
3 studies (136 participants) measuring objective SOL with PSG found no effect of the intervention. | — | 457 (8 RCTs) | ⊕⊕⊝⊝ Lowb,f | Data from 2 studies reporting objective SOL were presented in a format that did not allow for inclusion in a meta‐analysis. |
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| 5 studies (321 participants) measured SOL with the PSQI subscale, and 4 of these found shortened SOL with the music intervention. The mean score in the intervention group was 0.60 lower (0.83 lower to 0.37 lower; 3 studies, 197 participants). | ||||||
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Total sleep time – immediately post‐treatment
Assessed with: PSG and PSQIa subscale Follow‐up: 3–21 days for PSG measures and 21–90 days for PSQI subscale |
3 studies (136 participants) measuring total sleep time with PSG found no effect of the intervention. | — | 611 (9 RCTs) | ⊕⊕⊝⊝ Lowb,f | Data from 2 studies reporting objective total sleep time were presented in a format that did not allow for inclusion in a meta‐analysis. | |
| 5 studies (321 participants) used the PSQI subscale, and 4 studies found significant improvement in sleep duration. The mean score in the intervention group was 0.69 lower (1.16 lower to 0.23 lower; 3 studies, 197 participants). 1 study (154 participants) reported improved sleep duration using a categorical approach. | ||||||
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Sleep interruption – immediately post‐treatment
Assessed with: PSG and PSQIa subscale Follow‐up: 3–21 days for PSG measures and 21–90 days for PSQI subscale |
3 studies (136 participants) measuring wake time after sleep and number of awakenings with PSG found no effect of the intervention. | — | 457 (8 RCTs) | ⊕⊝⊝⊝ Very lowb,f,g | Data from 2 studies reporting objective sleep interruption were presented in a format that did not allow for inclusion in a meta‐analysis. |
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| 5 studies (321 participants) used the PSQI subscale. 3 studies found significant reduction in experienced sleep disturbance, whereas 2 studies found no effect. A meta‐analysis found no effect (MD −0.53, 95% CI −1.47 to 0.40; 3 studies, 197 participants). | ||||||
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Sleep efficiency – immediately post‐treatment
Assessed with: PSG and PSQIa subscale Follow‐up: 3–21 days for PSG measures and 21–90 days for PSQI subscale |
3 studies (136 participants) measuring sleep efficiency with PSG found no effect of the intervention. | — | 457 (8 RCTs) | ⊕⊕⊝⊝ Lowb,f | Data from 2 studies reporting objective sleep efficiency were presented in a format that did not allow for inclusion in a meta‐analysis. |
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| 5 studies (321 participants) used the PSQI subscale, and found improved sleep efficiency with the intervention. The mean score in the intervention group was 0.96 lower (1.38 lower to 0.54 lower; 3 studies, 197 participants). | ||||||
| Adverse events | None of the 10 included studies reported any adverse events. | — | — | — | — | |
| *The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% CI) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI) CI: confidence interval; ISI: Insomnia Severity Index; MD: mean difference; PSG: polysomnography; PSQI: Pittsburgh Sleep Quality Index; RCT: randomised controlled trial; SMD: standardised mean difference; SOL: sleep‐onset latency; TAU: treatment as usual. | ||||||
| GRADE Working Group grades of evidence High certainty: further research is very unlikely to change our confidence in the estimate of effect. Moderate certainty: further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. Low certainty: further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. Very low certainty: we are very uncertain about the estimate. | ||||||
aPSQI. Global score 0 indicates good sleep quality and 21 indicates severe sleep problems. Clinical cut off greater than 5 (Buysse 1989). Seven subscales including sleep latency, sleep duration, sleep efficiency and sleep disturbance. bDowngraded one level due to risk of bias: no blinding of participants and personnel (not possible), and sometimes no or unclear blinding of outcome assessment. cISI. Score from 0 to 28 with higher scores indicating more severe insomnia. dDowngraded one level due to inconsistency: I2 = 95%. eDowngraded one level due to imprecision: small number of participants and CIs include both benefit and harm. fDowngraded one level due to inconsistency: data were too heterogeneous to pool in a statistical synthesis. gDowngraded one level due to inconsistency: high heterogeneity and different directions of the effect.