. 2023 Jan 3;2023(1):CD011881. doi: 10.1002/14651858.CD011881.pub2

Summary of findings 5. Summary of findings table ‐ Multimodal interventions compared to usual care for sleep disturbances in dementia.

Multimodal interventions compared to usual care for sleep disturbances in dementia
Patient or population: sleep disturbances in dementia Setting: nursing home Intervention: multimodal interventions Comparison: usual care
Outcomes	*Anticipated absolute effects^ (95% CI)**		Relative effect (95% CI)	№ of participants (studies)	Certainty of the evidence (GRADE)	Comments
Outcomes	Risk with usual care	Risk with multimodal interventions	Relative effect (95% CI)	№ of participants (studies)	Certainty of the evidence (GRADE)	Comments
Total nocturnal sleep time (minutes)	The mean total nocturnal sleep time in the control group was 384 minutes (Alessi 2005), 438.3 minutes (McCurry 2011), and 328.9 minutes (Richards 2011).  Total nocturnal sleep time for multimodal interventions was 24.00 minutes higher (3.51 lower to 51.51 higher) in Alessi 2005, 29.4 minutes higher (25.90 lower to 84.70 higher) in McCurry 2011, and 35.3 minutes higher (7.99 higher to 62.61 higher) in Richards 2011.			272 (3 RCTs)	⊕⊕⊝⊝ Low^a,^b	All studies reported differences between groups in favour of the interventions using actigraphy after 32 days (Alessi 2005), 7 weeks (Richards 2011), and 6 months (McCurry 2011).
Consolidated sleep ‐ not measured	‐	‐	‐	‐	‐	‐
Sleep efficiency	The mean sleep efficiency in the control group was 66.3% (Alessi 1999), 80% (Alessi 2005), 78.1% (McCurry 2011), 68.5% (Richards 2011), and 60.8% (Schnelle 1999).  Sleep efficiency for multimodal interventions was 3.80% lower (17.96% lower to 10.36% higher) in Alessi 1999, 4% higher (1.42% lower to 9.42% higher) in Alessi 2005, 2.3% higher (5.08% lower to 9.68% higher) in McCurry 2011, 4.80% higher (0.47% higher to 9.13% higher) in Richards 2011, and without a difference in Schnelle 1999 (MD 0%, 4.61% lower to 4.61% higher).			485 (5 RCTs)	⊕⊝⊝⊝ Very low^a,^b,^c	3 studies found improvements in favour of the interventions after 32 days (Alessi 2005), 7 weeks (Richards 2011), and 6 months (McCurry 2011). 1 study found small differences in favour of the control group after 14 weeks (Alessi 1999). 1 study found no differences between groups (Schnelle 1999).
Total wake time at night (minutes)	The mean night‐time total wake time in the control group was 108 minutes (McCurry 2005) and 122 minutes (McCurry 2011).Night‐time total wake time for multimodal interventions was 36.00 minutes lower (89.66 lower to 17.66 higher) in McCurry 2005 and 7.00 minutes lower (52.90 lower to 38.90 higher) in McCurry 2011.			102 (2 RCTs)	⊕⊕⊝⊝ Low^a,^b	Both studies reported differences between groups in favour of the interventions using actigraphy after 6 months (McCurry 2005; McCurry 2011).
Number of nocturnal awakenings	The mean number of awakenings in the control group was 22.4 (Alessi 2005), 12.2 (McCurry 2005), 18.4 (McCurry 2011), and 4.5 (Schnelle 1999).  Number of awakenings for multimodal interventions was 0.1 higher (5.25 lower to 5.45 higher) in Alessi 2005, 4 lower (10.10 lower to 2.10 higher) in McCurry 2005, 4.7 lower (9.29 lower to 0.11 lower) in McCurry 2011, and 0.3 lower (0.76 lower to 0.16 higher) in Schnelle 1999.			404 (4 RCTs)	⊕⊕⊝⊝ Low^a,^c	2 studies found improvements in favour of the intervention using actigraphy after 5 nights and 6 months (McCurry 2005; McCurry 2011). 2 studies found no differences between study groups (Alessi 2005; Schnelle 1999).
Sleep onset latency ‐ not reported	‐	‐	‐	‐	‐
Adverse events	1 study reported unexpected and serious adverse events (Richards 2011). 1 participant had substernal chest pain 15 hours after exercising, but was negative for myocardial infarction; 1 had back, hip, and leg pain; and 1 had multifocal premature ventricular contractions or non‐specific t‐wave changes in their electrocardiogram.			589 (7 RCTs)	⊕⊕⊝⊝ Low^a,^b	‐
*The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).  CI: confidence interval
GRADE Working Group grades of evidence High certainty: we are very confident that the true effect lies close to that of the estimate of the effect. Moderate certainty: we are moderately confident in the effect estimate: the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different. Low certainty: our confidence in the effect estimate is limited: the true effect may be substantially different from the estimate of the effect. Very low certainty: we have very little confidence in the effect estimate: the true effect is likely to be substantially different from the estimate of effect.
See interactive version of this table: https://gdt.gradepro.org/presentations/#/isof/isof_question_revman_web_424366361397646497.

^a Downgraded one level for risk of bias: high or unclear risk of performance and detection bias in all studies ^b Downgraded one level for imprecision: wide confidence intervals ^c Downgraded one level for inconsistency: inconsistent results