Comparative effectiveness of non-pharmacological interventions on sleep in individuals with chronic musculoskeletal pain: A systematic review with network meta-analysis

作者：Jeremy Rui Chang, Yuen Kwan Cheung, Saurab Sharma, Shirley Xin Li, Rae RY. Tao, Janet Lok Chun Lee, Eliza R. Sun, Sabina M. Pinto, Zhixing Zhou, Howard H.K. Fong, Winnie W. Y. Chan, Kangyong Zheng, Dino Samartzis, Siu-Ngor Fu, Arnold Yu Lok Wong · 发表于：Sleep Medicine Reviews · 年份：2023 · DOI：10.1016/j.smrv.2023.101867 · 被引用次数：16 · 研究领域：Musculoskeletal pain and rehabilitation、Sleep and related disorders、Fibromyalgia and Chronic Fatigue Syndrome Research

This network meta-analysis aimed to estimate the comparative effectiveness of non-pharmacological interventions on sleep in individuals with chronic musculoskeletal pain. Seven databases were systematically searched up to February 2023. A random-effects network meta-analysis in a frequentist framework was performed to synthesize continuous data as standardized mean differences (SMD) along with a 95% confidence interval (95% CI). A total of 15,641 records were identified, and 107 randomized controlled trials involving 8,121 participants were included. Of 14 identified interventions, eight were significantly more effective than passive control in improving sleep quality at immediate post-intervention (SMDs = 0.67-0.74), with cognitive behavioral therapy (CBT) being the most effective treatment (SMD = 0.74, 95% CI: 0.45-1.03). Only CBT demonstrated sustained effects at short-term (SMD = 1.56; 95% CI: 0.62-2.49) and mid-term (SMD = 1.23; 95% CI: 0.44-2.03) follow-ups. Furthermore, CBT significantly improved subjective (SMD = 0.64; 95% CI: 0.25-1.03) and objective (SMD = 0.30; 95% CI: 0.01-0.59) sleep efficiency compared with passive control at immediate post-intervention. Our findings support CBT as the first-line treatment for improving sleep in individuals with chronic musculoskeletal pain, given its superior effectiveness across multiple sleep outcomes and its sustainable effects until mid-term follow-up. However, the certainty of evidence for these interventions in improving ...