Objectives
Patients with inflammatory arthritis (IA) have a high risk of sleep disturbances and disorders. The objective was to evaluate the evidence of non-pharmacological interventions targeting sleep disturbances or disorders in patients with IA.
Methods
A systematic search was undertaken from inception to September 8th, 2020. We included randomized trials concerning non-pharmacological interventions applied in adults with IA and concomitant sleep disturbances or disorders. Primary outcome was the sleep domain while secondary outcomes were core outcome domains for IA trials and harms. The Cochrane Risk of Bias tool was applied, and the overall quality of the evidence was assessed using GRADE. Effect sizes for continuous outcomes were based on the standardized mean difference, combined using random-effects meta-analysis.
Results
Six trials (308 patients) were included in the quantitative synthesis; three of these reported improvement in sleep in favor of the non-pharmacological intervention(s). The meta-analysis of the sleep domains indicated a large clinical effect of -0.80 (95 -1.33 to -0.28) in favor of non-pharmacological interventions targeting sleep disturbances or disorders. The estimate was rated down twice for risk of bias, and unexplained inconsistency; this was assessed as corresponding to low quality evidence. None of the secondary core outcomes used in contemporary IA trials indicated clinical benefit in favor of non-pharmacological interventions targeting sleep.
Conclusion
Non-pharmacological interventions targeting sleep disturbances/disorders in patients with IA indicated a promising effect on sleep outcomes, but not yet with convincing evidence.