Cross-sectional and longitudinal associations between sleep and health-related quality of life in pregnant women: A prospective observational study

BackgroundSleep disturbances are common in women, especially during pregnancy. Previous studies have confirmed the importance of sleep disturbances as a risk factor of adverse pregnancy outcomes and the need for screening and treatment of inadequate sleep. These reports, however, did not examine health-related quality of life which may be affected by sleep long before adverse clinical consequences are detectable in women during pregnancy.ObjectivesTo examine the cross-sectional and longitudinal association between sleep and health-related quality of life in pregnant women.DesignA prospective observational study.SettingA university-affiliated hospital in Taiwan and participants’ homes.ParticipantsA total of 164 pregnant women completed questionnaires and wore a wrist actigraphy monitor for 7 days each trimester.MethodsObjective sleep was measured by actigraphy, subjective sleep was measured by the Pittsburgh Sleep Quality Index, and health-related quality of life was measured using the SF-12v2 questionnaire across three trimesters. Multiple linear regression analyses were performed to evaluate the cross-sectional and longitudinal associations between sleep and health-related quality of life.ResultsSixty-four (39.0%) women consistently had an average sleep efficiency < 85% by actigraphy and 40 (24.4%) had a Pittsburgh Sleep Quality Index global score > 5 in all three trimesters. Cross-sectionally, more actigraphic daytime sleep (p = 0.04) and better subjective sleep quality (p < 0.01) were associated with better physical health-related quality of life in first-trimester pregnant women. Better actigraphic sleep efficiency (p = 0.04) and better subjective sleep quality (p < 0.01) were associated with better mental health-related quality of life in second-trimester pregnant women. Longer actigraphic total nighttime sleep (p < 0.01) and better subjective sleep quality (p < 0.01) were associated with better mental health-related quality of life in third-trimester pregnant women. Longitudinally, first-trimester actigraphic total nighttime sleep (p < 0.05) and subjective sleep quality (p < 0.01) predicted mental health-related quality of life in the second and third trimester.ConclusionsSleep disturbances are a highly prevalent and persistent problem in pregnant women. Adequate sleep is essential for women at all pregnancy stages and improving nocturnal sleep quantity and quality in early gestation is of utmost importance for an optimal health-related quality of life later in pregnancy.     

The effects of music on the sleep quality of adults with chronic insomnia using evidence from polysomnographic and self-reported analysis: a randomized control trial

BackgroundResearch-based evidence supports the therapeutic use of music to improve the sleep quality measured by self-reported questionnaires. However, scientific knowledge of the effects of music measured using standard polysomnography in chronic insomnia adults is currently insufficient.ObjectivesThe objective of this study was to evaluate the effect of soothing music on objective and subjective sleep quality in adults with chronic insomnia.MethodsFifty participants were enrolled in a randomized controlled trial conducted in the sleep laboratory of a hospital, with 25 participants allocated to the music group and 25 to the control group. For four days, the experimental group was exposed to soothing music selected by the participants or researchers for 45 min at nocturnal sleep time, whereas the control group was not exposed to music. Sleep was measured using polysomnography (PSG) and self-reported questionnaires. A general estimating equation was applied to analyze the data.ResultsAfter controlling for baseline data, the music group had significantly better scores for rested rating (p = 0.01), shortened stage 2 sleep (p = 0.03), and prolonged REM sleep (p = 0.04) compared to the control group, shown by the generalized estimating equations. However, there was no evidence of the effectiveness of music on other sleep parameters as measured by PSG. Additional findings indicate no difference in sleep quality between those who listened to their own preferred music (n = 10) and those who listened to music selected by the researchers (n = 15).ConclusionThe results contribute to knowledge of the effectiveness of music as a therapy to improve sleep quality in adults experiencing insomnia. Listening to soothing music at nocturnal sleep time improved the rested rating scores, shortened stage 2 sleep, and prolonged REM sleep, but has little effect on sleep quality as measured by polysomnography and self-reported questionnaires.     

Effects of music intervention on sleep quality of older adults: A systematic review and meta-analysis

BackgroundMusic interventions have several benefits for sleep quality. However, the effects of music interventions on sleep quality in older adults are controversial.ObjectiveTo summarize and evaluate the efficacy of music interventions on sleep quality in older adults.MethodsThe Cochrane Library, Embase, PubMed, Web of Science and Chinese National Knowledge Infrastructure (CNKI) were systematically retrieved until June 2020, updated on March 13, 2021. Both experimental and quasi-experimental studies were included if they evaluated the efficacy of music interventions on sleep outcomes in older adults. The methodological quality was assessed by the Cochrane RoB 2.0 and ROBINS-I Tool. The random effects models and effect measure (MD) were adopted, and sensitivity analysis by omitting each study was conducted to explore the source of heterogeneity.ResultsA total of 489 participants from 9 studies met the inclusion criteria. 6 studies were included in meta-analysis and sensitivity analysis, and 3 studies were included in the qualitative analysis. Main concerns about risk of bias were lack of blinding participants and investigators, and confounding factors might exist in non-RCTs. The Post-hoc meta-analysis indicated that music interventions might have a positive effect on sleep quality [MD = −2.64, 95 % CI (−3.76, −1.53), p < 0.001; I² = 75.0 %]. Only one study evaluated adverse events and reported zero discomfort.ConclusionsThe results indicated that music interventions might be beneficial for improving sleep quality, especially in sleep latency, sleep duration, sleep efficiency and sleep of daytime dysfunction in elderly individuals.     

The effects of footbath on sleep among the older adults in nursing home: A quasi-experimental study

ObjectivesTo examine the long-term effects of foot-bathing therapy, using different water temperatures, on the sleep quality of older adults living in nursing homes.DesignA quasi-experimental study design with non-equivalent control group.SettingsThirty participants were recruited from a nursing home in Gyeong-gi Province, South Korea.InterventionsThe participants were randomly assigned to experimental, placebo, and control groups. The foot-bathing therapy was performed for 30 min daily for four weeks. Water at 40 °C was used for the experimental group, while water at 36.5 °C was used for the placebo group. The control group did not receive any intervention.Main outcome measuresThe participants’ sleep patterns (total sleep amount, sleep efficiency, and sleep latency) and sleep-disturbed behaviors were compared based on group, using actigraphy and a sleep disorder inventory.ResultsThe total amount of sleep and sleep efficiency were significantly different for the experimental group, especially those with poor sleep quality. There were no differences in sleep latency or sleep-disturbed behaviors among the groups. The long-term effect of the therapy decreased in the third week of the therapy.ConclusionsDaily, 30-min foot-bathing therapy sessions with water at 40 °C were effective in improving sleep quality for older adults. The therapy was more effective for participants with poor sleep quality at baseline assessment than those with relatively good sleep quality. The long-term effects of foot-bathing therapy decreased three weeks after initiation; therefore, it might be desirable to deliver the therapy for two weeks, pause it for a week, and then resume it.     

The effects of music on the cardiac resuscitation education of nursing students

PurposeThe purpose of this study is to examine the effects of music on the appropriate performance of the rate and depth of chest compression for nursing students.MethodsThis randomized controlled study was conducted in the School of Nursing in Turkey between November 2014 and January 2015. The study’s participants were second-year nursing school students with no previous formal cardiac resuscitation training (n = 77). Participants were randomly assigned to one of two groups: an intervention group with music and a control group without music. During practical training, the intervention group performed chest compressions with music. The outcomes of this study were collected twice. The first evaluation was conducted one day after CPR education, and the second evaluation was conducted six weeks after the initial training.ResultsThe first evaluation shows that the participants in the intervention group had an average rate of 107.33 ± 7.29 chest compressions per minute, whereas the rate for the control group was 121.47 ± 12.91. The second evaluation shows that the rates of chest compression for the intervention and control groups were 106.24 ± 8.72 and 100.71 ± 9.54, respectively.ConclusionThe results of this study show that a musical piece enables students to remember the ideal rhythm for chest compression. Performing chest compression with music can easily be integrated into CPR education because it does not require additional technology and is cheap.     

Tailored educational supportive care programme on sleep quality and psychological distress in patients with heart failure: A randomised controlled trial

BackgroundUp to 74% of patients with heart failure report poor sleep in Taiwan. Poor symptom management or sleep hygiene may affect patients’ sleep quality. An effective educational programme was important to improve patients’ sleep quality and psychological distress. However, research related to sleep disturbance in patients with heart failure is limited in Taiwan.ObjectivesTo examine the effects of a tailored educational supportive care programme on sleep disturbance and psychological distress in patients with heart failure.Designrandomised controlled trial.Participants and settingEighty-four patients with heart failure were recruited from an outpatient department of a medical centre in Taipei, Taiwan. Patients were randomly assigned to the intervention group (n = 43) or the control group (n = 41).MethodsPatients in the intervention group received a 12-week tailored educational supportive care programme including individualised education on sleep hygiene, self-care, emotional support through a monthly nursing visit at home, and telephone follow-up counselling every 2 weeks. The control group received routine nursing care. Data were collected at baseline, the 4th, 8th, and 12th weeks after patients’ enrollment. Outcome measures included sleep quality, daytime sleepiness, anxiety, and depression.ResultsThe intervention group exhibited significant improvement in the level of sleep quality and daytime sleepiness after 12 weeks of the supportive nursing care programme, whereas the control group exhibited no significant differences. Anxiety and depression scores were increased significantly in the control group at the 12th week (p < .001). However, anxiety and depression scores in the intervention group remained unchanged after 12 weeks of the supportive nursing care programme (p > .05). Compared with the control group, the intervention group had significantly greater improvement in sleep quality (β = −2.22, p < .001), daytime sleepiness (β = −4.23, p < .001), anxiety (β = −1.94, p < .001), and depression (β = −3.05, p < .001) after 12 weeks of the intervention.ConclusionThis study confirmed that a supportive nursing care programme could effectively improve sleep quality and psychological distress in patients with heart failure. We suggested that this supportive nursing care programme should be applied to clinical practice in cardiovascular nursing.     

The effects of chamomile extract on sleep quality among elderly people: A clinical trial

BackgroundThe prevalence of insomnia increases with age. Chamomile is among the medicinal plants which are used as tranquilizer. Yet, there is inadequate experimental and clinical evidence regarding its hypnotic effects. This study sought to evaluate the effects of chamomile extract on sleep quality among elderly people.DesignA single-blind randomized controlled trial was performed.SettingA convenient sample of sixty elderly people who aged sixty or more and lived in Kahrizak day care nursing home, Karaj, Iran, were randomly allocated to a control and a treatment group. The treatment group received chamomile extract capsules (200 mg) twice a day for 28 consecutive days while the control group received wheat flour capsules (200 mg) in the same manner. Using the Pittsburgh Sleep Quality Index, sleep quality was assessed immediately before, two weeks after beginning, immediately after the completion, and two weeks after the completion of the intervention. The data were analyzed via the independent-sample t, Chi-square, and Fisher’s exact tests as well as the repeated measures analysis of variance.ResultsThe means of age in the control and the treatment groups were 70.73 ± 6.44 and 69.36 ± 4.99, respectively. Except for the habitual sleep efficiency component of the Sleep Quality Index, the study groups did not differ significantly from each other at baseline regarding the scores of the other components of the index. Moreover, at baseline, sleep quality in both groups was low, with no statistically significant between-group difference (P = 0.639). However, after the intervention, sleep quality in the treatment group was significantly better than the control group (P < 0.05).ConclusionThe use of chamomile extract can significantly improve sleep quality among elderly people. Thus, it can be used as a safe modality for promoting elderly people’s sleep.     

Effects of music listening on anxiety and physiological responses in patients undergoing awake craniotomy

ObjectiveThe purpose of this study was to explore the effects of music listening on the level of anxiety and physiological responses for awake craniotomy.MethodsAn experimental design with randomization was applied in this study. Participants in experimental group (19 patients) selected and listened music at their preferences in the waiting room and throughout the entire surgical procedure in addition to usual care while control group (19 patients) only gave usual care. State-Trait Anxiety Inventory (STAI), heartbeat, breathing, and blood pressure were collected for analysis.ResultsThe results of this study showed that after music listening, there was significant decrease in the level of anxiety (p < .001). The findings also showed that the music intervention significantly reduced heartbeat rate 84.5 (p < .004), systolic pressure 42 (p < .001), and diastolic pressure 38 (p < .001) over time. We concluded that music listening is associated with a decreased level of anxiety and distress after awake craniotomy patients.ConclusionThe results of this study can provide perioperative nursing care in providing music listening when patients were in the waiting room and during surgery to reduce the anxiety so as to reach the goal of human care and improve perioperative nursing care.     

Effect of low-impact aerobic exercise combined with music therapy on patients with fibromyalgia. A pilot study

ObjectiveFibromyalgia is a pathological entity characterized by chronic widespread musculoskeletal pain and the presence of “tender points”. It constitutes a significant health problem because of its prevalence and economic impact. The aim of the present study was to determine the therapeutic benefits of low impact aerobic exercise alone or in combination with music therapy in patients with fibromyalgia.MethodsA single-blind randomized controlled pilot trial was performed. Thirty-five individuals with fibromyalgia were divided into three groups: (G1) therapeutic aerobic exercise with music therapy (n = 13); (G2) therapeutic aerobic exercise at any rhythm (n = 13) and (CG) control (n = 9). The intervention period lasted eight weeks. Depression, quality of life, general discomfort and balance were assessed before and after intervention.ResultsAt post-intervention, group G1 improved in all variables (depression (p = 0.002), quality of life (p = 0.017), general discomfort (p = 0.001), and balance (p = 0.000)), while group G2 improved in general discomfort (p = 0.002). The change observed in balance was statistically different between groups (p = 0.01).ConclusionTherapeutic aerobic exercise is effective in improving depression and general discomfort in individuals with fibromyalgia. However, effectiveness is higher when combined with music therapy, which brings about further improvements in quality of life and balance.     

Effects of nurse-led home-based exercise & cognitive behavioral therapy on reducing cancer-related fatigue in patients with ovarian cancer during and after chemotherapy: A randomized controlled trial

BackgroundHigh levels of fatigue have been documented in ovarian cancer patients. However, increased levels of fatigue are positively associated with a high risk of sleep disturbance and depression.ObjectiveTo investigate the feasibility of a nurse-led home-based exercise and cognitive behavioral therapy (E&CBT) for ovarian cancer adults with cancer-related fatigue on outcomes of fatigue, plus other secondary outcomes (sleep disturbance and depression), either during or after completion of primary cancer treatment.DesignRandomized, single-blind control trial.SettingsGynaecologic oncology department of the First Hospital of Jilin University in China.Participants72 eligible women who recently had surgery and completed their first cycle of adjuvant chemotherapy were randomly assigned to two groups.InterventionThe experimental group received exercise and cognitive behavioral therapy. Five nurses with nursing master degree were trained to deliver this intervention. Patients received online interventions each week in the patient's place of residence or in the nurse-led clinic, as requested. Home visits, coupled with telephone-based motivational interviews twice a week were available with the permission of the participants. comparison group participants received services as usual.MeasurementsThe primary outcome was measured by the Chinese version of the Piper Fatigue Scale that has 4 subscales (Behavior, Affect, Sensory, and Cognition). Secondary outcomes were measured using the Self-Rating Depression Scale and the Pittsburgh Sleep Quality Index questionnaire. Repeated-measure ANOVA was used to examine the effectiveness of this intervention in reducing fatigue, depression, and improving sleep quality.ResultsFor baseline comparisons, no significant differences were found between the two groups. After the interventions, total fatigue scores were significantly reduced from T1 to T2, to T3 in the experimental group (4.37, 4.24, 3.90), respectively. The comparison group showed almost no change in total fatigue score over time. In the repeated measures ANOVA, the differences of behavioral fatigue score (F = 11.647, p = 0.001) and cognitive fatigue score (F = 5.741, p = 0.019) were statistically significant for the group by time interaction. After the interventions, the experimental group participants demonstrated significantly lower symptoms of depression compared with the comparison group (T2: p = 0.001 and T3: p < 0.001). Sleep duration, sleep dysfunction, daytime dysfunction as well as total sleep quality significantly improved.ConclusionNurse-delivered home-based E&CBT have measurable benefits in helping women with ovarian cancer to decrease cancer-related fatigue, depressive symptoms, and improving their quality of sleep.     

Active versus receptive group music therapy for major depressive disorder—A pilot study

ObjectivesTo compare the effects of 1) active group music therapy and 2) receptive group music therapy to group counseling in treatment of major depressive disorder (MDD).Design & settingOn top of standard care, 14 MDD outpatients were randomly assigned to receive 1) active group music therapy (n = 5), 2) receptive group music therapy (n = 5), or 3) group counseling (n = 4). There were 12 one-hour weekly group sessions in each arm.Main outcome measuresParticipants were assessed at baseline, 1 month (after 4 sessions), 3 months (end of interventions), and 6 months. Primary outcomes were depressive scores measured by Montgomery-Åsberg Depression Rating Scale (MADRS) Thai version. Secondary outcomes were self-rated depression score and quality of life.ResultsAt 1 month, 3 months, and 6 months, both therapy groups showed statistically non-significant reduction in MADRS Thai scores when compared with the control group (group counseling). The reduction was slightly greater in the active group than the receptive group. Although there were trend toward better outcomes on self-report depression and quality of life, the differences were not statistically significant.ConclusionGroup music therapy, either active or receptive, is an interesting adjunctive treatment option for outpatients with MDD. The receptive group may reach peak therapeutic effect faster, but the active group may have higher peak effect. Group music therapy deserves further comprehensive studies.     

Effect of nocturnal sound reduction on the incidence of delirium in intensive care unit patients: An interrupted time series analysis

IntroductionDelirium in critically-ill patients is a common multifactorial disorder that is associated with various negative outcomes. It is assumed that sleep disturbances can result in an increased risk of delirium. This study hypothesized that implementing a protocol that reduces overall nocturnal sound levels improves quality of sleep and reduces the incidence of delirium in Intensive Care Unit (ICU) patients.MethodsThis interrupted time series study was performed in an adult mixed medical and surgical 24-bed ICU. A pre-intervention group of 211 patients was compared with a post-intervention group of 210 patients after implementation of a nocturnal sound-reduction protocol. Primary outcome measures were incidence of delirium, measured by the Intensive Care Delirium Screening Checklist (ICDSC) and quality of sleep, measured by the Richards-Campbell Sleep Questionnaire (RCSQ). Secondary outcome measures were use of sleep-inducing medication, delirium treatment medication, and patient-perceived nocturnal noise.ResultsA significant difference in slope in the percentage of delirium was observed between the pre- and post-intervention periods (−3.7% per time period, p = 0.02). Quality of sleep was unaffected (0.3 per time period, p = 0.85). The post-intervention group used significantly less sleep-inducing medication (p < 0.001). Nocturnal noise rating improved after intervention (median: 65, IQR: 50–80 versus 70, IQR: 60–80, p = 0.02).ConclusionsThe incidence of delirium in ICU patients was significantly reduced after implementation of a nocturnal sound-reduction protocol. However, reported sleep quality did not improve.     

Comparing the effects of music and exercise with music for older adults with insomnia

AimTo examine the effects of a soothing music intervention before bedtime and a treadmill brisk walking exercise combined with music in the evening on sleep quality of sedentary older adults with chronic insomnia.BackgroundThere is evidence to support the use of complementary interventions to improve sleep. They are rarely applied in Taiwanese elderly population.MethodsUsing a crossover controlled trial, 38 participants aged 50 to 75 years were randomly assigned to a music intervention/brisk walking sequence or a brisk walking/music intervention sequence. Each participant completed two intervention sessions (separated by 1 week). Each intervention lasted 30 min. An actigraph extended with electroencephalography (EEG) and questionnaires were used to assess the sleep quality.ResultsBoth interventions exhibited beneficial effects on subjective sleep quality in adults with insomnia. Also listening to soothing music before bedtime significantly shortened the wake time after sleep onset measured by EEG, compared with brisk walking in the evening.ConclusionsThe interventions applied in this study could be applied as the evidence-based nursing interventions for insomnia older adults.     

Calidad del sueño en personas con diabetes tipo 2 controladas en el nivel primario y su asociación con características sociodemográficas y clínicas

Type 2 diabetes (DM2) is one of the diseases that cause the highest premature mortality and disability worldwide. Sleep disturbances have been associated with the onset of metabolic disorders and increased levels of glycated haemoglobin in diabetics.ObjectiveTo evaluate the quality of sleep of people with type 2 diabetes and its association with sociodemographic, clinical, and metabolic characteristics.MethodsObservational, cross-sectional, analytical study of 223 patients with DM2 between 20 and 64 years old, controlled in a primary health care centre in Chile.ResultsMost were women (66.4%), average age 54.7 years. Only 33% slept the required number of hours (7 to 9 hours) to maintain health. Fifty-seven point seven percent were metabolically unbalanced (Hb1Ac > 7%). Seventy-five point two percent presented sleep problems of varying severity, which were associated with being a woman, night pain, nocturia, time of diagnosis of diabetes, and depressive symptoms. Persons with poor sleep quality were 73% more likely to be metabolically decompensated, however, this result was not statistically significant: OR = 1.73 (CI:78-3.87).ConclusionsThe high frequency of poor sleep quality and metabolic decompensation in the sample stands out, which could complicate DM2. The association between poor sleep quality and DM2 decompensation is inconclusive. Future research will contribute to elucidating the role of sleep in metabolic compensation and in the prevention of metabolic disorders.     

Effectiveness of aerobic gymnastic exercise on stress,fatigue, and sleep quality during postpartum: A pilot randomized controlled trial

BackgroundGymnastics is a preferable safe exercise for postnatal women performing regularly.ObjectiveThe aim of this pilot randomized controlled trial was to determine whether the aerobic gymnastic exercise improves stress, fatigue, sleep quality and depression in postpartum women.DesignSingle-blinded, randomized controlled trial held from December 2014 until September 2015. Setting: Postnatal clinic of a medical center in southern Taiwan.Participants140 eligible postnatal women were systematically assigned, with a random start to experimental (n = 70) or a control (n = 70) group.InterventionsEngage in aerobic gymnastic exercise at least three times (15 min per section) a week for three months using compact disc in the home.Outcome measuresPerceived Stress Scale, Postpartum Fatigue Scale, Postpartum Sleep Quality Scale, and Edinburgh Postnatal Depression Scale.ResultsIn a two-way ANOVA with repeated measures, the aerobic gymnastic exercise group showed significant decrease in fatigue after practicing exercise 4 weeks and the positive effects extended to the 12-week posttests. Paired t-tests revealed that aerobic gymnastic exercise participants had improved significantly in perceived stress and fatigue after 4 weeks gymnastic exercise; these positive effects extended to the 12-week posttests. In addition, the changes in physical symptoms-related sleep inefficiency after 12 weeks gymnastic exercise were significantly decreased in the experimental group compared with the control group.Relevance to clinical practiceThe findings can be used to encourage postnatal women to perform moderate-intensity gymnastic exercise in their daily life to reduce their stress, fatigue and improve sleep quality.     

A brief yoga intervention implemented during chemotherapy: A randomized controlled pilot study

ObjectivesFatigue and other treatment-related symptoms (e.g., sleep disturbance) are critical targets for improving quality of life in patients undergoing chemotherapy. Yoga may reduce the burden of such symptoms. This study investigated the feasibility of conducting a randomized controlled study of a brief yoga intervention during chemotherapy for colorectal cancer.DesignWe randomized adults with colorectal cancer to a brief Yoga Skills Training (YST) or an attention control (AC; empathic attention and recorded education).SettingThe interventions and assessments were implemented individually in the clinic while patients were in the chair receiving chemotherapy.InterventionsBoth interventions consisted of three sessions and recommended home practice.Main outcome measuresThe primary outcome was feasibility (accrual, retention, adherence, data collection). Self-reported outcomes (i.e., fatigue, sleep disturbance, quality of life) and inflammatory biomarkers were also described to inform future studies.ResultsOf 52 patients initially identified, 28 were approached, and 15 enrolled (age Mean = 57.5 years; 80% White; 60% Male). Reasons for declining participation were: not interested (n = 6), did not perceive a need (n = 2), and other (n = 5). Two participants were lost to follow-up in each group due to treatment changes. Thus, 75% of participants were retained in the YST and 71% in the AC arm. Participants retained in the study adhered to 97% of the in-person intervention sessions and completed all questionnaires.ConclusionsThis study demonstrated the feasibility of conducting a larger randomized controlled trial to assess YST among patients receiving chemotherapy for colorectal cancer. Data collected and challenges encountered will inform future research.     

Can music improve sleep quality in adults with primary insomnia? A systematic review and network meta-analysis

BackgroundPrimary insomnia is one of the most common issues for adults. However, whether to use music intervention as a non-pharmacological method of treatment, as well as which treatment should be preferred, is still a matter of controversy. Therefore, we aimed to compare and rank music interventions and no-music controls for primary insomnia patients.MethodsA network meta-analysis was used to identify evidence from relevant clinical trials. We searched PubMed, Embase, the Cochrane Library, and the China National Knowledge Infrastructure Library for publications up to May 2017, pertaining to music intervention for primary insomnia patients. The prespecified primary outcome was sleep quality (scored by the PSQI and overall), and the secondary outcomes were sleep onset latency and sleep efficiency. We did pairwise meta-analyses using the random-effects model, later completing the random-effects network meta-analyses. The study was registered with PROSPERO, number CRD42017064750.ResultsWe deemed 20 trials to be eligible, involving 1339 patients and 12 intervention arms. For PSQI scores, all intervention arms were statistically more effective than the usual care, with patients ranking listening to music as the best means of intervention (SMD: −0.61, 95%CrI: −1.01 to −0.20). For overall sleep quality, only music-associated relaxation was statistically more effective than the patients’ usual care (−0.28, −0.48 to −0.08). In terms of sleep onset latency, music-associated relaxation and listening to music had significant advantages (−0.26, −0.64 to −0.09, and −0.28, −0.53 to −0.02); listening to music and music with exercise displayed a tendency to improve sleep efficiency.ConclusionsWhen considering the efficacy, music intervention seemed to offer clear advantages for adults with primary insomnia. Listening to music and music-associated relaxation are probably the best options to consider in the application of music intervention.     

Influences of sleep and the circadian rhythm on iron-status indices

ObjectivesThe aim was to study the influence of sampling time, food intake and sleep on tests used to screen for and monitor conditions of iron deficiency and overload.Design and methodsThe 24 h variations of iron, transferrin, transferrin saturation (TS) and ferritin were studied in seven healthy individuals during standardised food intake, and during night or day sleep.ResultsIron and TS showed clear diurnal variations, with peaks at 12.6 h and 12.8 h respectively, during night sleep, and at 19.7 h and 19.3 h, respectively, during day sleep. Ferritin did not demonstrate any circadian variation. Transferrin and ferritin were unaffected by sleep-condition. Meals did not have any effect except a slight decline of transferrin.ConclusionsTime of day and sleeping patterns had great influence on iron and TS, whereas no or only minor effects are seen on the concentration of ferritin and transferrin. Meals have limited effects.     

The effects of caffeine abstinence on sleep: A pilot study

AimThe aim of this study was to examine whether caffeine abstinence in the evening could improve the sleep quality of those who habitually consume coffee.DesignA double-blind control group design (caffeine and caffeine-free groups).SettingA university.SubjectsA convenience sampling of 10 students (mean age 21.4 years).MethodsIt was a 14-day experiment. For the first 7 days, all participants consumed caffeinated coffee. In the following 7 days, subjects consumed caffeinated or decaffeinated coffee according to their assigned group.MeasuresSleep–wake parameters, self-reported sleep quality and level of refreshment.ResultsThere were no significant differences (p > .05) among the data of the two groups identified. No significant changes (p > .05) were found in the sleep quality of either group during the study.ConclusionThis study confirms that caffeine abstinence in the evening might not be helpful in sleep promotion. It highlights the need to implement evidence-based practice in health promotion.