1. Trent Regional SAPC Conference 19 March 2019
Effects of non-pharmacological interventions on insomnia in patients with tinnitus: a systematic review & meta-analysis
Trent Regional SAPC Conference 19 March 2019
Despina Laparidou, Dr Ffion Curtis, Professor Alina Rodriguez, Professor Graham Law,
Dr Simon Durrant, Dr Robert H. Pierzycki, Professor A. Niroshan Siriwardena
Results
Five studies were included in the systematic review (only four studies in the meta-analysis).
The majority of the interventions were internet-based and targeted tinnitus distress with insomnia reported as a secondary outcome. Sleep management and/or guidance was an additional optional module in three studies (Beukes et al, 2017; Jasper et al, 2014; Weise et al, 2016).
The most common intervention modules were: psychoeducation, applied relaxation, positive imagery, focus exercises, cognitive restructuring, avoidance behaviour, behavioural activation, sound enrichment, exposure to tinnitus and relapse prevention.
Results demonstrated a significant reduction in insomnia as measured by the insomnia severity index [-3.28; 95% CI=-4.51,-2.05; I2= 0%]), which equates to a moderate effect size (0.5).
Risk of bias was considered low in all categories except blinding (participants and personnel and/or outcome assessment), which was not always possible due to study design.
Background
Tinnitus is the perception of sound (ringing or buzzing) in the ears or head in the absence of external sounds.
It affects about 10% of people in the United Kingdom, with rates of comorbid sleep problems ranging from 50 to 77%.
Papers identified through database searching:
Cochrane Library/CENTRAL n= 86
PROSPERO n= 5
HTA/DARE n= 0
Medline n= 333
CINAHL n= 2,423
Web of science n= 38
ClinicalTrials.gov n= 15
Papers identified through manual searching of identified records: n= 0
Potentially relevant papers identified:
n= 2,900
Duplicates excluded:
n= 212
Aim
Our aim was to systematically review the literature relating to the effectiveness of cognitive behavioural therapy (CBT) interventions on insomnia in patients with tinnitus.
Total of relevant papers identified:
n= 2,688
Articles excluded based on title & abstract screening: n= 2,631
Potentially relevant articles, selected for full-text screening: n= 57
Articles excluded based on inclusion criteria: n= 52
Articles included in final review: n= 5
Methods
A systematic literature search of seven scientific databases was performed, covering literature published up to August Database searching was supplemented with internet searching and forward/backward citation tracking from systematic reviews and included studies.
Eligibility criteria:
adult patients (living at home or in a care setting) with tinnitus;
CBT interventions for tinnitus and/or insomnia;
any comparator (i.e. usual care, alternative intervention);
randomised controlled trials or quasi-randomised controlled trials that reported sleep outcomes.
The primary outcome was a mean difference in sleep.
The quality of the included studies was assessed according to the Cochrane Risk of Bias assessment tool.
Two reviewers independently reviewed title/abstracts initially and then full-text papers, before proceeding with data extractions. Any discrepancies were resolved through discussion, or where required a third reviewer.
Conclusions
This systematic review and meta-analysis showed that CBT-based interventions can improve insomnia in people diagnosed with tinnitus.
Further research into interventions specifically targeting sleep problems would be advantageous, especially exploring which components of CBT are the most effective for alleviating sleep problems in patients with tinnitus.
Contact Information: Despina Laparidou, Research Assistant, Tel:
Prof Niro Siriwardena, Lead Researcher, Tel: