Oral magnesium supplementation for insomnia in older adults: a Systematic Review & Meta-Analysis

Abstract Background Magnesium supplementation is often purported to improve sleep; however, as both an over-the-counter sleep aid and a complementary and alternative medicine, there is limited evidence to support this assertion. The aim was to assess the effectiveness and safety of magnesium supplementation for older adults with insomnia. Methods A search was conducted in MEDLINE, EMBASE, Allied and Complementary Medicine, clinicaltrials.gov and two grey literature databases comparing magnesium supplementation to placebo or no treatment. Outcomes were sleep quality, quantity, and adverse events. Risk of bias and quality of evidence assessments were carried out using the RoB 2.0 and Grading of Recommendations Assessment, Development and Evaluation (GRADE) approaches. Data was pooled and treatment effects were quantified using mean differences. For remaining outcomes, a modified effects direction plot was used for data synthesis. Results Three randomized control trials (RCT) were identified comparing oral magnesium to placebo in 151 older adults in three countries. Pooled analysis showed that post-intervention sleep onset latency time was 17.36 min less after magnesium supplementation compared to placebo (95% CI − 27.27 to − 7.44, p = 0.0006). Total sleep time improved by 16.06 min in the magnesium supplementation group but was statistically insignificant. All trials were at moderate-to-high risk of bias and outcomes were supported by low to very low quality of evidence. Conclusion This review confirms that the quality of literature is substandard for physicians to make well-informed recommendations on usage of oral magnesium for older adults with insomnia. However, given that oral magnesium is very cheap and widely available, RCT evidence may support oral magnesium supplements (less than 1 g quantities given up to three times a day) for insomnia symptoms.

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Oral Magnesium Supplementation for Insomnia in Older Adults: A Systematic Review & Meta-Analysis

10.21203/rs.3.rs-192269/v1 ◽

2021 ◽

Author(s):

Jasmine Mah ◽

Tyler Pitre

Keyword(s):

Older Adults ◽

Meta Analysis ◽

Sleep Onset ◽

Risk Of Bias ◽

Sleep Onset Latency ◽

Post Intervention ◽

Magnesium Supplementation ◽

Quality Of Evidence ◽

Oral Magnesium

Abstract Background: Magnesium supplementation is often purported to improve sleep; however, as both an over-the-counter sleep aid and a complementary and alternative medicine, there is limited evidence to support this assertion. The aim was to assess the effectiveness and safety of magnesium supplementation for older adults with insomnia. Methods: A search was conducted in three databases comparing magnesium supplementation to placebo or no treatment. Outcomes were sleep quality, quantity, and adverse events. Risk of bias and quality of evidence assessments were carried out using the RoB 2.0 and Grading of Recommendations Assessment, Development and Evaluation (GRADE) approaches. Data was pooled and treatment effects were quantified using mean differences. For remaining outcomes, a modified effects direction plot was used for data synthesis. Results: Three trials were identified comparing oral magnesium to placebo in 151 older adults in three countries. Pooled analysis showed that post-intervention sleep onset latency time was 17.36 minutes less after magnesium supplementation compared to placebo (95% CI -27.27 to -7.44, p=0.0006). Total sleep time improved by 16.06 min in the magnesium supplementation group but was statistically insignificant. All trials were at moderate-to-high risk of bias and outcomes were supported by low to very low quality of evidence. Conclusion: This review confirms that the quality of literature is substandard for physicians to make well-informed recommendations on usage of oral magnesium for older adults with insomnia. However, given that oral magnesium is very cheap and widely available, there is weak evidence supporting improved sleep parameters after magnesium supplementation for insomnia symptoms.

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Outpatient total knee arthroplasty leads to a higher number of complications: a meta-analysis

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-020-01925-x ◽

2020 ◽

Vol 15 (1) ◽

Author(s):

Vittorio Bordoni ◽

Alberto Poggi ◽

Stefano Zaffagnini ◽

Davide Previtali ◽

Giuseppe Filardo ◽

...

Keyword(s):

Complication Rate ◽

Meta Analysis ◽

Grey Literature ◽

Operative Management ◽

Risk Of Bias ◽

Cochrane Library ◽

Moderate Risk ◽

Level Of Evidence ◽

Quality Of Evidence

Abstract Background Careful pre- and post-operative management can allow surgeons to perform outpatient TKA, making this a more affordable procedure. The aim of the present meta-analysis is to compare outpatient and inpatient TKA. Methods A systematic search of the literature was performed in July 2020 on PubMed, Web of Science, Cochrane library, and on the grey literature databases. The papers collected were used for a meta-analysis comparing outpatient and inpatient TKA in terms of complication and readmission rates. Risk of bias and quality of evidence were defined according to Cochrane guidelines. Results The literature search resulted in 4107 articles; of these, 8 articles were used for the meta-analysis. A total of 212,632 patients were included, 6607 of whom were TKA outpatients. The overall complication rate for outpatient TKAs was 16.1%, while inpatient TKAs had an overall lower complication rate of 10.5% (p = 0.003). The readmission rate was 4.9% in outpatient TKAs and 5.9% in inpatient TKAs. Only 3 studies reported the number of deaths, which accounted for 0%. The included studies presented a moderate risk of bias, and according to GRADE guidelines, the level of evidence for complications and readmissions was very low. Conclusions This meta-analysis documented that outpatient TKA led to an increased number of complications although there were no differences in the number of readmissions. However, future high-level studies are needed to confirm results and indications for the outpatient approach, since the studies currently available have a moderate risk of bias and a very low quality of evidence.

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Patient education materials for non-specific low back pain and sciatica: a protocol for a systematic review and meta-analysis

BMJ Open ◽

10.1136/bmjopen-2020-039530 ◽

2020 ◽

Vol 10 (9) ◽

pp. e039530

Author(s):

Bradley Furlong ◽

Kris Aubrey-Bassler ◽

Holly Etchegary ◽

Andrea Pike ◽

Georgia Darmonkow ◽

...

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Patient Education ◽

Grey Literature ◽

Risk Of Bias ◽

Low Back ◽

Quality Of Evidence ◽

Negative Beliefs ◽

Subacute Low Back Pain

IntroductionLow back pain accounts for more disability than any other musculoskeletal condition and is associated with severe economic burden. Patients commonly present with negative beliefs about low back pain and this can have detrimental effects on their health outcomes. Providing evidence-based, patient-centred education that meets patient needs could help address these negative beliefs and alleviate the substantial low back pain burden. The primary aim of this review is to investigate the effectiveness of patient education materials on immediate process, clinical and health system outcomes.Methods and analysisThe search strategy was developed in collaboration with a librarian and systematic searches will be performed in MEDLINE, EMBASE, CINAHL, PsycINFO and SPORTDiscus. We will also search trial registries and grey literature through the OpenGrey database. Study selection will include a title and abstract scan and full-text review by two authors. Only randomised controlled trials will be included in this review. Trials must include patients with low back pain or sciatica and investigate educational interventions with at least one of the following contrasts: (1) education alone versus no intervention; (2) education alone versus another intervention; (3) education in addition to another intervention versus the same intervention with no education. Data extraction, risk of bias and grading of the quality of evidence will be performed independently by two reviewers. Risk of bias will be assessed using the PEDro scale, and the quality of evidence will be assessed with the Grades of Recommendation, Assessment, Development and Evaluation approach. A random-effects model will be used for each contrast, and results will be pooled if the participants, interventions, and outcomes are homogeneous. If heterogeneity is high (I2 >75%), we will evaluate the magnitude and direction of the differences in effect sizes across studies to determine if it remains reasonable to pool the results. Analyses of acute and subacute low back pain (less than 12 weeks duration) will be performed separately from chronic low back pain (12 weeks or greater duration). Likewise, analyses of short-term (less than 6 months) and long-term (6 months or greater) follow-up will be performed separately. Subgroup analyses will be performed on non-specific low back pain, sciatica and mixed populations.Ethics and disseminationEthical approval is not required for this review. This study, along with its results, will be published in a peer-reviewed journal.

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The Effects of Green Exercise on Physical and Mental Wellbeing: A Systematic Review

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph16081352 ◽

2019 ◽

Vol 16 (8) ◽

pp. 1352 ◽

Cited By ~ 24

Author(s):

Ian Lahart ◽

Patricia Darcy ◽

Christopher Gidlow ◽

Giovanna Calogiuri

Keyword(s):

Perceived Exertion ◽

Meta Analysis ◽

Risk Of Bias ◽

Mental Wellbeing ◽

Affective Valence ◽

Post Intervention ◽

Green Exercise ◽

Quality Of Evidence ◽

Exercise Condition

We aimed to examine the evidence for the proposed additive effect of exercise in the presence of nature (green exercise) by systematically reviewing studies that investigated the effects of outdoor or virtual green exercise compared with indoor exercise. Our review updates an earlier review, whose searches were conducted in April 2010. Trials were eligible if: (a) participants in an outdoor or virtual exercise condition were exposed to views of nature (green exercise); (b) green exercise was compared with indoor exercise with no exposure to nature; (c) included an outcome related to physical or mental health; (d) used comparative or crossover trial design. We searched the following databases from 1st January 2010 to 28th June 2018: PubMed, CENTRAL, EMBASE, PsycINFO, GreenFile, and Sports DISCUS. We assessed risk of bias using the Cochrane “risk of bias” tool. Where possible we conducted a meta-analysis using the inverse variance random-effects method, and where this approach was not possible we presented the results qualitatively and in harvest plots. We identified 28 eligible trials. In a meta-analysis of just three longitudinal trials, the only statistical finding was slightly lower post-intervention perceived exertion with green versus indoor exercise (mean difference: −1.02; 95% confidence intervals: −1.88, −0.16). Compared with indoor exercise, acute bouts of outdoor green exercise may favorably influence affective valence and enjoyment, but not emotion, perceived exertion, exercise intensity, and biological markers. No other consistent statistical differences were observed, apart from a higher enjoyment of outdoor green versus virtual green exercise. We found a high risk of bias across trials and an overall low quality of evidence. In conclusion, there was limited evidence to support the view that green exercise offers superior benefits to exercise without exposure to nature. The low quality of evidence prohibits clear interpretation of trial findings. Future robust and rigorously designed trials are needed to evaluate the effects of long-term and multiple-bout exposure to nature during exercise compared with exercise indoors.

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Mindfulness-based therapy for insomnia for older adults with sleep difficulties: a randomized clinical trial

Psychological Medicine ◽

10.1017/s0033291721002476 ◽

2021 ◽

pp. 1-11

Author(s):

Francesca Perini ◽

Kian Foong Wong ◽

Jia Lin ◽

Zuriel Hassirim ◽

Ju Lynn Ong ◽

...

Keyword(s):

Older Adults ◽

Sleep Quality ◽

Behavioral Therapy ◽

Sleep Onset ◽

Exercise Program ◽

Severity Index ◽

Poor Sleep ◽

Sleep Onset Latency ◽

Post Intervention ◽

Insomnia Severity

Abstract Objective Poor sleep is a modifiable risk factor for multiple disorders. Frontline treatments (e.g. cognitive-behavioral therapy for insomnia) have limitations, prompting a search for alternative approaches. Here, we compare manualized Mindfulness-Based Therapy for Insomnia (MBTI) with a Sleep Hygiene, Education, and Exercise Program (SHEEP) in improving subjective and objective sleep outcomes in older adults. Methods We conducted a single-site, parallel-arm trial, with blinded assessments collected at baseline, post-intervention and 6-months follow-up. We randomized 127 participants aged 50–80, with a Pittsburgh Sleep Quality Index (PSQI) score ⩾5, to either MBTI (n = 65) or SHEEP (n = 62), both 2 hr weekly group sessions lasting 8 weeks. Primary outcomes included PSQI and Insomnia Severity Index, and actigraphy- and polysomnography-measured sleep onset latency (SOL) and wake after sleep onset (WASO). Results Intention-to-treat analysis showed reductions in insomnia severity in both groups [MBTI: Cohen's effect size d = −1.27, 95% confidence interval (CI) −1.61 to −0.89; SHEEP: d = −0.69, 95% CI −0.96 to −0.43], with significantly greater improvement in MBTI. Sleep quality improved equivalently in both groups (MBTI: d = −1.19; SHEEP: d = −1.02). No significant interaction effects were observed in objective sleep measures. However, only MBTI had reduced WASOactigraphy (MBTI: d = −0.30; SHEEP: d = 0.02), SOLactigraphy (MBTI: d = −0.25; SHEEP: d = −0.09), and WASOPSG (MBTI: d = −0.26; SHEEP (d = −0.18). There was no change in SOLPSG. No participants withdrew because of adverse effects. Conclusions MBTI is effective at improving subjective and objective sleep quality in older adults, and could be a valid alternative for persons who have failed or do not have access to standard frontline therapies.

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361 Relative Effectiveness of Cognitive Behavioral Therapy and its Components in Improving Insomnia Symptoms in Older Adults

SLEEP ◽

10.1093/sleep/zsab072.360 ◽

2021 ◽

Vol 44 (Supplement_2) ◽

pp. A144-A144

Author(s):

Kathleen O’Hora ◽

Beatriz Hernandez ◽

Laura Lazzeroni ◽

Jamie Zeitzer ◽

Leah Friedman ◽

...

Keyword(s):

Older Adults ◽

Cognitive Behavioral Therapy ◽

Behavioral Therapy ◽

Sleep Onset ◽

Post Treatment ◽

Cognitive Behavioral ◽

Sleep Onset Latency ◽

Significant Group ◽

Time Interaction ◽

Insomnia Symptoms

Abstract Introduction The prevalence of insomnia complaints in older adults is 30–48%, compared to 10–15% in the general population. Cognitive Behavioral Therapy for Insomnia (CBT-I) is a first-line, non-pharmacological sleep treatment for Insomnia. However, the relative impact of Behavioral (BT) and Cognitive (CT) components compared to that of CBT-I in older adults is unknown. Methods 128 older adults with insomnia were randomized to receive CBT-I, BT, or CT. Sleep diaries and the Insomnia Severity Index (ISI) were collected pre- and post-treatment and at a 6-month follow-up. We conducted split-plot linear mixed models with age and sex as covariates to assess within and between subject changes to test effects of group, time, and their interaction on ISI, sleep onset latency (SOL), wake after sleep onset (WASO), total sleep time (TST), time in bed (TIB), sleep efficiency (SE), and percent of treatment responders (ISI decrease>7) and remitters (ISI<8). Effect size (d) was calculated by dividing the difference between means by the root-mean-squared error of the mixed effects model. Results All treatments lead to a significant improvement across outcome measures at post-treatment (p’s<0.001) and 6-months (p’s<0.01), with the exception of TIB, response, and remission. For TIB, there was a significant Group x Time interaction (p<0.001): while all treatments significantly reduced TIB post-treatment relative to baseline, CBT-I (p<0.001,d=-2.26) and BT (p<0.001,d=-1.59) performed significantly better than CT (p=0.003, d=-0.68). In contrast, at 6-months CBT-I (p<0.001,d=-1.16) performed significantly better at reducing TIB than CT (p=0.195,d=-0.24) or BT (p=0.023,d=-0.61) relative to baseline. There was also a non-significant trend for a Group x Time interaction for remission status (p=0.062). Whereas, the percentage of remitters within all groups post-treatment did not differ from chance (p>0.234), at 6 months, the percentage of remitters was significantly higher than chance in CBT-I (73.63%,p=0.026) and BT (78.08%,p=0.012), but not CT (47.85%,p=0.826). There were no other significant time or interaction effects (all p>0.05). Conclusion CBT-I and its components are effective in improving subjective insomnia symptoms in older adults. Evidence suggests CBT-I may be superior to either CT or BT alone in improving TIB in older adults. Support (if any) NIMHR01MH101468; MIRECC at VAPAHCS

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Effect of early intervention for anxiety on sleep outcomes in adolescents: a randomized trial

European Child & Adolescent Psychiatry ◽

10.1007/s00787-021-01795-6 ◽

2021 ◽

Author(s):

Bente Storm Mowatt Haugland ◽

Mari Hysing ◽

Asle Hoffart ◽

Åshild Tellefsen Haaland ◽

Jon Fauskanger Bjaastad ◽

...

Keyword(s):

Early Intervention ◽

Standard Length ◽

Sleep Problems ◽

Sleep Onset ◽

Cognitive Behavioral ◽

Control Group ◽

Sleep Onset Latency ◽

Post Intervention ◽

Clinical Trial Registration

AbstractThe potential effect of early intervention for anxiety on sleep outcomes was examined in a sample of adolescents with anxiety (N = 313, mean 14.0 years, SD = 0.84, 84% girls, 95.7% Norwegians). Participants were randomized to one of three conditions: a brief or a standard-length cognitive-behavioral group-intervention (GCBT), or a waitlist control-group (WL). Interventions were delivered at schools, during school hours. Adolescents with elevated anxiety were recruited by school health services. Questionnaires on self-reported anxiety symptoms, depressive symptoms, and sleep characteristics were administered at pre- and post-intervention, post-waitlist, and at 1-year follow-up. Adolescents reported reduced insomnia (odds ratio (OR) = 0.42, p < 0.001) and shorter sleep onset latency (d = 0.27, p < 0.001) from pre- to post-intervention. For insomnia, this effect was maintained at 1-year follow-up (OR = 0.54, p = 0.020). However, no effect of GCBT on sleep outcomes was found when comparing GCBT and WL. Also, no difference was found in sleep outcomes between brief and standard-length interventions. Adolescents defined as responders (i.e., having improved much or very much on anxiety after GCBT), did not differ from non-responders regarding sleep outcomes. Thus, anxiety-focused CBT, delivered in groups, showed no effect on sleep outcomes. Strategies specifically targeting sleep problems in adolescents should be included in GCBT when delivered as early intervention for adolescents with elevated anxiety.Trial registry Clinical trial registration: School Based Low-intensity Cognitive Behavioral Intervention for Anxious Youth (LIST); http://clinicalrials.gov/; NCT02279251, Date: 11.31. 2014

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Nocturnal digital surveillance in aged populations and its effects on health, welfare and social care provision: a systematic review

BMC Health Services Research ◽

10.1186/s12913-021-06624-9 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Matt X. Richardson ◽

Maria Ehn ◽

Sara Landerdahl Stridsberg ◽

Ken Redekop ◽

Sarah Wamala-Andersson

Keyword(s):

Systematic Review ◽

Standard Care ◽

Social Care ◽

Grey Literature ◽

Care Quality ◽

Risk Of Bias ◽

Future Research ◽

Care Provision ◽

Digital Surveillance

Abstract Background Nocturnal digital surveillance technologies are being widely implemented as interventions for remotely monitoring elderly populations, and often replace person-based surveillance. Such interventions are often placed in care institutions or in the home, and monitored by qualified personnel or relatives, enabling more rapid and/or frequent assessment of the individual’s need for assistance than through on-location visits. This systematic review summarized the effects of these surveillance technologies on health, welfare and social care provision outcomes in populations ≥ 50 years, compared to standard care. Method Primary studies published 2005–2020 that assessed these technologies were identified in 11 databases of peer-reviewed literature and numerous grey literature sources. Initial screening, full-text screening, and citation searching steps yielded the studies included in the review. The Risk of Bias and ROBINS-I tools were used for quality assessment of the included studies. Result Five studies out of 744 identified records met inclusion criteria. Health-related outcomes (e.g. accidents, 2 studies) and social care outcomes (e.g. staff burden, 4 studies) did not differ between interventions and standard care. Quality of life and affect showed improvement (1 study each), as did economic outcomes (1 study). The quality of studies was low however, with all studies possessing a high to critical risk of bias. Conclusions We found little evidence for the benefit of nocturnal digital surveillance interventions as compared to standard care in several key outcomes. Higher quality intervention studies should be prioritized in future research to provide more reliable evidence.

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241 Remotely Delivered Yoga Nidra for Insomnia and Anxiety during COVID-19

SLEEP ◽

10.1093/sleep/zsab072.240 ◽

2021 ◽

Vol 44 (Supplement_2) ◽

pp. A96-A96

Author(s):

Erica Sharpe ◽

Matthew Butler ◽

Doug Hanes ◽

Ryan Bradley

Keyword(s):

Adult Population ◽

Sleep Onset ◽

Severity Index ◽

Index Score ◽

Average Score ◽

Sleep Onset Latency ◽

Post Intervention ◽

Natural Medicine ◽

National University ◽

Yoga Nidra

Abstract Introduction Insomnia and related anxiety affect 30 - 50% of the US adult population. These conditions often coexist, and contribute to increased mortality from depression, heart disease, and stroke. The current COVID-19 pandemic has heightened anxiety and sleeplessness, and 53% of US adults report the pandemic has affected their mental health. There is a need for research into therapies for anxiety and insomnia that can be delivered remotely for increased accessibility to reach more individuals in need. Methods To contribute to this need, we examined the effects of remotely delivered Yoga Nidra (translated to mean “yogic sleep”), a guided meditation practice, on anxiety and sleep. The practice was delivered in real-time before bed, or asynchronously via an online REDCap-based platform, once per week for 16-weeks from April to July (during the early months of the COVID-19 pandemic). Results Seventy-four individuals joined the study, of whom 71% reported subthreshold insomnia (Insomnia Severity Index score of 14 ± 4), and 74% reported anxiety (Generalized Anxiety Disorder Index score of 10 ± 5). Seventy-one (96%) participants accessed the asynchronous recordings. Remote delivery of this practice proved very feasible, with no adverse events reported, and although we provided no monetary compensation, 50% of our sample still completed a post-intervention survey. Further, 52% of n=25 respondents who completed both pre- and post-intervention sleep surveys reported decreased sleep onset latency (SOL) the following day, with a mean decrease of 10 minutes (95% CI = −19.0, −0.5) for all respondents, and strongest change (−34 min; p=.017) measured for those who reported SOL between 30-120 min at baseline. Overall state anxiety was decreased by 41% for n=32 respondents who completed pre-post State Trait Anxiety Index (STAI) surveys surrounding a single practice (average score of 47 ± 11 before practice vs. 27 ± 8 after practice, p<.0001). Conclusion Remotely delivered Yoga Nidra is feasible to deliver, and demonstrates potential benefits for anxiety and insomnia, warranting additional research. Support (if any) This work was supported by the R90 BRIDG grant at the Helfgott Research Institute at the National University of Natural Medicine.

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Duration of orthodontic treatment with fixed appliances in adolescents and adults: a systematic review with meta-analysis

Progress in Orthodontics ◽

10.1186/s40510-020-00334-4 ◽

2020 ◽

Vol 21 (1) ◽

Author(s):

Allen Abbing ◽

Vasiliki Koretsi ◽

Theodore Eliades ◽

Spyridon N. Papageorgiou

Keyword(s):

Treatment Duration ◽

Meta Analysis ◽

Risk Of Bias ◽

Adult Patients ◽

Comprehensive Treatment ◽

Orthodontic Appliances ◽

Duration Of Treatment ◽

Quality Of Evidence ◽

Fixed Appliances

Abstract Objectives Adults with fixed orthodontic appliances are increasing nowadays. Compared with adolescents, adults present biological differences that might influence treatment duration. Therefore, the aim of the study was to compare duration of treatment with fixed appliances between adults and adolescents. Materials and methods Eight databases were searched up to September 2019 for randomized and non-randomized clinical studies comparing treatment duration with fixed appliances in adolescents and adult patients. After duplicate study selection, data extraction, and risk of bias assessment with the Cochrane ROBINS-I tool, random effects meta-analyses of mean differences (MD) and their 95% confidence intervals (CIs) were performed, followed by assessment of the quality of evidence with GRADE. Results A total of 11 unique studies (one prospective and 10 retrospective non-randomized) with 2969 adolescents and 1380 adult patients were finally included. Meta-analysis of 7 studies found no significant difference in the duration of comprehensive treatment with fixed appliances (MD = − 0.8 month; 95% CI = − 4.2 to 2.6 months; P = 0.65; I2 = 92%) between adults and adolescents. Similarly, both distalization of upper first molars with skeletal anchorage for class II correction and the retraction of canines into the premolar extraction spaces lasted similarly long among adults and adolescents. On the other hand, alignment of palatally displaced canines lasted considerably longer in adults compared to adolescents (1 study; MD = 3.8 months; 95% CI = 1.4 to 6.2 months; P = 0.002). The quality of evidence for the meta-analysis was low due to the inclusion of non-randomized studies with considerable risk of bias. Conclusions While existing evidence does not indicate a difference in the overall duration of treatment with fixed appliances between adults and adolescents, the alignment of palatally displaced canines lasted significantly longer in adults. However, our confidence in these estimates is low due to the risk of bias in the included studies. Trial registration PROSPERO: (CRD42019148169)

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