Effectiveness of Light Therapy in Cognitively Impaired Persons: A Metaanalysis of Randomized Controlled Trials

The Effects of Light Therapy on Sleep, Depression, Neuropsychiatric Behaviors, and Cognition Among People Living With Dementia: A Meta-Analysis of Randomized Controlled Trials

OBJECTIVE

Alterations in the suprachiasmatic nucleus due to underlying pathologies disrupt the circadian rhythms in people living with dementia (PLWD). Circadian rhythms significantly impact sleep, emotional, and cognitive functions, with its synchronization depending on light exposure. We performed a meta-analysis to evaluate the effects of light therapy on sleep, depression, neuropsychiatric behaviors, and cognition among PLWD.

METHODS

A systematic search was conducted in Cochrane, ClinicalTrials.gov, Embase, EBSCOhost, Ovid-MEDLINE, PubMed, Scopus, Web of Science, and CINAHL databases. The pooled effect size was calculated using the Hedges' g with random-effects model adopted in comprehensive meta-analysis software. The Cochrane risk of bias (RoB 2.0) tool evaluated the quality of studies, while Cochrane's Q and I² tests assessed heterogeneity.

RESULTS

A total of 24 studies with 1,074 participants were included. Light therapy demonstrated small-to-medium effects on improving sleep parameters: total sleep time (Hedges' g = 0.19), wake after sleep onset (Hedges' g = 0.24), sleep efficiency (Hedges' g = 0.31), sleep latency (Hedges' g = 0.35), circadian rhythm (acrophase: Hedges' g = 0.36; amplitude: Hedges' g = 0.43), number of night awakenings (Hedges' g = 0.37), sleep disturbance (Hedges'g = 0.45), and sleep quality (Hedges' g = 0.60). Light therapy showed small-to-medium effect on reducing depression (Hedges' g = -0.46) with medium-to-large effect on cyclical function (Hedges' g = -0.68) and mood-related signs and symptoms (Hedges' g = -0.84) subscales. Light therapy also demonstrated small effect on reducing neuropsychiatric behaviors (Hedges' g = -0.34) with medium-to-large effect on agitation (Hedges' g = -0.65), affective symptom (Hedges' g = -0.70), psychosis (Hedges' g = -0.72), and melancholic behavior (Hedges' g = -0.91) subscales. Additionally, light therapy also improved cognition (Hedges' g = 0.39).

CONCLUSION

Light therapy could be used as a supportive therapy to improve sleep, depression, cognition, and neuropsychiatric behaviors among PLWD.

Sleep-wake behavioral characteristics associated with depression symptoms: findings from the Multi-Ethnic Study of Atherosclerosis

STUDY OBJECTIVES

To help prioritize target/groups for experimental intervention studies, we characterized cross-sectional associations between 24-hour sleep-wake measures and depression symptoms, and evaluated if similar sleep-wake-depression relationships existed in people with and without higher insomnia severity.

METHODS

Participants had ≥3 days of actigraphy data (n = 1884; mean age = 68.6/SD = 9.1; 54.1% female). We extracted 18 sleep, activity, timing, rhythmicity, and fragmentation measures from actigraphy. We used individual and multivariable regressions with the outcome of clinically significant depression symptoms (Center for Epidemiologic Studies Depression Scale ≥ 16). We conducted sensitivity analyses in people with higher insomnia severity (top quartile of the Women's Health Initiative Insomnia Rating Scale total score).

RESULTS

From separate models in the overall sample, the odds of having depression symptoms were higher with: later timing (e.g. activity onset time odds ratio [OR]/1 SD = 1.32; 95% confidence interval [CI]: 1.16 to 1.50), lower rhythmicity (e.g. pseudo-F OR/1 SD = 0.75; 95% CI: 0.66 to 0.85), less activity (e.g. amplitude OR/1 SD = 0.83; 95% CI: 0.72 to 0.95), and worse insomnia (OR/1 SD = 1.48, 95% CI: 1.31 to 1.68). In multivariable models conducted among people with lower insomnia severity, later timing, lower rhythmicity, and higher insomnia severity were independent correlates of depression. In people with higher insomnia symptom severity, measures of later timing were most strongly associated with depression symptoms.

CONCLUSIONS

These correlative observations suggest that experimental studies are warranted to test if: broadly promoting 24-hour sleep-wake functioning reduces depression even in people without severe insomnia, and if advancing timing leads to depression symptom reductions in people with insomnia.

The effect of light therapy on sleep disorders and psychobehavioral symptoms in patients with Alzheimer's disease: A meta-analysis

BACKGROUND

Although Alzheimer's disease (AD) mainly affects cognitive function, it is often accompanied by sleep disorders and psychobehavioral symptoms. These symptoms, including depression, agitation, and psychotic symptoms, are prominent hospitalization causes among patients with AD. Currently, relatively more research exists on light therapy for sleep disorders, while those on psychobehavioral symptoms are gradually increasing. However, no consensus exists on these results because of the vulnerability of light therapy to multiple factors, including light intensity and duration. Thus, further research investigating this aspect is warranted.

OBJECTIVE

To evaluate the efficacy of light therapy in improving sleep disorders and psychobehavioural symptoms in patients with AD.

METHODS

In this meta-analysis, relevant literature was searched in Embase, the Clinical Trials Registry, Web of Science, PubMed, and the Cochrane Library up to December 2022. Furthermore, a fixed-effects model was used for data analysis.

RESULTS

Fifteen randomized controlled trials involving 598 patients with AD were included. In the case of sleep disorders, our meta-analysis revealed that light therapy significantly improved sleep efficiency (MD = -2.42, 95% CI = -3.37 to -1.48, p < 0.00001), increased interdaily stability (MD = -0.04, 95% CI = -0.05 to -0.03, p < 0.00001), and reduced intradaily variability (MD = -0.07, 95% CI = -0.10 to -0.05, p < 0.00001). With respect to psychotic behavior, light therapy was found to alleviate depression (MD = -2.55, 95% CI = -2.98 to -2.12, p < 0.00001) as well as reduce agitation (MD = -3.97, 95% CI = -5.09 to -2.84, p < 0.00001) and caregiver burden (MD = -3.57, 95% CI = -5.28 to -1.87, p < 0.00001).

CONCLUSION

Light therapy leads to significant improvement in sleep and psychobehavioral symptoms and is associated with relatively fewer side effects in patients with AD, indicating its potential as a promising treatment option for AD.

The Effects of Light Therapy for Depression in Dementia: A Systematic Review and Meta-Analysis

BACKGROUND

Depression is one of the most common symptoms in patients with dementia.

OBJECTIVE

This meta-analysis aimed to evaluate the effect of light therapy on depression associated with dementia by using a single scale.

METHODS

Published studies based on the terms including "Dementia", "depression", and "Phototherapy" were searched. Web of Science, PubMed, Embase, CiNii, CNKI, Wanfang Database, and China Biology Medicine disc were adopted to collect randomized controlled studies or cross-controlled studies using the Cornell Dementia Depression Scale (CSDD) until February 2022. GRADE and Review Manager Version 5.4.1 were employed to assess the risk of bias. A meta-analysis was conducted by R 4.0.2 software based on the changes in CSDD scores.

RESULTS

A total of 1,055 studies were retrieved from the databases, and six studies were included after screening. Some 406 people with dementia were included with an average age of over 80 years. Forest plot results showed that light intervention improved depression scores of dementia patients (MD = -2.59, 95% CI: -4.46 to -0.71), and light intensity less than 1000 lux improved depression symptoms of dementia patients (MD = -2.76, 95% CI: -4.55 to -0.97). An intervention that lasted 8 to 12 weeks was the most effective (MD = -3.77, 95% CI: -6.93 to -0.60), and non-stable interventions such as ceiling LED lights exerted more positive effects (MD = -2.12, 95% CI: -3.38 to -0.85).

CONCLUSION

The overall results of the meta-analysis suggested that light intervention can improve the depressive symptoms of older patients with dementia.

Self-perception and anticipated efficacy of the anti-dementia multimodal program in 100 older adults with mild cognitive impairment

BACKGROUND

Effective and sustainable interventions are clearly needed for mild cognitive impairment (MCI) patients. Despite the clinical importance of the multimodal intervention approach, only one study using a multimodal approach demonstrated promising improvements in memory, attention, and executive functions, which also correlated with functional magnetic resonance imaging (MRI) blood oxygenation level dependent (BOLD) changes in cerebral activation in 50 MCI patients.

OBJECTIVE

To investigate the self-perception and anticipated efficacy of each element of the BRAIN-FIT multimodal intervention program (robotic-assisted gait training (RAGT), computerized cognitive therapy, music, light, transcranial direct current stimulation (tDCS), and diaphragmatic breathing exercises) and the correlation between memory, concentration, depression, and sleep in older adults with MCI.

METHODS

One hundred participants (mean±standard deviation: 8.63±78.4 years; 47 women) with MCI were recruited from a major university medical center and community dementia relief center. The survey questionnaire comprised four domains with 21 questions, including four pertaining to general demographic characteristics, eight related to exercise and activity, three related to sleep, and nine related to the BRAIN-FIT program. Chi-squared test was used to analyze the Likert scale data. The descriptive frequencies were calculated. Additionally, Spearman's rho statistics measure the rank-order association. The statistical significance was at P <  0.05.

RESULTS

A strong correlation was observed between memory and concentration (r = 0.850, P = 0.000), memory and depression (r = 0.540, P = 0.000), memory and sleep (r = 0.502, P = 0.000), concentration and depression (r = 0.602, P = 0.000), concentration and sleep (r = 0.529, P = 0.000) and sleep and depression (r = 0.497, P = 0.000). The correlation between medical services and sleep (r = 0.249, P = 0.012) was moderate. The chi-square test revealed a significant difference in memory and low-intensity duration of exercise (χ2[3,N = 100] = 11.69, P = 0.01), concentration and high-intensity exercise duration (χ2[3,N = 100] = 10.08, P = 0.02), concentration with low-intensity exercise duration (χ2[3,N = 100] = 21.11, P = 0.00), depression with high-intensity (χ2[3,N = 100] = 10.36, P = 0.02), high-intensity duration of exercise (χ2[3,N = 100] = 10.48, P = 0.02); low-intensity (χ2[3,N = 100] = 7.90, P = 0.48), and low-intensity duration of exercise (χ2[3,N = 100] = 9.69, P = 0.02). Additionally, significant differences were observed between sleep and high-intensity (χ2[3, N = 100] = 10.36, P = 0.02), low-intensity (χ2[3, N = 100] = 18.14, P = 0.00), and low-intensity duration of exercise (χ2[3, N = 100] = 18.30, P = 0.00). Among the participants 5% answered RAGT, and 20% responded that they had experienced computerized cognitive therapy. Music therapy (20 %), diaphragmatic breathing exercises (45 %), and light therapy (10 %) were used. No patient had experienced tDCS. Conversely, 11% of the participants answered RAGT for programs they wanted to experience and 21% responded to computerized cognitive therapy. 25% of music therapy, 22% of diaphragmatic breathing exercises, 5% of light therapy, and 16% of tDCS participants said they wanted to experience it. Finally, 63% of the participants wanted to participate in the BRAIN-FIT program.

CONCLUSION

The present study's results provide clinical evidence-based insights into the utilization of BRAIN-FIT in MCI to maximize cognitive score improvement of memory, concentration, depression, and sleep. Therefore, when designing the BRAIN-FIT, six intervention items were set in proportion to the preference based on the survey, to reduce participants' feeling of repulsion. The program was configured according to exercise intensity.

The Effects of Light Therapy on Sleep, Agitation and Depression in People With Dementia: A Systematic Review and Meta-analysis of Randomized Controlled Trials

OBJECTIVE

To evaluate the effects of light therapy on the alleviation of sleep disturbances, agitation and depression in people with dementia.

METHODS

A search was performed in PubMed, Medline, SCOPUS, Web of Science, EMBASE, CINAHL, Cochrane Library, for studies published between 2000 and 2021.

RESULTS

A total of 4315 articles were screened. Sixteen articles were eligible for this review and 11 randomized controlled studies were included in the meta-analysis. Light therapy had a significant effect on reducing the number of awakenings in sleep (n = 4; 95% CI = -.56, -.05; I2 = 0%; SMD = -.31) but was not significant in reducing the wake after sleep onset (n = 3; 95% CI = -.14, .59; I2 = 0%; SMD = .23), agitation (n = 4; 95% CI = -1.02, .45; I2 = 87%; SMD = -.28) and depression (n = 6; 95% CI = -.80, .40, I2 = 85%; SMD = -.20).

CONCLUSION

Light therapy appeared to be more effective in terms of alleviating sleep disturbances, rather than reducing agitation and depression, but its long-term effects remain unclear.

Light, sleep-wake rhythm, and behavioural and psychological symptoms of dementia in care home patients: Revisiting the sundowning syndrome

OBJECTIVES

It is believed that inadequate environmental light, especially in facilities such as care homes, contribute to the diurnal changes of behavioural and psychological symptoms of dementia (BPSD) historically referred to as "sundowning syndrome". Conceptual models of sundowning phenomena have shifted emphasis from the role of light in vision (image forming) to its role in circadian rhythm modulation. However, the grounds for this change are unclear and the evidence on which it is based has not been examined comprehensively.

METHODS

We have searched literature on sundowning syndrome and its association with light and studies evaluating BPSD, behavioural rhythm and environmental light in care homes in four databases (PubMed, Web of Science, Embase and Cochrane Library) from inception to 31 January 2021.

RESULTS

Of the nine studies investigating light, behavioural rhythm and BPSD in care homes identified, we found evidence that insufficient natural light exposure was associated with worsening of BPSD and disrupted activity rhythm but it was not clear whether this related to image forming or disrupted circadian rhythm. There was a paucity of evidence in relation to the role of low levels of light for image forming in the context of a specific BPSD symptom: visual hallucinations. We also found literature on the possible role of light outside the visible spectrum influencing cognition. Based on the evidence, we proposed a new model integrating different components of light in BPSD and sundowning syndrome that combines its image forming and circadian roles.

CONCLUSIONS

Inadequate light may be a risk factor for BPSD and sundowning syndrome for dementia patients through a range of different mechanisms. It is recommended that multiple neuro-endocrinological and socio-environmental factors relevant to light such as adjusting the environmental setting, increasing light exposure, and scheduling activities should be considered when treating dementia patients with BPSD.

Non-Pharmacological Treatments of Neuropsychiatric Symptoms in Mild Cognitive Impairment (MCI)

Mild cognitive impairment (MCI) is a syndrome defined by objective cognitive deficits that do not impact functional independence. Individuals with MCI develop dementia at an annual rate of 10 to 15%. Neuropsychiatric symptoms (NPS) are common non-cognitive features of neurocognitive disorders and have a major impact on the wellbeing and quality of life of affected individuals and their families. Non-pharmacological interventions for NPS are considered the first-line treatment because of the limited efficacy and side-effect potential of current pharmacological agents. This article summarizes the literature on non-pharmacological treatments for NPS in MCI. The limited number of studies specific to individuals with MCI and its various etiologies, as well as the overall heterogeneity of research design and methodologies, make the evidence base inconclusive. Nevertheless, some studies support psychosocial interventions aimed at individuals with MCI and their caregivers.

Pilot Study of the Effects of Bright Ambient Therapy on Dementia Symptoms and Cognitive Function

Light therapy potentially improves dementia symptoms. In this study, we examined the effects of bright light therapy on neuropsychiatric behaviors and cognitive function. Thirty-five participants were assigned to either the experimental or comparison group. The experimental group was exposed to bright light at 2,500 lux, and the comparison group was exposed to 114–307 lux. The instruments used were the Neuropsychiatric Inventory and the Mini-Mental State Examination. The experimental group showed a significant improvement in Neuropsychiatric Inventory scores; these scores, which were calculated using generalized estimating equations with medication (benzodiazepines) as a covariate, were reduced by 65% (P < 0.001) and 78% (P = 0.001) by the 5th and 9th weeks, respectively. At the same time, Mini-Mental State Examination scores increased by 19% (P = 0.007) and 28% (P = 0.04), respectively. However, differences in outcomes between the 5th and 9th weeks were not significant. A 4-week regimen of bright light therapy was the most effective, with higher adherence and acceptability.

Ambient bright lighting in the morning improves sleep disturbances of older adults with dementia

BACKGROUND

Ambient light therapies are potentially effective in improving sleep disturbances and circadian rhythms. This study created a new lighting intervention model for elderly patients with dementia. It is hypothesized that exposure to bright ambient light in the morning is more effective than general lighting in improving sleep disturbances and circadian rhythms.

METHODS

A single-blind longitudinal-group experimental design was employed. The dementia participants came from the community and nursing homes. Those in the experimental group were exposed to ambient light at 2500 lux, and those in the comparison group were exposed to 114-307 lux. The corresponding sleep disturbances and circadian rhythms were determined using an accelerometer (XA-5). A longitudinal experimental design was adopted to observe the time to an effective response.

RESULTS

The covariates of benzodiazepine use and total activity during the day were analyzed using generalized estimating equations. The experimental group showed significant sleep efficiency improvement, with mean increases of 41.9% (P < 0.001) and 31.7% (P = 0.002), sleep time increases of 141 min (P = 0.001) and 135 min (P = 0.008), awakening time decreases of 116 min (P = 0.001) and 108 min (P = 0.002), and sleep onset advancements of 60-84 min/sleep offset delays of 57-79 min upon the fifth and ninth week, respectively. A 4-week bright ambient light intervention was the most effective.

CONCLUSIONS

This study found that bright ambient light in the morning is beneficial for improving sleep disturbances and was driven by stabilizing circadian rhythms.

The effects of bright light treatment on affective symptoms in people with dementia: a 24-week cluster randomized controlled trial

BACKGROUND

The majority of people with dementia have behavioral and psychological symptoms of dementia (BPSD), including depression, anxiety and agitation. These may be elicited or aggravated by disrupted circadian rhythms. Bright light treatment (BLT) is a promising non-pharmacological approach to the management of BPSD, but previous research has yielded mixed results.

METHODS

Eight nursing home dementia units (1 unit = 1 cluster) with 78 patients were invited to participate in a cluster randomized controlled trial from September 2017 to April 2018 investigating the effects of BLT on sleep and circadian rhythms (primary outcome) and BPSD (secondary outcome). Ceiling mounted LED-panels were installed in the intervention group (four units), providing light at 1000 lx and 6000 K (vertically at 1.2 m) between 10 a.m. and 3 p.m., with lower values in the mornings and evenings. Standard indoor light was used in the control group (four units). BPSD were assessed with The Cornell Scale for Depression in Dementia (CSDD) and the Neuropsychiatric Inventory Nursing Home Version (NPI-NH). Data collection took place at baseline and after 8, 16 and 24 weeks. Multilevel regression models with and without false discovery rate correction were used for the analysis, with baseline values and dementia stage entered as covariates.

RESULTS

Sixty-nine patients were included in the study at baseline. Compared to the control group, the intervention group had a larger reduction on the composite scores of both the CSDD (95% CI = - 6.0 - - 0.3) and the NPI-NH (95% CI = - 2.2 - - 0.1), as well as on the NPI-NH Affect sub-syndrome, and the CSDD Mood related signs sub-scale at follow-up after 16 weeks. With FDR correction, the group difference was significant on the CSDD Mood related signs sub-scale (95% CI = - 2.7 - - 0.8) and the NPI-NH Affect sub-syndrome (95% CI = - 1.6 - - 0.2). No differences were found between conditions at weeks 8 or 24.

CONCLUSION

Compared to the control condition, affective symptoms were reduced after 16 weeks in the group receiving BLT, suggesting BLT may be beneficial for nursing home patients with dementia.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT03357328 . Retrospectively registered on November 29, 2017.

Ambient bright light treatment improved proxy-rated sleep but not sleep measured by actigraphy in nursing home patients with dementia: a placebo-controlled randomised trial

BACKGROUND

Up to 70% of nursing home patients with dementia suffer from sleep problems. Light is the main zeitgeber to the circadian system and thus has a fundamental impact on sleep-wake behaviour. Low indoor light levels in nursing homes have been reported, and in combination with age-related reductions in light sensitivity, insufficient light exposure is likely to contribute to sleep problems in this population. Increasing daytime light exposure using bright light treatment (BLT) may represent a feasible non-pharmacological treatment for sleep problems in nursing home patients with dementia.

METHODS

The present study reports on sleep outcomes, which are the primary outcomes of the DEM.LIGHT trial (Therapy Light Rooms for Nursing Home Patients with Dementia- Designing Diurnal Conditions for Improved Sleep, Mood and Behavioural Problems), a 24-week cluster-randomised placebo-controlled trial including 8 nursing home units and 69 resident patients. The intervention comprised ambient light of 1000 lx and 6000 K from 10:00 to 15:00, with gradually increasing and decreasing light levels prior to and following this interval, using ceiling mounted light-fixtures and light emitting diode technology. The placebo condition had continuous standard light levels (150-300 lx, ~ 3000 K). Sleep was assessed at baseline and follow-up at week 8, 16, and 24, using the proxy-rated Sleep Disorder Inventory (SDI) and actigraphy (Actiwatch II, Philips Respironics). Mixed linear models were used to evaluate intervention effects, adjusting for relevant covariates such as age, gender, number of drugs, severity of dementia, eye disease, and estimated light exposure.

RESULTS

Sleep as measured by the SDI was significantly improved in the intervention group compared to the control group from baseline to week 16 (B = - 0.06, 95% CI -0.11 - -0.01, p < .05) and from baseline to week 24 (B = - 0.05, 95% CI -0.10 - -0.01, p < .05). There was no effect according to the SDI at week 8 and no significant effects in terms of actigraphically measured sleep.

CONCLUSIONS

Proxy-rated sleep improved among nursing home patients with dementia following 16 and 24 weeks of BLT. These improvements were not corroborated by actigraphy recordings.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT03357328 . Registered 29 November 2017 - Retrospectively registered.

Light interventions and sleep, circadian, behavioral, and psychological disturbances in dementia: A systematic review of methods and outcomes

Dementia is a devastating disease with a global impact, and there is an urgent need for effective interventions to alleviate the accompanying disturbances in behavior, mood, sleep, and circadian rhythms. Bright light treatment (BLT) is a promising non-pharmacological intervention; however, studies have yielded conflicting results. This systematic review provides a comprehensive overview of the effect of BLT in dementia, with a specific focus on how study characteristics might have affected the available results. The included studies were small and comprised time-limited interventions and follow-ups. Light values, adherence to treatment, and time of year were not consistently reported. Varying designs, methods, and population characteristics such as age, gender, dementia diagnosis, circadian phase, and baseline symptoms may have moderated the outcomes and affected review results. The use of crossover designs and too high illumination as placebo lights might have nullified positive effects of BLT. Because some studies had negative outcomes after ambient BLT with high amounts of short wavelengths, more modest light levels should be further investigated. Employing rigorous designs and detailed reporting of intervention characteristics, i.e., the illumination, correlated color temperature, timing, and duration of light utilized, are of utmost importance to establish the optimal treatment approach in this population. Systematic review registration number: PROSPERO CRD42017051004.

Expert Consensus on the Care and Management of Patients with Cognitive Impairment in China

The cognitive disease consensus was prepared by panels of health and public representatives based on actual clinical practice in Geriatric Departments in Chinese hospitals and a systematic literature review. This consensus reflects the medical knowledge accumulated by those experts and provides information about professional medical care and advice. A multidisciplinary panel of specialists (neurologists, psychiatrists, and nursing specialists) reports an expert consensus on the medical knowledge accumulated from those experts and provides information about professional medical care and advice. The recommendations focus on the care and management of older adults with mild cognitive impairment, the objectives and methods of maintaining cognition and training, the assessments and measures of daily care for patients at different stages of dementia, the assessments and coping strategies for the behavioral and psychological symptoms of dementia, principles and suggestions for an appropriate living environment, arrangements for recreational activities, the care and management of patients with end-stage dementia, and suggestions for addressing stress in caregivers.

Non-pharmacological interventions for sleep and quality of life: a randomized pilot study

OBJECTIVE

to estimate the effects of non-pharmacological interventions to improve the quality of sleep and quality of life of patients with heart failure.

METHOD

pilot study of a randomized controlled trial with 32 individuals assigned to four groups. Sleep was assessed using the Pittsburgh Sleep Quality Inventory, while health-related quality of life was assessed using the Minnesota Living with Heart Failure Questionnaire, at the baseline and at the 12th and 24th weeks. The means of the outcomes according to intervention groups were compared using analysis of covariance; effect sizes were calculated per group.

RESULTS

all groups experienced improved quality of sleep and health-related quality of life at the end of the intervention (week 12) and at follow-up (week 24), though differences were not statistically significant (p between 0.22 and 0.40). The effects of the interventions at the 12th week ranged between -2.1 and -3.8 for the quality of sleep and between -0.8 and -1.7 for quality of life, with similar values at the 24th week.

CONCLUSION

the effects found in this study provide information for sample size calculations and statistical power for confirmatory studies. Brazilian Clinical Trials Registry - RBR 7jd2mm.

A systematic review of non-pharmacological interventions to improve nighttime sleep among residents of long-term care settings

Background

Disturbances in sleep and circadian rhythms are common among residents of long-term care facilities. In this systematic review, we aim to identify and evaluate the literature documenting the outcomes associated with non-pharmacological interventions to improve nighttime sleep among long-term care residents.

Methods

The Preferred Reporting Items for Systematic Reviews guided searches of five databases (MEDLINE, Embase, CINAHL, Scopus, and Cochrane Library) for articles reporting results of experimental or quasi-experimental studies conducted in long-term care settings (nursing homes, assisted-living facilities, or group homes) in which nighttime sleep was subjectively or objectively measured as a primary outcome. We categorized each intervention by its intended use and how it was administered.

Results

Of the 54 included studies evaluating the effects of 25 different non-pharmacological interventions, more than half employed a randomized controlled trial design (n = 30); the others used a pre-post design with (n = 11) or without (n = 13) a comparison group. The majority of randomized controlled trials were at low risk for most types of bias, and most other studies met the standard quality criteria. The interventions were categorized as environmental interventions (n = 14), complementary health practices (n = 12), social/physical stimulation (n = 11), clinical care practices (n = 3), or mind-body practices (n = 3). Although there was no clear pattern of positive findings, three interventions had the most promising results: increased daytime light exposure, nighttime use of melatonin, and acupressure.

Conclusions

Non-pharmacological interventions have the potential to improve sleep for residents of long-term care facilities. Further research is needed to better standardize such interventions and provide clear implementation guidelines using cost-effective practices.

Electronic supplementary material

The online version of this article (10.1186/s12877-018-0794-3) contains supplementary material, which is available to authorized users.