Finding Sleep in Multimorbidity: A Systematic Review of Evidence on Effective Treatment Modalities for Insomnia in People Living with Multimorbidity.

Abstract

Background: Comorbid insomnia is a common presenting condition in medical clinics and primary care practice. This is often managed with pharmacotherapy with little success and higher healthcare costs. Despite the high prevalence of insomnia in people living with multimorbidity, its management remains challenging for primary care physicians as many of these patients have multiple symptoms, multiple comorbid conditions and are taking multiple medications. This study set out to systematically review the evidence on effective treatment modalities for comorbid insomnia with a view to determine what interventions ultimately translate to better therapeutic outcomes.

Methods: Published RCT studies were identified via medical and allied health online databases EMBASE, OVID, MEDLINE, CINAHL, Cochrane database and PubMed. Study selection and extraction was obtained from 32 randomised control trials were systematically extracted, collated and analysed. Those included were studies that examined the effects of interventions for comorbid insomnia in adults while studies without clear outcomes were excluded. The interventions included pharmacological and non- pharmacological methods while the outcome variables were subjective and objective sleep parameters.

Results: A total of 4,578 participants were reviewed (from 32 RCTs) with a mean age of 48.72 years. There was paucity of data from lowincome regions, especially Africa. In developed countries, pharmacotherapy, cognitive behavioural therapy (CBT-I) and herbal therapy were effective in treating comorbid insomnia with moderate to large effect sizes.

Conclusion: While pharmacotherapy and CBT-I have both been found to be efficacious in managing comorbid insomnia, we advocate for more research in low- and middle- income countries.