Insomnia among hospitalized inpatients: A systematic review and network meta-analysis
Abstract
Insomnia affects up to 50% of hospitalized patients and is strongly associated with longer hospital stays and higher mortality rates, especially among vulnerable individuals. Despite its prevalence, it's often overlooked in clinical practice and research. Our systematic review analyzed and compared pharmacological interventions for insomnia in hospitalized patients. We searched five major databases for randomized controlled trials published before January 2024. A total of 29 trials (1913 patients, mean age 58.4 ± 9.66) were finally included. Different drug classes were evaluated, including benzodiazepines, Z-drugs, melatonin receptor agonists, antidepressants, antihistamines, alpha-2 adrenergic agonists, and dietary supplements. We conducted a network meta-analysis on drugs' efficacy across subjective sleep quality, sleep latency, total sleep duration, and nocturnal awakenings. Notably, only a minority of studies focused on fragile populations, such as geriatric and critically ill patients. Results are also discussed according to potential moderating factors (i.e., gender, age, admission setting). Our review provides a framework for the pharmacologic treatment of insomnia disorder in inpatients. Differences in study methodologies limit the generalizability of findings, highlighting the urgent need for standardized research to fill existing gaps. We therefore propose a concise protocol to guide the design of future studies on this clinically important topic.
How strong is the evidence?
Evidence Hub reads this as a meta-analysis, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid. Reported size: 1,913 participants or records.
Read the paper
Related studies
- A Systematic Review and Network Meta-Analysis of Randomized Controlled Trials Evaluating the Evidence Base of Melatonin, Light Exposure, Exercise, and Complementary and Alternative Medicine for Patients with Insomnia Disorder
- Use of Melatonin and/on Ramelteon for the Treatment of Insomnia in Older Adults: A Systematic Review and Meta-Analysis
- Influence of evening light exposure on polysomnographically assessed night-time sleep: A systematic review with meta-analysis
- Use of melatonin in children and adolescents with idiopathic chronic insomnia: a systematic review, meta-analysis, and clinical recommendation
- Significant potential of melatonin therapy in Parkinson’s disease – a meta-analysis of randomized controlled trials
- Meta-Analysis: Melatonin for the Treatment of Primary Sleep Disorders
Go deeper in Evidence Hub
Evidence Hub adds a study data sheet (design, sample size, evidence level, key numbers), an AI summary and a chat grounded in the paper's text.