Effects of Pharmacologic and Nonpharmacologic Interventions for the Management of Sleep Problems in People With Fibromyalgia: Systematic Review and Network Meta-Analysis of Randomized Controlled Trials.

objectiveFibromyalgia is a chronic condition characterized by widespread musculoskeletal pain and fatigue. Almost everyone with fibromyalgia has sleep problems. We aimed to evaluate the effectiveness and safety of current interventions for the management of fibromyalgia-related sleep problems.

methodsMajor electronic databases were searched in November 2021. We focused on randomized controlled trials assessing pharmacologic and/or nonpharmacologic interventions in adults and children and identified 168 studies for inclusion. We assessed the methodologic quality of included studies using the Cochrane Risk-of-Bias tool. Our primary outcome of interest was sleep quality assessed using validated patient-reported outcome measures.

resultsResults from primary studies were analyzed using network meta-analyses (NMA). The NMA for sleep quality included 65 studies evaluating 35 treatment categories (8,247 participants). Most studies were at high overall risk of bias. Compared with placebo or sham treatments, there was some evidence that exercise (specifically land-based aerobic exercise training in combination with flexibility training [standardized mean difference (SMD) -4.69, 95% credible interval (Crl) -8.14 to -1.28] and aquatic-based aerobic exercise training [SMD -2.63, 95% Crl -4.74 to -0.58]) may improve sleep. There was also a suggestion that land-based strengthening exercise, psychological and behavioral therapy with a focus on sleep, electrotherapy, weight loss, dental splints, antipsychotics, and tricyclics may have a modest effect on sleep.

conclusionThere is a low level of certainty surrounding the effectiveness of interventions for the management of sleep problems in people with fibromyalgia, but some forms of exercise training appear more likely to provide an improvement in sleep quality.