Can mindful awareness practices improve sleep quality and reduce daytime impairment in older adults with moderate sleep disturbance?
Date of publication of the randomized controlled trial: April 2015
Design
Randomized controlled trial (RCT).
Participants
49 older adults (mean age: 66.3 years, male %: 33%) who are at least 55 years old, with active sleep disturbance and no smoking habit, substance dependence, depression, cognitive impairment, obesity, or current practice of meditation of any form.
Intervention
A weekly 2-hour, 6-session group based mindful awareness practices (MAPS) program.
Comparator
Comparison 1: MAPS versus sleep hygiene education.
Major Outcomes
Outcome 1: Moderate sleep disturbance measured by Pittsburgh Sleep Quality Index (PSQI). Higher scores indicated poor sleep quality;
Outcome 2: Insomnia symptoms measured by Athens Insomnia Scale. Higher scores indicated worse insomnia symptoms;
Outcome 3: Fatigue interference measured by Fatigue Symptom Inventory- Interference. Higher scores indicated worse fatigue interference;
Outcome 4: Fatigue severity measured by Fatigue Symptom Inventory- Severity. Higher scores indicated worse fatigue severity.
Settings
This trial was performed in an outpatient setting.
Comparison    MAPS versus sleep hygiene education
Main Results
MAPS group had shown significantly greater improvement on moderate sleep disturbance compared to sleep hygiene education group (mean difference (MD): 1.8, 95% CI: 0.6 to 2.9). MAPS group also resulted in significantly greater improvement on insomnia symptoms (MD: 1.6, 95% CI: 0.2 to 3.0), fatigue interference (MD: 10.5, 95% CI: 4.7 to 16.3) and fatigue severity (MD: 6.0, 95% CI: 3.7 to 8.2).
Comparison: MAPS versus sleep hygiene education among older adults with moderate sleep disturbance
Outcomes No. of studies (Total number of participants) Mean score (SD)/ No. of participants Heterogeneity test (I2) MD (95% CI) p value Overall quality of evidence*
Intervention Comparator
1 1 (49) 7.4 (1.9)/ 24 9.1 (2.0)/ 25 Not applicable as there is only 1 study. 1.8 (0.6 to 2.9) Not reported Moderate
2 1 (49) 9.1 (2.4)/ 24 10.7 (2.5)/ 25 Not applicable as there is only 1 study. 1.6 (0.2 to 3.0) Not reported Moderate
3 1 (49) 22.6 (9.9)/ 24 33.1 (10.4)/ 25 Not applicable as there is only 1 study. 10.5 (4.7 to 16.3) Not reported Moderate
4 1 (49) 13.6 (3.8)/ 24 19.5 (4.0)/ 25 Not applicable as there is only 1 study. 6.0 (3.7 to 8.2) Not reported Moderate
Keys: SD = standard deviation; CI = confidence interval; MD = mean difference.
Comparison    MAPS versus sleep hygiene education
Main Results
MAPS group had shown significantly greater improvement on moderate sleep disturbance compared to sleep hygiene education group (mean difference (MD): 1.8, 95% CI: 0.6 to 2.9). MAPS group also resulted in significantly greater improvement on insomnia symptoms (MD: 1.6, 95% CI: 0.2 to 3.0), fatigue interference (MD: 10.5, 95% CI: 4.7 to 16.3) and fatigue severity (MD: 6.0, 95% CI: 3.7 to 8.2).
Comparison: MAPS versus sleep hygiene education among older adults with moderate sleep disturbance
Outcomes 1 2 3 4
No. of studies (Total number of participants) 1 (49) 1 (49) 1 (49) 1 (49)
Mean score (SD)/ No. of participants Intervention 7.4 (1.9)/ 24 9.1 (2.4)/ 24 22.6 (9.9)/ 24 13.6 (3.8)/ 24
Comparator 9.1 (2.0)/ 25 10.7 (2.5)/ 25 33.1 (10.4)/ 25 19.5 (4.0)/ 25
MD (95% CI) 1.8 (0.6 to 2.9) 1.6 (0.2 to 3.0) 10.5 (4.7 to 16.3) 6.0 (3.7 to 8.2)
p value Not reported Not reported Not reported Not reported
Overall quality of evidence* Moderate Moderate Moderate Moderate
Keys: SD = standard deviation; CI = confidence interval; MD = mean difference.
Conclusion
Benefits
MAPS program had significant benefits on improving moderate sleep disturbance, insomnia symptoms, fatigue interference and fatigue severity compared to sleep hygiene education among older adults. For all outcome, the overall quality of evidence is moderate. Further research is fairly likely to have an important impact on our confidence in this estimate of effect.
Harms
No adverse events were reported.
Link to Original Article
https://www.ncbi.nlm.nih.gov/pubmed/25686304
The synopsis is based on the following article:
Black DS, O’Reilly GA, Olmstead R, Breen EC, Irwin MR. Mindfulness meditation and improvement in sleep quality and daytime impairment among older adults with sleep disturbances: a randomized clinical trial. JAMA Internal Medicine. 2015 Apr 1;175(4):494-501.


* Interpretation of quality assessment results:
• Very low: Further research is most likely to have an important impact on our confidence in this estimate of effect.
• Low: Further research is likely to have an important impact on our confidence in this estimate of effect.
• Moderate: Further research is fairly likely to have an important impact on our confidence in this estimate of effect.
• High: Further research is unlikely to have an important impact on our confidence in this estimate of effect.
• Very high: Further research is most unlikely to have an important impact on our confidence in this estimate of effect.

Details of assessment method can be found at Chung VC, Wu XY, Ziea ET, Ng BF, Wong SY, Wu JC. Assessing internal validity of clinical evidence on effectiveness of CHinese and integrative medicine: Proposed framework for a CHinese and Integrative Medicine Evidence RAting System (CHIMERAS). European Journal of Integrative Medicine. 2015 Aug 31;7(4):332-41.