Can music-assisted relaxation improve sleep quality among older people with sleep complaints?
Date of publication of the systematic review: July 2009
Design
Systematic review of 5 randomized controlled trials (RCTs).
Participants
308 participants with sleep complaints (mean age: 51 years). The reviewers did not report gender proportion of the participants.
Intervention
Music-assisted relaxation (MAR) with a duration of 20 and 46 minutes per sessions. The music must have been Intentionally applied for the promotion of sleep quality in a passive way. The follow-up time varied between two days to three weeks.
Comparator
Comparison 1: MAR (with or without additional relaxation measures) versus control that receive no intervention;
Comparison 2: MAR with additional relaxation measures versus control that receive no intervention;
Comparison 3: MAR without added relaxation measures versus control that receive no intervention.
Major Outcomes
Outcome 1: Post intervention sleep quality, with higher score indicating poor sleep quality.
Settings
Among the 5 included trials, three recruited patients in hospital settings while for the remaining studies were conducted in outpatient setting
Comparison    Music-assisted relaxation with or without additional relaxation measures versus no intervention
Main Results
Compared to no intervention, MAR with or without additional relaxation measures showed significant improvement on sleep quality (pooled standardized mean difference (pooled SMD): -0.74, 95% CI: -0.96 to -0.52).
Comparison 1: MAR with or without additional relaxation measures versus no intervention
Outcomes No. of studies (Total number of participants) Standardized mean/ No. of participants Heterogeneity test (I2) Pooled SMD (95% CI) Overall quality of evidence*
Intervention Comparator
1 5 (308) Not reported/ 170 Not reported/ 138 36% -0.74 (-0.96 to -0.52) Moderate
Keys: SMD = standardized mean difference; CI = confidence interval.
Comparison    Music-assisted relaxation with additional relaxation measures versus no intervention
Main Results
Compared to no intervention, MAR with additional relaxation measures showed significant improvement on sleep quality (pooled SMD: -0.68, 95% CI: -0.95 to -0.40).
Comparison 2: MAR with added relaxation measures versus control among participants with sleep complaints
Outcomes No. of studies (Total number of participants) Standardized mean/ No. of participants Heterogeneity test (I2) Pooled SMD (95% CI) Overall quality of evidence*
Intervention Comparator
1 4 (217) Not reported/ 109 Not reported/ 108 0% -0.68 (-0.95 to -0.40) Moderate
Keys: SMD = standardized mean difference; CI = confidence interval.
Comparison    Music-assisted relaxation (MAR) without additional relaxation measures versus no intervention
Main Results
Compared to no intervention, MAR without additional relaxation measures showed significant improvement on sleep quality (pooled SMD: -0.85, 95% CI: -1.22 to -0.49).
Comparison 3: MAR without added relaxation measures versus control among participants with sleep complaints
Outcomes No. of studies (Total number of participants) Standardized mean/ No. of participants Heterogeneity test (I2) Pooled SMD (95% CI) Overall quality of evidence*
Intervention Comparator
1 2 (123) Not reported/ 61 Not reported/ 62 80% -0.85 (-1.22 to -0.49) Low
Keys: SMD = standardized mean difference; CI = confidence interval.
Comparison    Music-assisted relaxation with or without additional relaxation measures versus no intervention
Main Results
Compared to no intervention, MAR with or without additional relaxation measures showed significant improvement on sleep quality (pooled standardized mean difference (pooled SMD): -0.74, 95% CI: -0.96 to -0.52).
Comparison 1: MAR with or without additional relaxation measures versus no intervention
Outcomes 1
No. of studies (Total number of participants) 5 (308)
Standardized mean/ No. of participants Intervention Not reported/ 170
Comparator Not reported/ 138
Pooled SMD (95% CI) -0.74 (-0.96 to -0.52)
Overall quality of evidence* Moderate
Keys: SMD = standardized mean difference; CI = confidence interval.
Comparison    Music-assisted relaxation with additional relaxation measures versus no intervention
Main Results
Compared to no intervention, MAR with additional relaxation measures showed significant improvement on sleep quality (pooled SMD: -0.68, 95% CI: -0.95 to -0.40).
Comparison 2: MAR with added relaxation measures versus control among participants with sleep complaints
Outcomes 1
No. of studies (Total number of participants) 4 (217)
Standardized mean/ No. of participants Intervention Not reported/ 109
Comparator Not reported/ 108
Pooled SMD (95% CI) -0.68 (-0.95 to -0.40)
Overall quality of evidence* Moderate
Keys: SMD = standardized mean difference; CI = confidence interval.
Comparison    Music-assisted relaxation (MAR) without additional relaxation measures versus no intervention
Main Results
Compared to no intervention, MAR without additional relaxation measures showed significant improvement on sleep quality (pooled SMD: -0.85, 95% CI: -1.22 to -0.49).
Comparison 3: MAR without added relaxation measures versus control among participants with sleep complaints
Outcomes 1
No. of studies (Total number of participants) 2 (123)
Standardized mean/ No. of participants Intervention Not reported/ 61
Comparator Not reported/ 62
Pooled SMD (95% CI) -0.85 (-1.22 to -0.49)
Overall quality of evidence* Low
Keys: SMD = standardized mean difference; CI = confidence interval.
Conclusion
Benefits
Compared to no intervention, MAR, with or without additional relaxation measures, was effective for improving sleep quality in patients with sleep complaints. For the outcome in comparisons 1 and 2, 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. For the outcome in comparison 3, the overall quality of evidence is low. Further research is likely to have an important impact on our confidence in this estimate of effect.
Harms
No adverse effects were reported in all included trials.
Link to Original Article
http://www.ncbi.nlm.nih.gov/pubmed/19456998
The synopsis is based on the following article:
de Niet G, Tiemens B, Lendemeijer B, Hutschemaekers G. Music-assisted relaxation to improve sleep quality: meta-analysis. J Adv Nurs. 2009 Jul;65(7):1356-64


* 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.