Effects of Pharmacological and Non-pharmacological Interventions for the Management of Sleep Problems in People with Fibromyalgia: Systematic Review and Network Meta-analysis of Randomised Controlled Trials

Clinical Context: Fibromyalgia is a chronic condition characterised by widespread musculoskeletal pain and fatigue. Almost everyone with fibromyalgia has sleep problems.

Objective: We aimed to evaluate the effectiveness and safety of current interventions for the management of fibromyalgia-related sleep problems.

Methods: Major electronic databases were searched in November 2021. We focused on randomised controlled trials assessing pharmacological and/or non-pharmacological interventions in adults and children and identified 168 studies for inclusion. We assessed the methodological 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.

Results: Results from primary studies were analysed using network meta-analyses (NMA). The NMA for sleep quality included 65 studies evaluating 35 treatment categories (8247 participants). Most studies were at high overall risk of bias. Compared to placebo or sham treatments, there was some evidence that exercise (specifically land-based aerobic exercise training in combination with flexibility training [SMD -4.69, 95%, 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 behavioural therapy with a focus on sleep, electrotherapy, weight loss, dental splints, antipsychotics, and tricyclics may have a modest effect on sleep.

Conclusions: There 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.