Effectiveness of Information and Communication Technology (ICT) Interventions in Elderly’s Sleep Disturbances: A Systematic Review and Meta-Analysis

Abstract

Sleep is a crucial factor for human health and is closely related to quality of life. Sleep disturbances constitute a health problem that should be solved, especially when it affects the elderly. This study aims to examine the effectiveness of information and communication technologies (ICT) interventions in managing sleep disturbances in the elderly. The study used a systematic review of three databases: Ovid-Medline, Ovid-EMBASE, and the Cochrane library database for papers published till 15 April 2021. Two authors independently selected and screened relevant studies based on predefined inclusion criteria. The meta-analysis of randomized controlled trials (RCTs) was carried out using Review Manager 5.4. Two authors independently screened the titles and abstracts of 4297 studies considering both inclusion and exclusion criteria. The complete texts of 47 articles were then evaluated, 31 articles were excluded, and finally, 16 articles were selected. Our meta-analysis showed that the cognitive-behavioral therapy for insomnia (CBT-I) group had a significantly reduced Insomnia Severity Index (ISI) compared to the control group (−4.81 [−5.56, −4.06], p < 0.00001, I2 = 83%) in RCTs, with a significant reduction in ISI (3.47 [1.58, 5.35], p = 0.0003) found in quasi-experimental studies. A significant improvement was found in total sleep time in the CBT-I group compared to the control group (29.24 [15.41, 43.07], p <0.0001) in RCTs, while the CBT-I group showed significantly reduced wake time after sleep onset compared to the control group (−20.50 [−26.60, −14.41], p < 0.00001). In addition, a significant reduction in depression was found in the CBT-I group compared to the control group (−2.11 [−2.85, −1.37], p < 0.00001, I2 = 0%) in RCTs. The quality of life–mental component score (5.75 [1.64, 9.87], p = 0.006, I2 = 0%) and the quality of life–physical component score (5.19 [0.76, 9.62], p = 0.02, I2 = 0%) showed significant improvement in the CBT-I group compared to the control group. ICT interventions showed positive effects on sleep disturbances of the elderly, specifically confirming the positive effect on depression and quality of life as well as the indicators directly related to sleep such as ISI and quality of sleep. Thus, the application of ICT in the healthcare sector will be greater in the future, with changes in the nursing education and practice guidelines so that nurses can play a pivotal role in promoting health behaviors such as sleep-related quality of life and daily activities of the elderly.

Information and Communication Technology-Based Application for Cognitive Behavioral Therapy among Community-Dwelling Older Adults with Insomnia: Development and Validation Study

“…Among the elements that constitute CBT for sleep disorders, the behavioral elements include stimulus control therapy, sleep restriction therapy, and muscle relaxation therapy for sleep disorder; furthermore, the cognitive elements are similar to CBT for depression. Sleep hygiene includes education on common sense and general behavioral principles about sleep [ 6 , 8 , 28 , 37 ].…”

“…The analysis considered 16 studies (10 RCTs, 5 quasi-experimental studies, and 1 retrospective study) using the RoB tool, revealing a low attrition risk and reporting bias. Most studies were from the US (10) and predominantly published in 2019 and 2020 [28].…”

“…One systematic review and meta-analysis investigated the effects of computer-based CBT (CCBT-I) on individuals older than 18 years and found that CCBT-I had a beneficial effect in the treatment of insomnia [ 27 ]. Another systematic review and meta-analysis confirmed that ICT intervention positively affected sleep disorders among older adults, depression, and quality of life, as well as indicators directly related to sleep, such as ISI and sleep quality [ 28 ].…”

Relevance of sleep for wellness: New trends in using artificial intelligence and machine learning

“…Information and communication technologies aided cognitive-behavioral therapy, Audiovisual Stimulation, Music Video Intervention, and Gight (Innovative Automated Guiding Light) has been used to treat insomnia. It improved sleep-related outcomes and other wellness metrics, such as depression, quality of life, and physical activity[ 22 ]. An initial literature proved the efficacy of therapy for sleep disorders through mobile apps.…”