Abstract
Objective
Fibromyalgia 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.
Methods
Major 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.
Results
Results 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.
Conclusion
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.
Fibromyalgia 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.
Methods
Major 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.
Results
Results 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.
Conclusion
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.
| Original language | English |
|---|---|
| Number of pages | 11 |
| Journal | Arthritis Care & Research |
| Early online date | 26 Mar 2025 |
| DOIs | |
| Publication status | E-pub ahead of print - 26 Mar 2025 |
Bibliographical note
Open access via the Wiley agreementWe are grateful to the researchers, health professionals, and patient partners who were involved in the Advisory Group and specifically to Pamela Andrews, Scottish Medicines Consortium and National Cancer Medicines Advisory Group, Healthcare Improvement Scotland; Filip Bellon, Faculty of Nursing and Physiotherapy, Universitat de Lleida, Catalonia, Spain; Carolina Climent Sanz, Universitat de Lleida, Catalonia, Spain; Daniel Clauw, Professor of Anesthesiology Medicine (Rheumatology) and Psychiatry at the University of Michigan; Anna Durrans, Research Programme Manager, Versus Arthritis; Michael Prior, patient partner from Nottingham; Des Quinn, chair of Fibromyalgia Action UK; Neil W. Scott, Medical Statistics Team, Institute of Applied Health Sciences, University of Aberdeen; and David Walsh, Professor of Rheumatology at the University of Nottingham and Consultant Rheumatologist at Sherwood Forest Hospitals NHS Foundation Trust. We also thank Catriona Young, postgraduate student, University of Aberdeen, for her help in assessing a sample of full-text papers that were initially excluded because they did not report sleep outcomes in their title or abstract and Beverley Smith and Anne Buckle for their secretarial and administrative support.
Data Availability Statement
Supporting information:Additional supplementary information cited in this article can be found online in the Supporting Information section.
Funding
National Institute for Health and Care Research (GrantNumber(s): 132999; Grant recipient(s): Miriam Brazzelli)
| Funders | Funder number |
|---|---|
| National Institute for Health and Care Research | 132999 |