Treatments for enhancing sleep quality in fibromyalgia: a systematic review and meta-analysis.

OBJECTIVES: Sleep disturbance is a key symptom of fibromyalgia and a risk factor for chronic widespread pain. This systematic review and meta-analysis aims to assess the effectiveness of pharmacological treatments and cognitive behavioural therapy (CBT) in improving sleep quality in fibromyalgia patients. METHODS: A systematic search of PubMed, MEDLINE, Embase, Cochrane CENTRAL, and CINAHL was conducted for randomized controlled trials (RCTs) published up to April 2023. Studies assessing pharmacological or CBT interventions with sleep-related outcomes were included. Data were extracted, and meta-analyses were performed where applicable. Study quality and bias were evaluated using the Cochrane Risk of Bias tool. RESULTS: Forty-seven RCTs, including 11094 participants, were reviewed. CBT for insomnia (CBT-I) showed a significant improvement in sleep quality (SMD -0.63, 95%CI -0.98 to -0.27), while CBT for pain (CBT-P) had no significant impact. Pharmacological agents such as pregabalin and sodium oxybate moderately improved sleep, but there was uncertainty around this evidence. Amitriptyline, milnacipran, and duloxetine showed no significant benefit for sleep. Study heterogeneity was moderate, and no publication bias was detected. CONCLUSION: CBT-I is a promising treatment for enhancing sleep quality in fibromyalgia. Pharmacological treatments like pregabalin may be beneficial but should be used cautiously due to potential risks. Future research should prioritise trials focusing on sleep as a primary outcome and explore the comparative effectiveness of pharmacological treatments and CBT-I in fibromyalgia. Understanding the mechanisms linking sleep and fibromyalgia will also help guide future therapies.