Systematic Review of the Prevalence, Predictors, and Treatment of Insomnia in Palliative Care

• Published in: American Journal of Hospice and Palliative Medicine Vol. 37; no. 11; pp. 957 - 969
• Main Authors: Nzwalo, Isa, Aboim, Maria Ana, Joaquim, Natércia, Marreiros, Ana, Nzwalo, Hipólito
• Format: Book Review Journal Article
• Language: English
• Published: Los Angeles, CA SAGE Publications 01-11-2020
• Subjects: Hospice and Palliative Care Nursing; Humans; Palliative Care; Prevalence; Quality of Life; Sleep Initiation and Maintenance Disorders - epidemiology; Sleep Initiation and Maintenance Disorders - therapy; end-of-life; cancer; hospice; advanced disease; palliative care; insomnia
• ISSN: 1049-9091; 1938-2715
• DOI: 10.1177/1049909120907021

Introduction:
The primary function of palliative care is to improve quality of life. The recognition and treatment of symptoms causing suffering is central to the achievement of this goal. Insomnia reduces quality of life of patients under palliative care. Knowledge about prevalence, associated factors, and treatment of insomnia in palliative care is scarce.
Methodology:
Literature review about the prevalence, predictors, and treatment options of insomnia in palliative care patients. Primary sources of investigation were identified and selected through Pubmed and Scopus databases. The research was complemented by reference search in identified articles and selected reviews. OpenGrey and Google Scholar were used for searching grey literature. Study quality analysis was based on the Newcastle-Ottawa Scale.
Results:
A total of 65 studies were included in the review. Most studies had acceptable /good quality. The prevalence of insomnia in the included studies ranged from 2.1% to 100%, with a median overall prevalence of 49.5%. Sociodemographic factors such as age; clinical characteristics such as functional status, disease stage, pain, and use of specific drugs, including opioids; psychological factors such as anxiety/depression; and spiritual factors such as feelings of well-being were identified as predictors. The treatment options identified were biological (pharmacological and nonpharmacological), psychological (visualization, relaxation), and spiritual (prayer).
Conclusions:
The systematic review showed that the prevalence of insomnia is high, with at least one in 3 patients affected in most studies. Insomnia’s risk factors and treatment in palliative care are both associated to physical, psychological, social, and spiritual factors, reflecting its true holistic nature.