The effect of yoga on sleep quality and insomnia in women with sleep problems: a systematic review and meta-analysis

Wei-Li Wang, Kuang-Huei Chen, Ying-Chieh Pan, Szu-Nian Yang, Yuan-Yu Chan, Wei-Li Wang, Kuang-Huei Chen, Ying-Chieh Pan, Szu-Nian Yang, Yuan-Yu Chan

Abstract

Background: To examine the effectiveness and safety of yoga of women with sleep problems by performing a systematic review and meta-analysis.

Methods: Medline/PubMed, ClinicalKey, ScienceDirect, Embase, PsycINFO, and the Cochrane Library were searched throughout the month of June, 2019. Randomized controlled trials comparing yoga groups with control groups in women with sleep problems were included. Two reviewers independently evaluated risk of bias by using the risk of bias tool suggested by the Cochrane Collaboration for programming and conducting systematic reviews and meta-analyses. The main outcome measure was sleep quality or the severity of insomnia, which was measured using subjective instruments, such as the Pittsburgh Sleep Quality Index (PSQI), Insomnia Severity Index (ISI), or objective instruments such as polysomnography, actigraphy, and safety of the intervention. For each outcome, a standardized mean difference (SMD) and confidence intervals (CIs) of 95% were determined.

Results: Nineteen studies in this systematic review included 1832 participants. The meta-analysis of the combined data conducted according to Comprehensive Meta-Analysis showed a significant improvement in sleep (SMD = - 0.327, 95% CI = - 0.506 to - 0.148, P < 0.001). Meta-analyses revealed positive effects of yoga using PSQI scores in 16 randomized control trials (RCTs), compared with the control group in improving sleep quality among women using PSQI (SMD = - 0.54; 95% CI = - 0.89 to - 0.19; P = 0.003). However, three RCTs revealed no effects of yoga compared to the control group in reducing insomnia among women using ISI (SMD = - 0.13; 95% CI = - 0.74 to 0.48; P = 0.69). Seven RCTs revealed no evidence for effects of yoga compared with the control group in improving sleep quality for women with breast cancer using PSQI (SMD = - 0.15; 95% CI = - 0.31 to 0.01; P = 0.5). Four RCTs revealed no evidence for the effects of yoga compared with the control group in improving the sleep quality for peri/postmenopausal women using PSQI (SMD = - 0.31; 95% CI = - 0.95 to 0.33; P = 0.34). Yoga was not associated with any serious adverse events.

Discussion: This systematic review and meta-analysis demonstrated that yoga intervention in women can be beneficial when compared to non-active control conditions in term of managing sleep problems. The moderator analyses suggest that participants in the non-breast cancer subgroup and participants in the non-peri/postmenopausal subgroup were associated with greater benefits, with a direct correlation of total class time with quality of sleep among other related benefits.

Keywords: Complementary and alternative medicine; Insomnia; Meta-analysis; Review; Sleep quality; Women; Yoga.

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Flowchart of the results of the literature search
Fig. 2
Fig. 2
Risk of bias in individual studies. +, low risk of bias;?, unclear risk of bias; −, high risk of bias (a). Risk of bias for each criterion presented as percentages across all included studies (b)
Fig. 3
Fig. 3
Funnel plot of estimate of publication bias in meta-analysis of the effects of yoga on women’s sleep quality compared to control groups (PSQI). SE: standard error; SMD: standardized mean difference
Fig. 4
Fig. 4
Forest plots for the effects of yoga on sleep quality in women versus control groups. a the global score of the Pittsburgh Sleep Quality Index (PSQI) b the global score of the Insomnia Severity Index (ISI). CI, confidence interval; IV, inverse variance; SD, standard deviation
Fig. 5
Fig. 5
c Forest plots of the effects of yoga on the sleep quality of women with breast cancer (including women under treatment and women who had completed treatment) versus a control group using the global score of the Pittsburgh Sleep Quality Index (PSQI). CI, confidence interval; IV, inverse variance; SD, standard deviation
Fig. 6
Fig. 6
Forest plots displaying the effects of yoga versus control groups on sleep quality in peri/postmenopausal women in (d) the global score of the Pittsburgh Sleep Quality Index (PSQI) (e) the global score of Insomnia Severity Index (ISI). CI, confidence interval; IV, inverse variance; SD, standard deviation

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