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Grant MD, Marbella A, Wang AT, et al. Menopausal Symptoms: Comparative Effectiveness of Therapies [Internet]. Rockville (MD): Agency for Healthcare Research and Quality (US); 2015 Mar. (Comparative Effectiveness Reviews, No. 147.)

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Menopausal Symptoms: Comparative Effectiveness of Therapies [Internet].

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Appendix KSleep Disturbance Plots

Figure K-1 is a forest plot for the pairwise comparison of standard dose estrogens compared with placebo (N=14 trials) on sleep dysfunction, Key Question 1. Eleven of the trials showed statistically significant improvements in sleep, while three of the 14 trials had 95 percent confidence intervals including zero. The pooled SMD is 0.24 (95% CI: 0.17 to 0.31).

Figure K-1

Sleep disturbance forest plot of pairwise comparisons—estrogen (standard dose) compared with placebo.

Figure K-2 is a forest plot for the pairwise comparison of low or ultralow dose estrogens compared with placebo (N=9 trials) on sleep dysfunction, Key Question 1. Six trials showed statistically significant improvements in sleep while three of the trials had 95 percent confidence intervals including zero. The pooled SMD is 0.46 (95% CI: 0.29 to 0.64).

Figure K-2

Sleep disturbance forest plot of pairwise comparisons—estrogen (low and ultralow dose) compared with placebo.

Figure K-3 is a forest plot for standard dose estrogens compared with low/ultralow dose estrogens (N=5 trials) on sleep dysfunction, Key Question 1. One trial showed standard dose estrogens significantly worse for sleep dysfunction and four trials showed no difference between standard and low/ultralow doses. The pooled SMD showed no difference between estrogen doses (SMD: -0.08; 95% CI: -0.16 to 0.01).

Figure K-3

Sleep disturbance forest plot of pairwise comparisons—standard and low/ultralow dose estrogen.

Figure K-4 is a forest plot for the pairwise comparison of SSRIs compared with placebo (N=2 trials) on sleep dysfunction, Key Question 1. One trial showed SSRIs significantly improved sleep dysfunction and one trial showed no difference compared with placebo. The pooled SMD is 0.46 (95% CI: 0.24 to 0.69).

Figure K-4

Sleep disturbance forest plot of pairwise comparisons—SSRIs compared with placebo.

Figure K-5 is a forest plot for the pairwise comparison of gabapentin compared with placebo (N=2 trials) on sleep dysfunction, Key Question 1. One large trial showed gabapentin significantly improving sleep dysfunction and one small trial showing no difference compared with placebo. The pooled SMD is 0.33 (95% CI: 0.18 to 0.49).

Figure K-5

Sleep disturbance forest plot of pairwise comparisons—gabapentin compared with placebo.

Figure K-6 is a forest plot for the pairwise comparison of isoflavones compared with placebo (N=6 trials) on sleep dysfunction, Key Question 1. Three trials showed isoflavones significantly improving sleep dysfunction and three trials showed no difference compared with placebo. The pooled SMD is 0.37 (95% CI: 0.10 to 0.64).

Figure K-6

Sleep disturbance forest plot of pairwise comparisons—isoflavones compared with placebo.

Figure K-B967 is a forest plot for the pairwise comparison of ginseng compared with placebo (N=2 trials) on sleep dysfunction, Key Question 1. Neither trial showed a difference compared with placebo. The pooled SMD is 0.13 (95% CI: -0.05 to 0.32).

Figure K-7

Sleep disturbance forest plot of pairwise comparisons—ginseng compared with placebo.

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