Critical Appraisal Literature Review

Running head: CRITICAL APPRAISAL LITERATURE REVIEW
CRITICAL APPRAISAL LITERATURE REVIEW
Name of the Student:
Name of the University:
Author’s Note:

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What is the review purpose, objective or
questions?
The assessment aims to critically review and
appraises a selected article, ‘The effect of
non-pharmacological sleep interventions on
depression symptoms:
A meta-analysis of randomised controlled
trials’ that was published in Sleep Medicine
Reviews. A bimonthly peer-review medical
journal particularly focuses on the aspect of
diagnosis and therapy of sleep-related
disorder or disturbance
(Journals.elsevier.com, 2020). The impact
factor of the journal is 10.517 that states that
the review was taken from an influential
journal.
Was there a published protocol for this
review? If yes-please provide the references
As per the study, the evaluation was
conducted as per the accordance with the
direction of the desired reporting factors
used for systematic reviews as well as meta-
analyses (PRISMA) statement. This
protocol was registered with the
PROSPERO registry (Gee et al., 2019).
What are the inclusion criteria for this
review?
The inclusion criteria of the systematic
review were it is published in a reputed
journal; the topic is related to depression
and sleeping intervention and needs to be

3CRITICAL APPRAISAL LITERATURE REVIEW
recent. Therefore, this article was chosen as
it was published in 2018 and the aim of the
review is to study the influence of sleep
intervention that do not include
pharmacological elements on depression
with the help of randomised controlled
trials.
What types of studies were included? The use of meta-analysis with the help of
randomised controlled trials were used in
this study.
What database/search engines were
searched?
The four electronic databases that have been
used in searching were PsycINFO,
CINAHL, Medline and Central from the
time of inception to 2018 in the month of
May.
Were the search terms suitable for the
purpose of this review?
The search terms used were sleep, insomnia,
sleep treatment, sleep disorder and
intervention, treatment, therapy, help,
hygiene, support or education and
depression or mood. The language was
English and hand search was done.
What search limits were applied? There was no search limit.
Does the PRISMA flowchart adequately
described how articles were identified,
screened, assessed for eligibility, appraised
The PRISMA flowchart was adequately
used that stated the way articles were
identified, screened, assessed, assessed and

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and selected for inclusion in the review? designated for the presence in the article
(Sokouti & Sokouti, 2018).
What critical appraisal instrument(s)
was/were used to determine methodological
quality of the article? Were these
instruments appropriate?
The included studies were selected by two
reviewers and cross-checked for accuracy.
Various characteristics were taken into
consideration for customising the data and
in case of insufficient data were found, the
author was contacted. The quality was
assessed using the Cochrane collaboration
risk of bias tool. In the case of excluding the
studies, insufficient data was stated to be the
only reason for rejecting them; however,
due to the large number, it was listed or
given individual reason for the rejection. It
was reported that due to quality reasons,
1985 studies were rejected. After the
reviewing session, a selection of 49 articles
were selected for conducting the meta-
analysis. According to Xu et al., (2017),
Review Manager Version 5.3 was applied
for conducting the critical analysis of the
paper where standardised in term of mean
differences of depression scores and
confidence intervals were estimated to be
95% for each study. A random-effects

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model was opted, and the use of statistical
heterogeneity using the I2 and Chi2 was
assessed. In addition to this, publication bias
was evaluated through visual inspection and
construction of the funnel plot that leads to
calculation Rosenthal’s failsafe N.
Furthermore, the use of posthoc subgroup
analysis was used for conducting the
investigation of the effect of depression on
the effect size of the study (Muysers et al.,
2020). For assessing the consequence of the
intervention on the signs and symptoms
exhibited by depression, a random-effects
meta-regression was carried on the
subjective sleep quality.
Are the included studies summarised
adequately?
From the introduction section, it can be
stated that reviewed studies adequately were
critique; thus, allowing the audience to
grasp a background study and gaining
knowledge related to the study topic, the
impact of sleep interventions related to
non-pharmacological on depression
symptoms. According to Mansano-
Schlosser and Ceolim (2017), it can be
stated that inadequate or deficient amounts

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of sleep can be considered to be a risk factor
for depression and thus, it is found to have a
contribution to maintenance and onset of the
disorder. However, issues related to
sleeping was not a direct focused for
involvement in this case. Thus, ranges of
non-pharmacological treatments are found
to be operative in minimising the problem
of sleeping (Holzinger et al., 2019).
However, it is unclear that the intervention
strategies are more holistic in limiting the
symptoms of depression. The critique of the
result was valid and adequate in nature as it
was divided into different sections that
highlighted the aspects of characteristics
considered for including studies, risk of
bias, and the meta-analysis section with
respect to the study. A table depicted that
summarized the articles chosen for meta-
analysis. In the discussion section, the
overall results were stated that critically
aligned with the research objective. As per
the study, it was noted that from the meta-
analysis, it was found that sleep intervention
in relation to non-pharmacological aspects

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was useful in reducing the depression
symptoms. It stated the clinical implication
that is the utility of the outcome of clinical
practice; thus, providing a future direction
to it (Hirano, Pandolfino & Boeckxstaens,
2017). Moreover, it clearly stated the
limitations of the overall study that helped
in understanding the shortcomings of the
research both from the perspective of the
study as well as clinical implication thus,
assessing the analysis in an appropriate
manner. Cepeda-Carrion et al., (2017)
opined that the ability of research to
adequately transfer knowledge in a
systematic manner is critical in nature as it
suffices the utility in clinical application. In
this particular study, it was found that the
use of non-pharmacological intervention can
be effectively applied, which will help in
reducing the cost of treatment. However, it
can be stated that monitoring needs to be
done in case of intervention to maintain its
efficacy and effectiveness. On an overall
basis, it can be noted that certain limitations
affected the analysis. The diagnostic criteria

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included sleeping issues as a symptom;
however, this was accountable in a small
proportion of the total score; therefore, the
changes cannot be applied in the population.
The sample did not include important
studies that had reported there is an elevated
symptom of depression that limited the
scope to a certain extent. Another critical
aspect that was found to be limiting in this
study it was unable to access where the
treatment was offered before or after the
participation in the sleep intervention; thus,
the reports were inconsistent in nature,
leading to the disparity. Moreover, one more
aspect that needs to be highlighted in those
nine trials that were eligible in the inclusion
was not included due to insufficient data
(Gee et al., 2019). This affected the analysis
and outcome of the meta-study in a
significant way.
Are excluded studies listed with reason for
the exclusion?
No
How was the data abstracted and
synthesised?
The data was appropriately abstracted and
synthesised.
Is there adequate critique of the studies The major strengths of the article were it

9CRITICAL APPRAISAL LITERATURE REVIEW
reviewed, including discussion of the study
limitations?
aligned with the research objective
throughout the study and it does not deviate
from it anyway, it had critically reviewed
and assessed the data from all possible
perception using high-quality statistical
analysis tools that reported the outcome
along with the risk of bias incorporated in it.
Were the level of evidence reported in this
systematic review? What is your assessment
of the level of evidence included in this
review?
From the opinion of Gurevitch et al.,
(2018), meta-analysis belongs to the highest
level of evidence because it involves
systematic review that utilised a quantitative
method for assessing the result. Thus, an
evidence-based study filtered analysis for
conducting the analysis. In this particular
study, the use of meta-analysis of the
randomised controlled trials was done that
indicates that it belongs to the highest level
of evidence. For any study to be effective, it
is crucial to have an implication on the
practical world, in this case, in clinical
practice.
How should the information from this
systematic review be applied in clinical
practice?
From the critical review of the article, it can
be stated that the study used the highest
level of evidence in addressing the research

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topic; thus, reliability and validity factors
can be quantified. The study demonstrated
several strengths that can be leveraged on in
conducting further investigation to gain
more understanding on this topic; however,
some limitations were identified in this
article that paves the way for more in-depth
investigation of the research topic that will
help in understanding the clinical
implication of non-pharmacological
intervention of sleep on depression. It can
be concluded that the study in relation to the
mechanism of sleeping intervention needs to
be evaluated for mitigating the issue of
mental health.

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References
Cepeda-Carrion, I., Martelo-Landroguez, S., Leal-Rodríguez, A. L., & Leal-Millán, A.
(2017). Critical processes of knowledge management: An approach toward the
creation of customer value. European Research on Management and Business
Economics, 23(1), 1-7.doi: 10.1016/j.iedeen.2016.03.001
Gee, B., Orchard, F., Clarke, E., Joy, A., Clarke, T., & Reynolds, S. (2019). The effect of
non-pharmacological sleep interventions on depression symptoms: A meta-analysis of
randomised controlled trials. Sleep medicine reviews, 43, 118-128. Doi:
10.1016/j.smrv.2018.09.004
Gurevitch, J., Koricheva, J., Nakagawa, S., & Stewart, G. (2018). Meta-analysis and the
science of research synthesis. Nature, 555(7695), 175. Doi: 10.1038/nature25753
Hirano, I., Pandolfino, J. E., & Boeckxstaens, G. E. (2017). Functional lumen imaging probe
for the management of esophageal disorders: expert review from the clinical practice
updates committee of the AGA Institute. Clinical Gastroenterology and
Hepatology, 15(3), 325-334. Doi: 10.1016/j.cgh.2016.10.022
Holzinger, B., Mayer, L., Levec, K., Munzinger, M. M., & Klösch, G. (2019). Sleep
coaching: non-pharmacological treatment of non-restorative sleep in Austrian railway
shift workers. Archives of Industrial Hygiene and Toxicology, 70(3), 186-193. Doi:
10.2478/aiht-2019-70-3244
Journals.elsevier.com. (2020). Sleep Medicine Reviews. Retrieved 10 February 2020, from
https://www.journals.elsevier.com/sleep-medicine-reviews

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Mansano-Schlosser, T. C., & Ceolim, M. F. (2017). Association between poor clinical
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Muysers, C., Dmitrienko, A., Kulmann, H., Kirsch, B., Lippert, S., Schmelter, T., ... &
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1-12. Doi: 10.1007/s43441-019-00082-6
Sokouti, M., & Sokouti, B. (2018). A PRISMA-compliant systematic review and analysis on
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Doi: 10.1016/j.cosrev.2018.05.002
Xu, Z., Huang, F., Koesters, M., & Ruesch, N. (2017). Challenging mental health related
stigma in China: Systematic review and meta-analysis. II. Interventions among people
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