Effect of Cervical Manual Therapy on Sleep Quality: A Scoping Review of Randomized Controlled Trials
Abstract
1. Background
2. Methods
2.1. Research Questions of Scoping Review
- Main question
- -
- What is the current status of RCTs utilizing CMT that include sleep quality-related outcome measures?
- Secondary questions
- -
- What CMT techniques have demonstrated improvements in sleep quality?
- -
- What are the characteristics of patient populations that showed or did not show improvement in sleep quality?
- -
- In what aspects does sleep quality improve (e.g., sleep latency, duration, or depth)?
- -
- Based on the above analyses, what directions should future research take to investigate the mechanisms underlying the effects of CMT on sleep quality?
2.2. Literature Search Strategy
2.3. Eligibility Criteria
2.4. Data Extraction
2.5. Data Analysis
3. Results
3.1. Characteristics of RCTs Meeting the Inclusion Criteria
3.2. Interventions and Outcome Measurements for Sleep Quality in RCTs
3.3. Effects on Sleep Quality in RCTs
3.4. Subscale Analysis
4. Discussion
4.1. Summary of Evidence
4.1.1. Overall Efficacy of CMT on Sleep Quality
4.1.2. Efficacy of CMT Across Conditions and Techniques
4.1.3. Effect on Sleep Depth, Efficiency, and Duration
4.2. Modulating 5-HTergic Activity
4.2.1. Potential Linkage Between 5-HT, Sleep and CMT
4.2.2. Pathologic Conditions of 5-HT Modulation and CMT
4.3. Regulation of the HPA Axis
4.3.1. Efficacy of CMT on HPA Axis and Sleep Architecture
4.3.2. Dysregulation of HPA Axis in FM
4.4. Limitation and Perspectives
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
List of Abbreviations
ANS | Autonomic nervous system |
CMT | Cervical manual therapy |
FM | Fibromyalgia |
HPA | Hypothalamic–pituitary–adrenal axis |
ME/CFS | Myalgic encephalomyelitis/chronic fatigue syndrome |
MET | Muscle energy technique |
MFT | Myofascial technique |
RCTs | Randomized controlled trials |
QoL | Quality of life |
SCI | Spinal cord injury |
STT | Soft tissue technique |
5-HT | 5-hydroxytryptamine |
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Items | Count |
---|---|
N. of RCT | 10 |
N. of participants (female) | 552 (383) |
Mean N. of participant (±SD) | 55.2 ± 30.1 |
Mean age (±SD) a | 49.6 ± 12.0 |
Condition of participants (N. of RCT, %) | 10 (100.0) |
Fibromyalgia | 4 (40.0) |
Chronic neck pain | 2 (20.0) |
Sleep bruxism | 2 (20.0) |
Obstructive sleep apnea | 1 (10.0) |
Post-cardiac surgery | 1 (10.0) |
Type of intervention (N. of RCTs, %) b | 10 (100.0) |
Soft tissue technique (STT) | 7 (70.0) |
Joint manipulation (JM) | 6 (60.0) |
Myofascial technique (MFT) | 6 (60.0) |
Muscle energy technique (MET) | 2 (20.0) |
Mean treatment time per session (minutes ± SD) | 51.9 ± 41.8 |
Mean N. of treatment time (±SD) | 11.6 ± 5.1 |
Mean treatment period (weeks ± SD) | 5.6 ± 3.9 |
Mean N. of measurements per RCT (±SD) | 6.2 ± 2.4 |
Measurement for sleep quality (N. of RCTs, %) b | |
Pittsburgh Sleep Quality Index (PSQI) | 9 (90.0) |
Epworth Sleepiness Scale (ESS) | 2 (20.0) |
Patient Reported Outcomes Measurement Information System (PROMIS-sleep disturbance subscale) | 1 (10.0) |
Polysomnography (PSG) | 1 (10.0) |
Disorder (Author, Year) | N. of Participants (Female, Mean Age) | Intervention (Control, Tx. Period) | Type of Tx. a | Finding (Statistical Significance) | |
---|---|---|---|---|---|
Subject Sleep Quality | Others | ||||
Primary Sleep Disorder | |||||
Obstructive sleep apnea (Paolucci, 2023) [21] | 52 (30, 61.0) | MFT d (myofunctional therapy, 4 weeks) | MFT | PSQI (total score): p < 0.01 ESS (total score): NS | snoring, SpO2: p < 0.05 AHI c, N. of apneas, ODI, heart rate: NS |
Sleep bruxism (Kadıoğlu, 2024) [22] | 30 (21, 18–25 b) | manual therapy (exercise, 8 weeks) | JM, MFT, STT | PSQI (total score) c: p < 0.01 | pain c, stress c, QoL c, bruxism symptom, trigger point: NS |
Sleep bruxism (Örenler, 2022) [23] | 29 (29, 28.4) | manual therapy (occlusal splint, 8 weeks) | JM, MFT | PSQI (total score): p < 0.05 | TMJ ROM, satisfaction: p < 0.05 pain, physical function: p < 0.01 |
Secondary Sleep Disorder | |||||
Chronic neck pain (Cholewicki, 2022) [24] | 87 (66, 42.1) | osteopathic manual therapy (wait-list, 4–6 weeks) | JM, MET, MFT, STT | PROMIS (sleep disturbance): p < 0.01 | pain c: p < 0.01 physical function c, fatigue, depression: p < 0.05 activity, work, social role, anxiety: NS |
Chronic neck pain (Hadamus, 2021) [25] | 40 (32, 63.5) | MET d (Swedish massage, 2 weeks) | MET | PSQI (total score) c: p < 0.01 | - |
Fibromyalgia (Ughreja, 2024) [26] | 66 (58, 37.3) | craniosacral therapy (sham Tx., 12 weeks) | JM, MFT, STT | PSQI (total score) c: p < 0.05 | PPT, FM symptom, physical function, fatigue, kinesiophobia, emotional distress: NS |
Fibromyalgia (Nadal-Nicolás, 2020) [27] | 24 (24, 53.0) | massage (placebo, 4 weeks) | STT | PSQI (total score) c: NS | pain c: p < 0.05 fatigue c, mood c: NS |
Fibromyalgia (Castro Sánchez, 2019) [28] | 64 (58, 47.1) | MFT (dry needling, 4 weeks) | MFT, STT | PSQI (total score): NS | trigger pont c, QoL, FM symptom, pain, anxiety, depression, fatigue: NS |
Fibromyalgia (Moustafa, 2015) [29] | 120 (52, 52.5) | manual therapy d (rehabilitative program 12 weeks) | JM | PSQI (total score): NS | spinal posture: p < 0.01 FM symptom c, pain, PPT, anxiety, depression: NS |
Post-cardiac surgery (Nerbass, 2010) [30] | 40 (13, 61.9) | massage (no Tx., 3 days) | JM, STT | Subscales of PSQI, ESS sleep effectiveness c: p < 0.05 total sleep time c, sleep disorder c: NS | fatigue, pain: NS |
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Kim, D.-Y.; Go, D.-H.; Kim, H.-J.; Lee, N.-W.; Lee, Y.J.; Lee, S.-H.; Ha, I.-H. Effect of Cervical Manual Therapy on Sleep Quality: A Scoping Review of Randomized Controlled Trials. Life 2025, 15, 1557. https://doi.org/10.3390/life15101557
Kim D-Y, Go D-H, Kim H-J, Lee N-W, Lee YJ, Lee S-H, Ha I-H. Effect of Cervical Manual Therapy on Sleep Quality: A Scoping Review of Randomized Controlled Trials. Life. 2025; 15(10):1557. https://doi.org/10.3390/life15101557
Chicago/Turabian StyleKim, Do-Young, Dong-Hyun Go, Hak-Jae Kim, Nam-Woo Lee, Yoon Jae Lee, Sook-Hyun Lee, and In-Hyuk Ha. 2025. "Effect of Cervical Manual Therapy on Sleep Quality: A Scoping Review of Randomized Controlled Trials" Life 15, no. 10: 1557. https://doi.org/10.3390/life15101557
APA StyleKim, D.-Y., Go, D.-H., Kim, H.-J., Lee, N.-W., Lee, Y. J., Lee, S.-H., & Ha, I.-H. (2025). Effect of Cervical Manual Therapy on Sleep Quality: A Scoping Review of Randomized Controlled Trials. Life, 15(10), 1557. https://doi.org/10.3390/life15101557