Clinical scientific journals have significant implications for medical practice. Medical practitioners may use the publications to administer a care procedure. This draws the need for critical appraisal of scientific journals to minimize errors and irrelevance. New scientific journals which propose new significant medical practices are published more frequently. In addition, the media and the ability to carry out online advertisement has increased the popularity of newly published scientific journals. This phenomenon can potentially cause significant implications to the quality, delivery, and cost of care, more so if the proposed changes do not conform with the studied data and the analysis findings of the publication. A well-evaluated study result does not guarantee its application in the areal medical situation since considering a study as a potential reference for medical practice requires the assessment of many frontiers in the clinical field.
Moreover, many of the published scientific journals do not evaluate the weaknesses of their respective study, making it the reader’s responsibility to identify and analyze the possible weaknesses of the study as a whole. Such a situation is time-consuming for a medical practitioner who searches for information and needs to verify the validity of the source. The medical practitioner has no time for systematic assessment of the methodological rigor and validity of the results. There are associations such which solve this problem by establishing a pre-assessment of scientific journals to establish a relevant distinction between relevant and irrelevant publications. This paper, however, focuses on the critical evaluation of a scientific journal that proposes sleeping deprivation(SD) as a cure for depression. The main objective of this journal was to establish a systematic assessment of previously published literature to identify the repercussions and safety of using sleep deprivation as a treatment for the treatment of bipolar and unipolar depression.
Critical Appraisal: Sleep deprivation as a treatment for depression
The journal Sleep deprivation as a treatment for depression was first published on 3rd November 2020. The study was based on systematic review and meta-analysis assessment procedures. The study’s main objective was to establish whether sleep deprivation can be used as a treatment procedure for depression. The research question for this paper focused on the side effects and safety of sleep deprivation therapy as a procedure for treating depression. The publication employed a systematic literature review concerning the PRISMA guidelines. Additionally, Randomised Controlled Trials(RCT) studies were utilized in the analysis process to minimize inaccuracy.
In some cases, however, qualitative studies were employed to evaluate patient experiences directly. Though some articles provided evidence on the potential application of sleep deprivation as a therapy procedure for depression, the procedures were only applicable in short-short term basis. According to the review findings, one week following the intervention, the results showed that Sleep deprivation combined with standard treatment did not reduce depressive symptoms. Additionally, there was no identifiable superiority of sleeping deprivation over antidepressants. However, the review elaborates that the results were different in some instances. For instance, the differences were significant in a post hoc analysis focusing on studies with elderly patients (p<0.001). There are uncertainties relating to the effectiveness of sleep deprivation as a standard treatment for depression. First, the effect of sleep deprivation on the overall quality of sleep is insufficiently explored. Moreover, there are uncertainties on SD implications on everyday functioning and quality of life.
Despite all these uncertainties, this report was published without any conflict of interest among the authors and without any discussion on the research limitations of the study. Some of the essential downsides of the study were ignored. Therefore careful analysis does not support the contention that Sleeping deprivation can be a beneficial medical procedure or that its benefits are more profound than the overall harms. This critical appraisal would mainly assess the validity of the study’s methodology and results.
What is the methodology of this study?
The clinical question investigated in Sleep deprivation as a treatment for depression systematic review and meta-analysis is clearly defined. The population of interest is clearly described as adults above 18 years suffering from depression, including bipolar depression. Intervention criteria are also described as sleeping deprivation therapy for at least one night under supervision. Additionally, the comparator and standard treatment are well illustrated. Regarding the reviews, comparator sleeping deprivation therapy should not be administered to patients without prior underlying treatments such as exercise and medication. Sleep deprivation therapy procedures were to be compared with other standard treatments, such as antidepressants. However, the studies utilizing electroconvulsive therapy (ECT) were excluded from the review. Also, the outcomes of fundamental interest such as suicide, symptoms of depression, and self-harm are well described. Other important outcomes such as the quality of sleep, impact cts on everyday functioning, and the health quality are considered in the review.
The types of papers utilized in this study addressed the clinical question. The main types of studies included; randomized controlled trials. The population under study is divided into two main groups, namely treatment, and control. The overall outcome of each group is evaluated independently were utilized in evaluating the intervention. Cohort studies were also used in the study. Chorley’s studies prove valuable for this review since they involve studying a single group of subjects at a single point in time.
Additionally, case series were also utilized in the review with at least 50 patients to analyze any complications. Qualitative studies were also incorporated as part of the review methodology design to provide information on patient experience with at least five patients. However, despite the critical choice of the reviewed studies, the findings were different across the studies. Some studies identified the superiority of Sleapig deprivation in comparison with other standard treatments, while other studies identified it to be insignificant.
Was the methodology valid?
The methodology of this review is considered valid because valid bibliographical sources were used to justify the results.Authors(KM nad IS ) systematically investigated library databases such as PubMed, EMBASE, PsycINFO, Cochrane, CINAHL, among other relevant academic databases. Additionally, reference lists of relevant articles were reviewed. Authors (KM and IS) utilized a detailed strategy to conduct literature searches in critically selected relevant articles. Besides, the respective authors, independent of each other, evaluated the relevance of the selected articles to establish inclusion and exclusion criteria. All the publications utilized in this review were recently published within a period of fewer than five years. Also, the study selection considered in this review incorporated publications published in the English language only.
This review’s authors also considered the rigor of the reviewed articles to assess their significant quality. Two authors, namely(MI and LS), each extracted information from reliable studies while another author(CW) evaluated the data extraction process. Additionally, all authors using a checklist evaluated the potential risk bias of the RCT studies. This checklist particularly assessed; performance bias, selection bias conflict of interest. They were reporting bias, attrition bias, and conflict of interest. However, Assessment of Social Services (SBU) tools were used to assess qualitative studies.
Additionally Grading of Recommendation Assessment, Development and Evaluation(GRADE) system(GRADE) was utilized to assess the certainty of the evidence extracted from literature reviews. The fundamental factors assessed included; The risk of bias such as randomization, dropouts, compliance, and intention-to-treat analysis. Consistency, including the magnitude across studies and the overlap of confidence, we’re also asked to evaluate the certainty of the evidence. In addition, the authors also evaluate the directness of the study, such as setting, control, and intervention of the study were also assessed. The Grade system is also utilized in precision evaluation by critically assessing the sample size.
What are the results?
The overall results were different across the studies. Following an essential critical analysis, the included studies were as follows; One cohort study and six RCT(n=215 patients) investigated Sleeping deprivation as an ad-on compared with standard treatment.SD compared with other treatments was examined in three RCT studies (n=148 patients). Additional seven case series were also included in the review to assist in complications assessment following SD therapy. Finally, a follow-up quantitative study provided additional data on patients’ experience during SD therapy sessions.
The results across all the studies were displayed. However, their consistency and validity are questionable. In a comparison between SD with other treatments, three RCT studies were examined with 148 patients. One study compared SD with light therapy utilizing exercise as a comparator, while the other two compared Sleeping deprivation with medication. Despite the presence of a minor risk of bias across these three studies, there are uncertainties on the directness of these studies. The sample size of one of these studies was limited, only focusing on elderly patients. In addition, the study compared with other treatments showed significantly limited duration.
However, in the investigation of Sleeping deprivation as an add-on compared to standard treatment, six RCT studies with 215 patients and a single cohort study were examined. Except for a single study, all these studies reported significant limitations in key study aspects, such as the risk of bias and directness of a study. All the studies had their Sleeping deprivation protocols, while others differed inpatient population like those focused on studies of elderly patients. Additionally, the results precision of the study is also limited mainly because two of the studies had a small sample size. However, in some instances, the results from different sources proved similar. For example, studies by Martiny et al. and Kundereman were identified in five publications, each focusing on different investigations.
The main reason for the significant difference in the results is the differences in the directness and preciseness of every study. The sample size and the study methodology is inconsistent across all studies. Every study also employed its analysis protocol contributing substantial uncertainties.
Are the results valid?
The overall results have significant limitations. All the publications utilized in the review had no clearly defined baseline and standard deviation, mainly because the analysis process focused on post-treatment assessment only. This is a less efficient method than the statistical analysis process employed in single studies. Moreover, there is significant inconsistency regarding the heterogeneity between the study protocols, their populations, and the outcome measures. Also, the limitation associated with utilizing the HDRS scale as the standard measurement for depression is considerable. The scale has been criticized for inaccuracy due to its ability to change in scale in situations where depression is lacking. Additionally, a significant number of studies showed no effect in one week following the beginning of the intervention.
Additionally, the precision of the results is also uncertain. Most of the studies present wide interval confidence and lower overall confidence. Forinsatncce, the meta-analysis of active depressants compared to HDRS placebo reported SMD of -0.35 to -0.3o with patients with mild depression symptoms. Besides, the results provide insufficient information on critical study outcomes such as quality of sleep, quality of life, everyday functioning, and the length of hospital stay. The results suggest more in-depth studies regarding sleeping deprivation as a treatment measure for depression.
Relevance of this review in the United States.
According to this review, Sleeping deprivation therapy is only applicable in a limited population, mainly the elderly suffering mild depression. In this context, this study applies developed countries such as the US with a relatively high elder population. Additionally, the review outcomes show no significant outcomes such as mortality through suicide. HDRS reports’ reviews also conform with the American food and Drug Administration(FDA) requirements. The FDA recommends an average test. Difference between two points as the minimal difference in clinical. Therefore Sleeping deprivation can be potentially administered to a critically selected population in the United States.
Moreover, the clinical risks of SD are also insignificant. The only identifiable substantial risk across all the studies in the review was the switch to mania which was reported in an average of 5.5% of the studies utilized in the review. However, this observation is limited since the switch mania effect is common during treatments of bipolar disorders. It may occur sententiously or can be triggered by stress. As Benedetti elaborates, “Evenantidepresants can cause a rise of 15-40% switch mania during treatments”.The switch mania effect is also dependent on the study design, the age of the population under study, and the types of depressants used in conducting tests. All these prove the limitations of switch mania as a contradicting factor for applying Sleeping deprivation in the united states.
However, there are limitations concerning sleeping deprivation therapy as a treatment measure for bipolar depression.SD must be applied with another treatment procedure since it is inferior on its own. Before applying SD therapy, well-structured underlying treatments such as exercises must be practiced to facilitate its effectiveness.
Qualitative and Quantitative study
Both qualitative and quantitative approaches are analysis tools used in evaluating investigation findings. In research work, both approaches can be utilized simultaneously or independently, depending on the nature and the scope of the study. However, there are major significant differences associated with qualitative and quantitative analysis. Some of the fundamental differences relate to the objectives and the methodological design. Quantitative studies majorly advocate for numerical results obtained through reliable experiments. This study approach, On the other hand, qualitative studies are more focused on the quality of the information despite the means of acquisition; The study can be obtained in words or writings. Qualitative study is mainly used in understanding concepts and t gain more experiences or a third party. This type of research approach is used to gather more insights into concepts that are not well understood.
Additionally, the methodological approaches of both quantitative and quantitative studies are widely different. Some of the common quantitative methods include experiments that involve manipulating variables to establish a relevant cause-and-effect relationship. Another commonly applicable methodology in quantitative research is observation, where variables are practically counted in a natural environment. This methodology is primarily applicable in an environment where the variables cannot be controlled. The survey is also another fundamental methodology in a quantitative study. It involves questionnaires of critically chosen questions with direct and simple answers. They are often distributed online or in person.
In contrast, the common methodologies in a qualitative study include interviews, Ethnography, literature review, and focused group. The interview is the most frequently used qualitative study methodology, and it involves asking a sample of respondents open-ended questions verbally. On the other hand, Ey for ethnography involves an individual’s participation in a community for an extended period, mainly studying foreign culture. However, literature review involves the assessment of published work by other authors. Lastly, a focused group is a qualitative study methodology that involves discussion to brainstorm about the opinions relevant to the research.
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