Journal of Affective Disorders 288 (2021) 1–9

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Journal of Affective Disorders

journal homepage: www.elsevier.com/locate/jad

Review article

The Therapeutic Effect of Aromatherapy on Insomnia: a Meta-Analysis

Yueheng Tang, Minmin Gong, Xin Qin, Hao Su, Zhi Wang, Hui Dong *
Institute of Integrated Traditional Chinese and Western Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei
430030, China

A R T I C L E I N F O A B S T R A C T

Keywords: Background: : Insomnia is a more and more common sleep disorder, which affects health and quality of life.
Aromatherapy Aromatherapy is one of the effective treatments to improve sleep quality. This paper is to comprehensively
Insomnia evaluate the existing research on aromatherapy as a treatment of insomnia to verify its therapeutic effect.
Meta-analysis
Results: : 16 studies (19 comparisons) met inclusion and exclusion criteria were used for meta-analysis. The
Randomized controlled trials
results showed that aromatherapy had a significant effect on improving sleep quality (WMD: -2.52; 95% CI: -3.24
to -1.79). Subgroup analysis showed that different types of patients from different countries can improve their
sleep quality through aromatherapy. The inhalation group, rather than the massage group had an obvious
therapeutic effect, which may be due to the number of studies using massage included in our analysis is too
small. What’s more, different intervention duration does not seem to have a significant effect on the efficacy of
aromatherapy.
Conclusion: : Aromatherapy has a significant effect on improving sleep quality. It can be used as one of the non-
pharmacological treatments for insomnia, and relevant guide should be formulated to facilitate future clinical
applications.

1. Introduction Drug therapy, psychotherapy, physiotherapy, and cognitive-

Sleep is one of the indispensable needs of human beings and is
essential for maintaining physical and mental health(Moul et al., 2002).
Insomnia is a sleep disorder characterized by frequent and persistent
difficulties in falling asleep and/or maintaining sleep and leading to
dissatisfaction with sleep(Practice, 2017). According to epidemiological
studies, 45.4% of the respondents in China have experienced varying
degrees of insomnia in the past month, and 10% to 15% of adults meet
the diagnostic criteria for insomnia. The symptoms of nearly half of the
patients with severe insomnia can last for more than 10 years(Practice,
2017; Sleep Disorder Group, 2012). A large number of studies have
shown that insomnia seriously affects health and quality of life, and can
cause a variety of problems, including memory problems, depression,
irritability, cardiovascular and cerebrovascular diseases and so on
(Baglioni et al., 2011; Janson et al., 2001; Roane and Taylor, 2008).
Therefore, looking for effective ways to improve sleep quality has a
positive effect on individual health and social health.
behavioral therapy for insomnia (CBTI), are commonly used treat­
ments for insomnia currently(Lee and Lee, 2006). However, as the
number of insomnia patients increases rapidly, more feasible treatments
are needed for insomnia. Recently, more and more studies have found
that aromatherapy is one of the non-drug treatments to improve sleep
quality. Aromatherapy has a long history in China, and it has been used
to strengthen the body and treat diseases since ancient times. Aroma­
therapy works by inhaling, massaging, bathing and other ways to apply
aromatic extracts to the human body. Compared with drug therapy,
aromatherapy is more economical, simpler to use, and has fewer side
effects. It is widely used in relieving stress, improving sleep disorders,
and the treatment of depression, anxiety, etc. Nasiri Lari et al. found that
inhaled lavender can improve sleep quality and quantity, quality of life
and mood in diabetic patients suffering from insomnia. Lytle et al.
conducted a randomized controlled trial of 50 patients with insomnia in
an intermediate care unit and found that lavender aromatherapy may be
an effective way to improve sleep (The score of the Richard Campbell

Abbreviations: CBM, China Biomedical Literature Database; CBTI, Cognitive-behavioral therapy for insomnia; CI, Confidence Interval; CNKI, Chinese National
Knowledge Infrastructure; PSQI, Pittsburgh Sleep Quality Index; RCTs, Randomized Controlled Trials; VIP, Chinese Science and Technology Periodical Database;
WMD, Weighted Mean Difference.
* Corresponding author.
E-mail addresses: 597508414@qq.com (Y. Tang), 2415715957@qq.com (M. Gong), 1396806232@qq.com (X. Qin), 1030257410@qq.com (H. Su), 2410216693@
qq.com (Z. Wang), tjhdonghui@163.com (H. Dong).

https://doi.org/10.1016/j.jad.2021.03.066
Received 28 July 2020; Received in revised form 11 March 2021; Accepted 19 March 2021
Available online 26 March 2021
0165-0327/© 2021 Elsevier B.V. All rights reserved.
Y. Tang et al. Journal of Affective Disorders 288 (2021) 1–9

Sleep Questionnaire was higher in the intervention group (48.25) than (1) Patients: patients with insomnia, whether primary or secondary,
in the control group (40.10)).(Lytle et al., 2014; Nasiri et al., 2016; acute or chronic.
Nasiri Lari et al., 2020). (2) Intervention: aromatherapy.
There are many clinical studies on the use of aromatherapy in the (3) Control: no intervention or use of placebo.
treatment of insomnia. The results show that aromatherapy has a sig­ (4) Outcome measure: the Pittsburgh Sleep Quality Index (PSQI) was
nificant effect on improving sleep quality in different populations applied to evaluate the quality of sleep.
through different ways, but different studies are different in application (5) Study design: randomized controlled trials.
fields, types, duration, and so on, the quality of these studies is also
uneven. At present, there is no systematic comprehensive analysis of The exclusion criteria were:
randomized controlled trials (RCTs) investigating the efficacy of
aromatherapy in the treatment of insomnia. Therefore, this paper con­ (1) Aromatherapy combined with other treatments such as music
ducts a meta-analysis of the therapeutic effect of aromatherapy on therapy and acupuncture.
insomnia, in order to verify the therapeutic effect of aromatherapy on (2) Studies published in other languages rather than English.
insomnia and to provide guidance for the clinical use of aromatherapy in (3) Studies with incomplete or unavailable data.
the future. (4) University research papers, reports, observational studies, over­
lapping publications and studies related to animal experiments.
2. Methods
2.4. Data extraction and quality assessment
2.1. Study design
The literature data extraction and quality assessment were inde­
This meta-analysis analyzes the reported effects of aromatherapy as a pendently completed by two researchers, and the decision was assisted
treatment for insomnia. by a third party when there was a disagreement. The data collected
included the first author, year of publication, country, sample charac­
teristics, sample size, intervention measures, intervention style, dosage,
2.2. Literature search strategies
duration. The quality of the literature was evaluated by JADAD scale
(Moher et al., 1996), which was evaluated from four aspects: randomi­
Two researchers carried out the literature search process indepen­
zation, concealment of allocation, double blinding, withdrawals and
dently. The key parameters are as follows: The participants were adults
dropouts. The total score ranges from 0 to 7 points, of which 0 to 3 points
aged 18 years or older. The interventions consisting of all types of
representing low quality and 4 to 7 points representing high quality
aromatherapy (inhalation, massage, skin application, capsule prepara­
research.
tion, etc.). The comparisons included placebo or no intervention. And
the outcome measure was the Pittsburgh Sleep Quality Index (PSQI).
2.5. Statistical analysis
The databases searched included PubMed, Web of Science, ScienceDir­
ect, OVID, ClinicalKey, Chinese National Knowledge Infrastructure
All the analyses were performed using Stata software (version 15.1).
(CNKI), China Biomedical Literature Database (CBM), Wanfang Data
The results of an individual RCT were analyzed as continuous data, and
Resource System and Chinese Science and Technology Periodical
as there was no statistically significant differences between the inter­
Database (VIP). The search time is limited from inception till October
vention and control group in terms of the score of PSQI before the
2020. The words searched included as following: aromatherapy, essential
intervention in each study, the effect were calculated using the mean
oil, fragrance, insomnia, sleep disorder, sleep disturbance, the quality of
and standard deviation of the score of PSQI after intervention in the
sleep.
intervention group and the control group. The summary results of PSQI
The search strategy for PubMed was: (((("sleep initiation and main­
were calculated by weighted mean difference (WMD) and its 95% con­
tenance disorders"[MeSH Terms] OR ("sleep"[All Fields] AND "ini­
fidence interval (CI), using the random effects models. The heteroge­
tiation"[All Fields] AND "maintenance"[All Fields] AND "disorders"[All
neity of the included studies was calculated using the I2 and P values of
Fields]) OR "sleep initiation and maintenance disorders"[All Fields] OR
the Q test. I2 ≥ 50% or P <.10 was considered to have significant het­
"insomnia"[All Fields]) OR ("sleep wake disorders"[MeSH Terms] OR
erogeneity(Egger et al., 1997). A sensitivity analysis was performed on
("sleep"[All Fields] AND "wake"[All Fields] AND "disorders"[All Fields])
the PSQI to assess the impact of individual studies on the overall anal­
OR "sleep wake disorders"[All Fields] OR ("sleep"[All Fields] AND "dis­
ysis. Subgroup analyses were conducted based on the study region, ar­
order"[All Fields]) OR "sleep disorder"[All Fields])) OR ("sleep wake
omatic substance, style, dosage, duration, types of patients and Jadad
disorders"[MeSH Terms] OR ("sleep"[All Fields] AND "wake"[All Fields]
score to explore the potential heterogeneity among the included studies.
AND "disorders"[All Fields]) OR "sleep wake disorders"[All Fields] OR
The funnel plot and Begg test were used to assess the publication bias of
("sleep"[All Fields] AND "disturbance"[All Fields]) OR "sleep dis­
the included studies.
turbance"[All Fields])) OR (quality[All Fields] AND ("sleep"[MeSH
Terms] OR "sleep"[All Fields]))) AND ((("aromatherapy"[MeSH Terms]
3. Results
OR "aromatherapy"[All Fields]) OR ("oils, volatile"[MeSH Terms] OR
("oils"[All Fields] AND "volatile"[All Fields]) OR "volatile oils"[All
3.1. Literature search
Fields] OR ("essential"[All Fields] AND "oil"[All Fields]) OR "essential
oil"[All Fields])) OR ("odorants"[MeSH Terms] OR "odorants"[All Fields]
Two researchers searched electronic databases according to the
OR "fragrance"[All Fields])) AND Randomized Controlled Trial[ptyp] .A
search strategies independently, 417 articles were obtained through
similar strategy was applied to the Cochrane Library and Embase. These
preliminary search, 185 articles were excluded due to duplicates, 179
search terms were adapted and used in the Chinese databases with no
articles were excluded after reading titles and abstracts.
limitations.
After evaluating the full text of 53 articles, 37 of them were excluded
due to using other scales (n=28), not RCTs (n=6), overlapping publi­
2.3. Literature inclusion and exclusion criteria cations (n=1) and other reasons (n=2). 16 articles consisting of 19
comparisons were eventually included in this meta-analysis(Afshar
Based on the PICOS principle, the inclusion criteria of study pub­ et al., 2015; Chang et al., 2017; Cheraghbeigi et al., 2019; Effati-Daryani
lished in medical journals were as follows: et al., 2018; Genc et al., 2020; Haiyan et al., 2015; Hajibagheri et al.,

2
Y. Tang et al.
2014; Hamzeh et al., 2020; Heydarirad et al., 2019; Kao et al., 2017;
Karadag et al., 2017; Mirghafourvand et al., 2016; Nematolahi et al.,
2018; Ozkaraman et al., 2018; Rafii et al., 2020; Ya-bo et al., 2017). The
literature screening process and results are shown in Figure 1.
3.2. Study characteristics
This meta-analysis included 19 comparisons involving a total of 1346
insomnia patients. These studies were published between 2014 and
2020 (of which 18 (94.74%) occurred in the past five years), mainly in
Iran, China, Turkey. Each comparison included 30 to 158 patients (6
comparisons for adult individuals, 6 for cancer patients, 3 for cardiac
patients, 2 for postpartum women, and 2 for inpatients). The aromatic
substances used in these studies include lavender, rosemary, orange
peel, tea tree, peppermint, blended, and mixed essential oils. The
intervention duration ranges from 3 days to 8 weeks, with 15 compar­
isons using inhalation, 2 comparisons using massage, 1 using capsule,
and 1using skin application. The quality of the literature was evaluated
by the JADAD scale, where 2 comparisons scored 7 points, 3 compari­
sons scored 6 points, 3 comparisons scored 5 points, and 6 comparisons
scored 4 points. The specific characteristics of the literature are shown in
Table 1.
3.3. Meta-analysis
A total of 1346 patients were included in this study, consisting of the
intervention group (n=681) and the control group (n=665). Using the
fixed effects model analysis, it was found that there was significant
heterogeneity in the included studies (I2=90.6%, P<.00001), so the
random effects models was used for analysis. The total WMD showed
that the level of PSQI in the intervention group was significantly lower
than that in the control group (WMD: -2.52; 95% CI: -3.24 to -1.79,
Figure 2), which can be considered that the difference between the
intervention group and the control group is statistically significant, that
is, aromatherapy significantly improved sleep quality. Significant het­
erogeneity was observed in the included studies (I2 = 90.6%, P
<.00001). Moreover, a meta-analysis using Cohen’ d effect size was
performed as well, the result also showed that aromatherapy plays a role
in improving sleep quality (Supplementary Figure 1). Supplementary
Figure 2, which showed the results of the sensitivity analysis of the
included studies, indicated that the combined results remained stable
after excluding any trail.
Figure 1. Flow diagram of selection process of trials.
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Journal of Affective Disorders 288 (2021) 1–9
3.4. Subgroup analysis
Due to high heterogeneity between the studies, we conducted ana­
lyses of seven subgroups. The study region, aromatic substance, style,
duration, control group, types of patients and Jadad score were selected
for subgroup analysis. The analysis of the study region (Iran, China,
Turkey) showed that, there were significant differences in the three
subgroups, the heterogeneity in the China subgroup was slightly lower
than others, however, the difference in this subgroup was not as sig­
nificant as the other two subgroups (Supplementary Figure 3). The
subgroup analysis of intervention styles indicated that the therapeutic
effect in the intervention group was significantly better than that in the
control group when using inhalation. By contrast, the aromatherapy
showed no significant effect on insomnia in the massage group
(Figure 3). We also analyzed the subgroup of the duration, which
showed that there were obvious benefits in all three subgroups
(Figure 4). In the aromatic substance subgroup, less heterogeneity was
found in the 3 trials with rose subgroup, and each substance showed
powerful effect on insomnia (Figure 5). According to the subgroup of the
control group, no matter use placebo or no intervention, the interven­
tion groups all showed significant differences (Figure 6). What’s more,
the subgroup analysis of Jadad score demonstrated that there was low
heterogeneity in the low-quality subgroup (Jadad score <4) (Supple­
mentary Figure 4). In addition, we performed a subgroup analysis of the
different types of insomnia patients, the results showed that aroma­
therapy had an effect on every types of patients, among which it had
better effect on insomnia patients with cardiovascular disease or cancer.
It is interesting that there was no heterogeneity in inpatients subgroup.
(Supplementary Figure 5).
3.5. Publication bias
Supplementary Figure 6 showed the results of the published bias
analysis of this study using the Begg test in Stata 15.1, which indicated
that there was no publication bias of PSQI (p>0.462).
4. Discussion
A growing number of studies have shown that aromatherapy can be
used to improve sleep quality in patients with insomnia (Blackburn
et al., 2017; Chien et al., 2012; Cho et al., 2013). However, there is no
systematic comprehensive analysis of RCTs investigating the effective­
ness of aromatherapy in the treatment of insomnia. This paper evaluated
the therapeutic effect of aromatherapy for insomnia with PSQI as an
Y. Tang et al. Journal of Affective Disorders 288 (2021) 1–9

Table 1
The specific characteristics of the included studies.
Author Year Country Sample Sample Size Interventions Intervention Dosage Duration Jadad
Characteristics Intervention Control Intervention Group Control Style Score
Group Group Group

Afshar 2015 Iran postpartum 79 79 10% lavender placebo inhalation 4 drops 8w 4

women essential oil
Chang 2017 Taiwan, female nurses on 27 23 5ml of sweet none massage 5ml 4w 5
China monthly rotating almond oil
shifts combined with
100ul of sweet
marjoram essential
oil
Cheraghbeigi 2019 Iran cardiac patients 50 50 a mixture of sweet none massage 10- 7d 6
almond oil and 15ml
lavender oil
Effati-Daryani 2018 Iran pregnant women 46 45 lavender cream placebo skin 60g 8w 7
application
Fatma 2020 Turkey elderly 30 29 3% lavender none inhalation 2 drops 4w 4
individuals essential oil
Hajibagheri 2014 Iran cardiac patients 30 30 Rosa damascene none inhalation 3 drops 3d 3
essential oil
Hamzeh1 2020 Iran cancer patients 40 40 lavender essential placebo inhalation 3 drops 7d 5
oil
Hamzeh2 2020 Iran cancer patients 40 40 peppermint placebo inhalation 3 drops 7d 5
essential oil
Heydarirad 2019 Iran cancer patients 15 15 10% Rosa essential none inhalation 5 drops 2w 6
oil
Kao1 2017 Taiwan, career women 31 32 lavender essential placebo inhalation 5 drops 4w 3
China oil
Kao2 2017 Taiwan, career women 33 32 blended essential placebo inhalation 5 drops 4w 3
China oil
Karadag 2015 Turkey patients in 30 30 2% lavender none inhalation 2 drops 15d 4
Coronary essential oil
Intensive Care
Unit
Mirghafourvand 2016 Iran postpartum 48 48 orange peel placebo inhalation 10 8w 7
women essential oil drops
Nematolahi 2018 Iran university 34 34 rosemary capsules placebo capsule 500mg 4w 6
students
1
Ozkaraman 2018 Turkey cancer patients 30 20 lavender essential placebo inhalation 3 drops 4w 4
treated with oil
chemotherapy
Ozkaraman2 2018 Turkey cancer patients 20 20 tea tree oil placebo inhalation 3 drops 4w 4
treated with
chemotherapy
Qi 2016 China colorectal cancer 34 35 a mixture of none inhalation 3 drops 10d 3
patients geranium oil,
bergamot oil and
lavender oil
Rafii 2020 Iran burn patients 34 33 lavender and placebo inhalation 4 drops 1w 3
chamomile
Yu 2017 China patients in 30 30 2% lavender placebo inhalation 5 drops 15d 2
Hepatobiliary essential oil
Surgery ICU

outcome measure based on RCTs.
PSQI, a self-report questionnaire which is consists of 7 components
and 19 items, evaluates subjective sleep quality, sleep latency, sleep
duration, habitual sleep efficiency, sleep disturbances, use of sleep
medication, and daytime dysfunction. Each item is scored between 0 and
3, providing an overall score ranging from 0 to 21. A total score of 5 or
higher represents sleep disorder. This meta-analysis selected most of the
RCTs using PSQI to evaluate the sleep quality that had been concen­
trated over the past 5 years, including 1346 insomniacs. The summary
results showed that the PSQI score of patients treated with aroma­
therapy was decreased significantly (the higher the PSQI score, the
worse the sleep quality). Although several studies reported that there
was no significant difference between the intervention group and the
control group, all studies have shown that aromatherapy plays a positive
role in the treatment of insomnia. These results indicate that aroma­
therapy is more effective in improving sleep quality.
Currently, the most common aromatic substances used for insomnia
are lavender, orange peel, rose, etc. Subgroup analysis for different
aromatic substances was performed in this paper, and the results showed
that there were obvious differences in the three subgroups. However,
there are only a handful of literatures have studied the therapeutic effect
of different essential oils on insomnia. Therefore, whether the treatment
effects of different types of aromatic substances are different or not need
to be verified by more studies.
Interestingly, the results of subgroup analysis of PSQI showed that
the studies using inhalation were significantly more than that of mas­
sage, which was inconsistent with the results previously reported by Min
YC(YC, 2011). It can be seen that there were significant differences in
PSQI in the inhalation subgroup, indicating that inhaling aromatic
substances, rather than using aromatic substances for massage could
obviously improve the quality of sleep. This is inconsistent with the
findings reported by Roh and Park that the effect of the massage group
was greater than that of the inhalation group in the treatment of
depression or anxiety disorders(KH and H, 2009).
Nevertheless, we cannot consider that the massage group is inef­
fective in the treatment of insomnia, because a large number of studies

4
Y. Tang et al. Journal of Affective Disorders 288 (2021) 1–9

Figure 2. Meta-analysis of the intervention group versus the control group on PSQI for patients with primary insomnia.

Figure 3. Subgroup analysis of intervention style.

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Y. Tang et al.
Figure 4. Subgroup analysis of intervention duration.
have confirmed that aromatherapy has an effect on insomnia, whether
through inhalation or massage. What’s more, only two of the studies we
included in this meta-analysis using massage, it is likely that the result of
the subgroup analysis of different intervention types is less reliable due
to the small sample size. More clinical studies on using aromatic sub­
stances for massage to treat insomnia are needed to provide stronger
evidence in the future. In addition, the subgroup analysis of the duration
can be seen that there were significant differences between the inter­
vention group and the control group under different intervention
duration (< 2w, 2-4w, > 4w), and there was no obvious difference
among the three groups, which suggested that different intervention
duration does not seem to have a significant effect on the efficacy of
aromatherapy. Due to the different incidence of insomnia in different
regions and people in different regions have different living and medi­
cation habits, we also conducted a subgroup analysis of the study region,
of which the results showed that the differences between the interven­
tion group and the control group of the three subgroups were statisti­
cally significant.
In the literature quality evaluation process, we distinguished high-
quality literature from low-quality literature, and conducted a sub­
group analysis based on the jadad scores. The results showed that both
the two subgroups showed significant difference before and after
intervention. However, we don’t think that this subgroup analysis is
unnecessary, because the jadad scale evaluates literatures from four
aspects: randomization, concealment of allocation, double blinding,
withdrawals and dropouts. We tend to think that high-quality literatures
will be more persuasive in judging the effectiveness of treatment. What’s
more, because of the included population had different reasons for
insomnia, a subgroup analysis of the insomnia patients was performed,
and the results demonstrated that the patients with cardiovascular dis­
ease or cancer can improve their sleep quality to a greater extent
through aromatherapy, and more scientific experiments are needed to
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Journal of Affective Disorders 288 (2021) 1–9
explore the reasons for this result.
It is well known that CBTI is a first-line treatment for chronic
insomnia in adults of any age, and its therapeutic effect on insomnia had
been recognized internationally(Qaseem et al., 2016; Riemann et al.,
2017). In recent years, with the rapid increase in the incidence of
insomnia all over the world, the role of aromatherapy in the treatment of
insomnia is becoming more and more prominent, which has been
confirmed by more and more studies. Aromatherapy, which is a method
that uses the special properties of aromatic drugs to improve the cir­
culation and endocrine system of the human body. The application of
aromatherapy in China has a long history. Nowadays, aromatherapy has
attracted wide attention as a supplement and alternative therapy to treat
diseases with integrated Chinese and Western medicine. Therefore, we
carried out this meta-analysis, through the results of the analysis, we
think that when the duration of intervention is reasonable, aroma­
therapy as a non-pharmacological therapy is effective in improving sleep
quality with fewer side effects, and we believe that inhalation is more
effective than massage. As for the mechanism of aromatherapy for
insomnia, the current mainstream idea is that the mechanism is related
to the olfactory pathway. The results of the study by Mc Sorley et al.
showed that the decline in sleep quality is related to the decline in odor
recognition(McSorley et al., 2017). However, the current research on its
specific pathway and drug mechanism is still insufficient, and more
in-depth research is still needed in the future.
It is worth mentioning that the heterogeneity of this meta-analysis
was high, and the sensitivity analysis of the included studies showed
high stability, while the subgroup analysis still showed high heteroge­
neity. This may be due to the different sample characteristics of different
studies (including postpartum women, university students, inpatients,
patients with chronic disease, etc.), using of different aromatic sub­
stances (different kinds of single essential oil from different manufac­
turers, different proportion of mixed essential oils, etc.), the use of
Y. Tang et al. Journal of Affective Disorders 288 (2021) 1–9

Figure 5. Subgroup analysis of aromatic substance.

Figure 6. Subgroup analysis of the control group.

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Y. Tang et al.
specific implementation measures are different, and so on.
However, our meta-analysis still has the following limitations: 1) The
outcome measures included in the literature are only PSQI, which may
have certain limitations on assessing the effectiveness of aromatherapy
in the treatment of insomnia, other evaluation scales need to be
analyzed in the future; 2) Although some studies used multicenter
studies, most of the studies were still conducted in one hospital,
geographical restrictions reduce the representativeness of the sample; 3)
The inconsistent concentrations of essential oils used in each study may
also cause bias in the summary results; 4) Only the intervention style,
duration, aromatic substances, etc., were analyzed in this paper, the
subgroup analysis could also be carried out from the aspects of age of
patients, dosage of aromatic substances and so on; 5) The blind method
used in some of the included studies was not described in detail, and
future research needs to consider the error caused by improper use of
blind method.
5. Conclusion
In summary, the pooled results of the meta-analysis showed that
aromatherapy significantly improved the clinical symptoms of patients
with insomnia compared with the control group when PSQI was used as
the outcome measure. Inhalation is more effective than massage. In
addition, more rigorously designed large-scale studies are needed in the
future to validate the efficacy of aromatherapy in the treatment of
insomnia, depression and anxiety disorders. At the same time, more
studies should be carried out on the characteristics of patients, types of
aromatic substances, and mechanism of aromatherapy, in order to help
the clinical application of aromatherapy in the future.
Declarations
Ethics approval and consent to participate
Not applicable.
Consent to publish
Not applicable.
Availability of data and materials
We searched and analyzed published articles to which anyone can
gain access through different databases.
Funding
The research was supported by the National Natural Science Foun­
dation of China (No. 81874382) and the National Natural Science
Foundation of China (No. 81904011).
Authors’ Contributions
TYH designed the study and wrote the paper; TYH and GMM
searched the literature; TYH, SH and WZ extracted and analyzed the
data; QX and DH contributed to the improvement of the manuscript. All
authors approved the submitted and final versions.
Declaration of Competing Interest
The authors declare no conflict of interest.
Acknowledgements
Not applicable.
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Journal of Affective Disorders 288 (2021) 1–9
Supplementary materials
Supplementary material associated with this article can be found, in
the online version, at doi:10.1016/j.jad.2021.03.066.
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