TY - JOUR
T1 - Cognitive behavioral therapy for chronic insomnia: a systematic review and meta-analysis
AU - Trauer, James
AU - Qian, Mary Y
AU - Doyle, Joseph Samuel
AU - Rajaratnam, Shanthakumar M W
AU - Cunnington, David
PY - 2015/8/4
Y1 - 2015/8/4
N2 - Background: Because psychological approaches are likely to produce sustained benefits without the risk for tolerance or adverse effects associated with pharmacologic approaches, cognitive behavioral therapy for insomnia (CBT-i) is now commonly recommended as first-line treatment for chronic insomnia. Purpose: To determine the efficacy of CBT-i on diary measures of overnight sleep in adults with chronic insomnia. Data Sources: Searches of MEDLINE, EMBASE, PsycINFO, CINAHL, the Cochrane Library, and PubMed Clinical Queries from inception to 31 March 2015, supplemented with manual screening. Study Selection: Randomized, controlled trials assessing the efficacy of face-to-face, multimodal CBT-i compared with inactive comparators on overnight sleep in adults with chronic insomnia. Studies of insomnia comorbid with medical, sleep, or psychiatric disorders were excluded. Data Extraction: Study characteristics, quality, and data were assessed independently by 2 reviewers. Main outcome measures were sleep onset latency (SOL), wake after sleep onset (WASO), total sleep time (TST), and sleep efficiency (SE ). Data Synthesis: Among 292 citations and 91 full-text articles reviewed, 20 studies (1162 participants [64 female; mean age, 56 years]) were included. Approaches to CBT-i incorporated at least 3 of the following: cognitive therapy, stimulus control, sleep restriction, sleep hygiene, and relaxation. At the posttreatment time point, SOL improved by 19.03 (95 CI, 14.12 to 23.93) minutes, WASO improved by 26.00 (CI, 15.48 to 36.52) minutes, TST improved by 7.61 (CI, -0.51 to 15.74) minutes, and SE improved by 9.91 (CI, 8.09 to 11.73 ). Changes seemed to be sustained at later time points. No adverse outcomes were reported. Limitation: Narrow inclusion criteria limited applicability to patients with comorbid insomnia and other sleep problems, and accuracy of estimates at later time points was less clear. Conclusion: CBT-i is an effective treatment for adults with chronic insomnia, with clinically meaningful effect sizes
AB - Background: Because psychological approaches are likely to produce sustained benefits without the risk for tolerance or adverse effects associated with pharmacologic approaches, cognitive behavioral therapy for insomnia (CBT-i) is now commonly recommended as first-line treatment for chronic insomnia. Purpose: To determine the efficacy of CBT-i on diary measures of overnight sleep in adults with chronic insomnia. Data Sources: Searches of MEDLINE, EMBASE, PsycINFO, CINAHL, the Cochrane Library, and PubMed Clinical Queries from inception to 31 March 2015, supplemented with manual screening. Study Selection: Randomized, controlled trials assessing the efficacy of face-to-face, multimodal CBT-i compared with inactive comparators on overnight sleep in adults with chronic insomnia. Studies of insomnia comorbid with medical, sleep, or psychiatric disorders were excluded. Data Extraction: Study characteristics, quality, and data were assessed independently by 2 reviewers. Main outcome measures were sleep onset latency (SOL), wake after sleep onset (WASO), total sleep time (TST), and sleep efficiency (SE ). Data Synthesis: Among 292 citations and 91 full-text articles reviewed, 20 studies (1162 participants [64 female; mean age, 56 years]) were included. Approaches to CBT-i incorporated at least 3 of the following: cognitive therapy, stimulus control, sleep restriction, sleep hygiene, and relaxation. At the posttreatment time point, SOL improved by 19.03 (95 CI, 14.12 to 23.93) minutes, WASO improved by 26.00 (CI, 15.48 to 36.52) minutes, TST improved by 7.61 (CI, -0.51 to 15.74) minutes, and SE improved by 9.91 (CI, 8.09 to 11.73 ). Changes seemed to be sustained at later time points. No adverse outcomes were reported. Limitation: Narrow inclusion criteria limited applicability to patients with comorbid insomnia and other sleep problems, and accuracy of estimates at later time points was less clear. Conclusion: CBT-i is an effective treatment for adults with chronic insomnia, with clinically meaningful effect sizes
UR - http://annals.org/article.aspx?articleid=2301405
U2 - 10.7326/M14-2841
DO - 10.7326/M14-2841
M3 - Article
SN - 0003-4819
VL - 163
SP - 191
EP - 204
JO - Annals of Internal Medicine
JF - Annals of Internal Medicine
IS - 3
ER -