Cognitive Behavioural Therapy for Insomnia Monotherapy in Patients with Medical or Psychiatric Comorbidities: a Meta-Ana
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Cognitive Behavioural Therapy for Insomnia Monotherapy in Patients with Medical or Psychiatric Comorbidities: a Meta-Analysis of Randomized Controlled Trials Fu-Chun Zhou, et al. [full author details at the end of the article] # Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract
This is a meta-analysis of randomized controlled trials (RCTs) comparing cognitive behaviour therapy for insomnia (CBT-I) monotherapy with active control treatment for insomnia in patients with medical or psychiatric comorbidities. Both international (PubMed, EMBASE, PsycINFO, Cochrane Library) and Chinese (WanFang, and CNKI) databases were systematically searched. The random effects model was used. Thirteen RCTs comparing CBT-I (n = 441) and active controls (n = 412) groups were included. CBT-I group showed significant advantage over active controls at post-treatment assessment in terms of Insomnia Severity Index (ISI; SMD = -0.74), sleep onset latency (SMD = -0.36), wake after sleep onset (SMD = -0.21), sleep quality (SMD = 0.56), Pittsburgh sleep quality index total scores (PSQI; SMD = -0.76) and the total score of dysfunctional beliefs and attitudes about sleep scale (DBAS; SMD = -1.09). Subgroup analyses revealed significant improvement in sleep onset latency in patients with psychiatric disorders (SMD = -0.45), while significant reduction of number of wakeup after sleep onset was found in patients with medical conditions (SMD = -0.31). This metaanalysis found that CBT-I monotherapy had greater efficacy than other active control treatment for insomnia in patients with medical or psychiatric comorbidities. Keywords Cognitive behavioural therapy . Insomnia . Comorbidities . Meta-analysis
Introduction Insomnia is a common sleep disorder [1] that can lead to negative health outcomes, such as fatigue, increased daytime irritability, cognitive deficits and poor health status [2, 3]. Insomnia often co-exists with major medical conditions, such as diabetes [4], hypertension [5] and Fu-Chun Zhou, Yuan Yang, Yuan-Yuan Wang, Wen-Wang Rao and Shu-Fang Zhang contributed equally to this work. PROSPERO Registration Number: CRD42020171039 Electronic supplementary material The online version of this article (https://doi.org/10.1007/s11126-02009820-8) contains supplementary material, which is available to authorized users.
Psychiatric Quarterly
cancer [6], which increase personal suffering and even the risk of all-cause mortality [7]. In addition, insomnia also occurs in up to 40%–50% of patients with psychiatric disorders [8], such as depression [9], bipolar and anxiety disorder [10], and increases the risk of suicide [11, 12]. There is a complex association between insomnia and major medical/ psychiatric disorders. Medical and psychiatric disorders could precipitate the development of insomnia, while insomnia could increase the risk of medical/ psychiatric conditions. Therefore both insomnia and major medical/ psychiatric disorders need to be treated concurrently [1, 13]. Psychotropic medications, such as benzodiazepines
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