Ann Intern Med. 2016 Jul 19;165(2):113-24. doi: 10.7326/M15-1782. Epub 2016 May 3.
Psychological and behavioral interventions are frequently used for insomnia disorder.
To assess benefits and harms of psychological and behavioral interventions for insomnia disorder in adults.
Ovid MEDLINE, Embase, the Cochrane Central Register of Controlled Trials, and PsycINFO through September 2015, supplemented with hand-searching.
Randomized, controlled trials of psychological or behavioral interventions that were published in English and enrolled adults with insomnia disorder lasting 4 or more weeks.
Data extraction by single investigator confirmed by a second reviewer; dual investigator assessment of risk of bias; consensus determination of strength of evidence.
Sixty trials with low to moderate risk of bias compared psychological and behavioral interventions with inactive controls or other psychological and behavioral interventions. Cognitive behavioral therapy for insomnia (CBT-I) improved posttreatment global and most sleep outcomes, often compared with information or waitlist controls (moderate-strength evidence). Use of CBT-I improved several sleep outcomes in older adults (low- to moderate-strength evidence). Multicomponent behavioral therapy improved several sleep outcomes in older adults (low- to moderate-strength evidence). Stimulus control improved 1 or 2 sleep outcomes (low-strength evidence). Evidence for other comparisons and for harms was insufficient to permit conclusions.
A wide variety of comparisons limited the ability to pool data. Trials did not always report global outcomes and infrequently conducted remitter or responder analysis. Comparisons were often information or waitlist groups, and publication bias was possible.
Use of CBT-I improves most outcomes compared with inactive controls. Multicomponent behavioral therapy and stimulus control may improve some sleep outcomes. Evidence on other outcomes, comparisons, and long-term efficacy were limited.
Agency for Healthcare Research and Quality. (
CRD42014009908).
心理和行为干预常用于治疗失眠症。
评估心理和行为干预治疗成人失眠症的疗效和安全性。
通过 Ovid MEDLINE、Embase、Cochrane 对照试验中心注册库和 PsycINFO 检索 2015 年 9 月前的相关文献，并辅以手工检索。
纳入以英语发表、采用随机对照设计、针对成人失眠症（持续 4 周及以上）且使用心理或行为干预治疗的临床试验。
由单一研究者进行资料提取，然后由第二位研究者进行确认；由两位研究者对偏倚风险进行评估，并对证据强度进行共识判定。
60 项试验的偏倚风险为低到中度，将心理和行为干预与非活性对照或其他心理和行为干预进行了比较。失眠认知行为疗法（CBT-I）改善了治疗后总体和多数睡眠结局，且通常优于信息或等待对照组（中等强度证据）。CBT-I 用于老年患者可改善多种睡眠结局（低到中等强度证据）。多组分行为疗法用于老年患者可改善多种睡眠结局（低到中等强度证据）。刺激控制可改善 1 或 2 种睡眠结局（低强度证据）。其他比较和安全性的证据不足，无法得出结论。
各种比较限制了数据合并的能力。试验并非均报告总体结局，很少进行缓解者或应答者分析。对照通常为信息或等待组，可能存在发表偏倚。
与非活性对照相比，CBT-I 可改善多数结局。多组分行为疗法和刺激控制可能改善某些睡眠结局。其他结局、比较和长期疗效的证据有限。
美国卫生保健研究与质量署。（PROSPERO：CRD42014009908）。
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