Department of Clinical Psychology & EMGO Institute for Health and Care Research, VU University, Amsterdam, The Netherlands.
Department of Clinical Psychology & EMGO Institute for Health and Care Research, VU University, Amsterdam, The Netherlands.
Sleep Med Rev. 2018 Apr;38:3-16. doi: 10.1016/j.smrv.2017.02.001. Epub 2017 Feb 9.
Insomnia is a major public health problem considering its high prevalence, impact on daily life, co-morbidity with other disorders and societal costs. Cognitive behavioral treatment for insomnia (CBTI) is currently considered to be the preferred treatment. However, no meta-analysis exists of all studies using at least one component of CBTI for insomnia, which also uses modern techniques to pool data and to analyze subgroups of patients. We included 87 randomized controlled trials, comparing 118 treatments (3724 patients) to non-treated controls (2579 patients). Overall, the interventions had significant effects on: insomnia severity index (g = 0.98), sleep efficiency (g = 0.71), Pittsburgh sleep quality index (g = 0.65), wake after sleep onset (g = 0.63) and sleep onset latency (SOL; g = 0.57), number of awakenings (g = 0.29) and sleep quality (g = 0.40). The smallest effect was on total sleep time (g = 0.16). Face-to-face treatments of at least four sessions seem to be more effective than self-help interventions or face-to-face interventions with fewer sessions. Otherwise the results seem to be quite robust (similar for patients with or without comorbid disease, younger or older patients, using or not using sleep medication). We conclude that CBTI, either its components or the full package, is effective in the treatment of insomnia.
失眠是一个主要的公共卫生问题，考虑到其高发病率、对日常生活的影响、与其他疾病的共病和社会成本。认知行为治疗失眠症（CBTI）目前被认为是首选的治疗方法。然而，目前还没有对所有使用 CBTI 的至少一个组成部分治疗失眠症的研究进行荟萃分析，这些研究也使用现代技术来汇总数据和分析患者亚组。我们纳入了 87 项随机对照试验，比较了 118 种治疗方法（3724 名患者）与非治疗对照组（2579 名患者）。总体而言，干预措施对以下方面有显著影响：失眠严重程度指数（g=0.98）、睡眠效率（g=0.71）、匹兹堡睡眠质量指数（g=0.65）、睡眠后觉醒（g=0.63）和入睡潜伏期（g=0.57）、觉醒次数（g=0.29）和睡眠质量（g=0.40）。睡眠时间总时长的影响最小（g=0.16）。至少 4 个疗程的面对面治疗似乎比自助干预或疗程较少的面对面干预更有效。否则，结果似乎相当稳健（对有或没有合并症的患者、年轻或老年患者、使用或不使用睡眠药物的患者均如此）。我们的结论是，CBTI 无论是其组成部分还是完整的方案，对失眠症的治疗都是有效的。
