Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK.
Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK; Department of Clinical Psychology, University of Amsterdam, Amsterdam, the Netherlands.
Sleep Med Rev. 2019 Oct;47:90-102. doi: 10.1016/j.smrv.2019.06.002. Epub 2019 Jun 18.
It is well-established that cognitive behavioural therapy for insomnia (CBT-I) improves self-reported sleep disturbance, however the impact on objective sleep is less clear. This meta-analysis aimed to quantify the impact of multi-component CBT-I on objective measures of sleep, indexed via polysomnography (PSG) and actigraphy. Fifteen studies met inclusion criteria. Following appraisal for risk of bias, extracted data were meta-analysed using random-effects models. The quality of the literature was generally high, although reporting of methodological detail varied markedly between studies. Meta-analyses found no evidence that CBT-I reliably improves PSG-defined sleep parameters. Actigraphy evidence was more mixed; with a small effect for reduction in sleep onset latency (Hedge's g = -0.28 [95% confidence interval (CI) -0.51 to -0.05], p = 0.018) and a moderate effect for reduction in total sleep time (TST) (Hedge's g = -0.51 [95% CI -0.75 to -0.26], p < 0.001). In contrast, and consistent with recent meta-analyses, CBT-I was associated with robust improvements in diary measures of sleep initiation and maintenance (Hedge's g range = 0.50 to 0.79) but not TST. While the literature is small and still developing, the sleep benefits of CBT-I are more clearly expressed in the subjective versus objective domain.
已有充分证据表明，认知行为疗法治疗失眠症（CBT-I）可改善自我报告的睡眠障碍，但对客观睡眠的影响则不太明确。本荟萃分析旨在定量评估多组分 CBT-I 对多导睡眠图（PSG）和活动记录仪等客观睡眠测量指标的影响。有 15 项研究符合纳入标准。在评估偏倚风险后，使用随机效应模型对提取的数据进行荟萃分析。文献质量总体较高，但研究之间的方法细节报告差异很大。荟萃分析并未发现 CBT-I 能可靠改善 PSG 定义的睡眠参数的证据。活动记录仪的证据则更为混杂；入睡潜伏期的缩短（Hedge's g=-0.28 [95%置信区间（CI）-0.51 至-0.05]，p=0.018）和总睡眠时间（TST）的减少（Hedge's g=-0.51 [95% CI-0.75 至-0.26]，p<0.001）有较小和中等效应。相比之下，与最近的荟萃分析一致，CBT-I 与睡眠起始和维持的日记测量指标的显著改善相关（Hedge's g 范围为 0.50 至 0.79），但与 TST 无关。尽管文献规模较小且仍在不断发展，但 CBT-I 的睡眠益处更明显地表现在主观而非客观领域。
