认知行为疗法单独治疗失眠症：一项随机对照试验的荟萃分析。

Cognitive behavioural therapy monotherapy for insomnia: A meta-analysis of randomized controlled trials.

机构信息

Faculty of Health and Life Sciences, De Montfort University, Leicester, United Kingdom.

Unit of Psychiatry, Faculty of Health Sciences, University of Macau, Macao; Center for Cognition and Brain Sciences, University of Macau, Macao; Department of Psychiatry and Psychology, Southern Medical University Nanfang Hospital, Guangdong, China.

出版信息

Asian J Psychiatr. 2020 Mar;49:101828. doi: 10.1016/j.ajp.2019.10.008. Epub 2019 Oct 13.

DOI:10.1016/j.ajp.2019.10.008

PMID:32115395

Abstract

This was a meta-analysis of randomized controlled trials (RCTs) comparing the effects of cognitive behavioural therapy for insomnia (CBTI) as a monotherapy and active control treatments in persons with insomnia who have no major medical conditions or psychiatric comorbidities. PubMed, PsycINFO, EMBASE, Cochrane Library databases, WanFang and CNKI were systematically and independently searched. Standardized mean differences (SMDs) and risk ratio (RR) with their 95% confidence intervals (CIs) were calculated. Nine RCTs with 12 treatment arms comparing CBTI (n = 479) and active control (n = 510) groups were analyzed. Compared to the active control group, the CBTI group showed significantly less improvement in insomnia at post-CBTI assessment in terms of sleep efficiency (SMD: 0.32, 95% CI: 0.00 to 0.63), sleep latency (SMD: -0.33, 95% CI: -0.56 to -0.09), wake after sleep onset (SMD: -0.27, 95% CI: -0.52 to -0.01), the total scores of Pittsburgh Sleep Quality Index (SMD: -0.52, 95% CI: -0.86 to -0.19), the Insomnia Symptom Index (SMD: -0.68, 95% CI: -1.01 to -0.36), the Dysfunctional Attitudes and Beliefs About Sleep Scale (SMD: -0.76, 95% CI: -1.25 to -0.27), and the Athens Insomnia Scale (SMD: -0.66, 95% CI: -1.07 to -0.24). In this meta-analysis, CBTI monotherapy showed no advantage in improving insomnia compared with other standard treatments.

摘要

这是一项针对无重大医学疾病或精神共病的失眠症患者的随机对照试验（RCT）的荟萃分析，比较了失眠认知行为疗法（CBTI）作为单一疗法和积极对照治疗的效果。我们系统地、独立地检索了 PubMed、PsycINFO、EMBASE、Cochrane 图书馆数据库、万方和中国知网。计算了标准化均数差（SMD）和风险比（RR）及其 95%置信区间（CI）。分析了 9 项 RCT，共有 12 个治疗组比较 CBTI（n=479）和积极对照组（n=510）。与积极对照组相比，CBTI 组在 CBTI 后评估时的睡眠效率（SMD：0.32，95%CI：0.00 至 0.63）、睡眠潜伏期（SMD：-0.33，95%CI：-0.56 至-0.09）、睡眠起始后觉醒（SMD：-0.27，95%CI：-0.52 至-0.01）、匹兹堡睡眠质量指数总分（SMD：-0.52，95%CI：-0.86 至-0.19）、失眠症状指数（SMD：-0.68，95%CI：-1.01 至-0.36）、功能失调态度和睡眠信念量表（SMD：-0.76，95%CI：-1.25 至-0.27）和雅典失眠量表（SMD：-0.66，95%CI：-1.07 至-0.24）方面的失眠改善无优势。在这项荟萃分析中，CBTI 单一疗法在改善失眠方面与其他标准治疗相比没有优势。