Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, UK.
Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, UK; Big Health Inc., San Francisco, USA; Big Health Inc., London, UK.
Sleep Med Rev. 2021 Aug;58:101493. doi: 10.1016/j.smrv.2021.101493. Epub 2021 Apr 21.
Sleep restriction therapy (SRT) is an established treatment for insomnia that has been used in clinical practise for over 30 y. It is commonly delivered as part of multicomponent cognitive-behavioural therapy (CBT-I) but has also been linked to beneficial effects as a standalone intervention. In order to quantify the efficacy of SRT we performed a comprehensive meta-analysis of randomised controlled trials (RCTs) comparing SRT to minimally active or non-active control groups. Primary outcomes were self-reported insomnia severity and sleep diary metrics at post-treatment. Weighted effect sizes were calculated with Hedges' g and risk of bias was assessed by two independent raters with the Cochrane tool. Our search yielded eight RCTs meeting inclusion/exclusion criteria. Random effects models revealed large treatment effects in favour of SRT versus control for insomnia severity measured with the insomnia severity index (g = -0.93; 95% CI = -1.15, -0.71), sleep efficiency (g = 0.91; 95% CI = 0.52, 1.31), sleep onset latency (g = -0.62; 95% CI = -0.84, -0.40), and wake-time after sleep onset (g = -0.83; 95% CI = -1.11, -0.55). No effects were found for total sleep time (g = 0.02; 95% CI = -0.29, 0.34). Results should be interpreted in the context of the small number of comparisons (≤6 per outcome), high risk of bias (6 out of 8 studies met criteria for high risk), and heterogeneity in study design and SRT administration. Only a small number of studies provided outcomes at follow-up (n ≤ 3), hindering assessment of long-term effects. Sleep restriction therapy effectively improves insomnia severity and sleep continuity in the short term; more studies are needed to assess if effects are sustained at long-term follow-up (>3 m). Post-treatment effect sizes appear as large as multicomponent CBT-I. To reduce risk of bias, future studies should consider testing the effects of SRT against control groups that are matched for non-specific treatment effects. Large-scale pragmatic trials are also needed to test if SRT is effective in clinical practise and to quantify effects on daytime functioning and quality of life.
睡眠限制疗法（SRT）是一种经过临床实践验证的失眠治疗方法，已经使用了 30 多年。它通常作为多成分认知行为疗法（CBT-I）的一部分提供，但也已被证明作为一种独立的干预措施具有有益的效果。为了量化 SRT 的疗效，我们对比较 SRT 与最小活动或非活动对照组的随机对照试验（RCT）进行了全面的荟萃分析。主要结局是治疗后自我报告的失眠严重程度和睡眠日记指标。使用 Hedges'g 计算加权效应大小，并由两名独立的评分者使用 Cochrane 工具评估偏倚风险。我们的搜索结果包括符合纳入/排除标准的八项 RCT。随机效应模型显示，与对照组相比，SRT 对失眠严重程度（用失眠严重指数测量）、睡眠效率（g=0.91；95%CI=0.52，1.31）、入睡潜伏期（g=-0.62；95%CI=-0.84，-0.40）和睡眠后醒来时间（g=-0.83；95%CI=-1.11，-0.55）具有较大的治疗效果。总睡眠时间（g=0.02；95%CI=-0.29，0.34）无影响。结果应在比较数量较少（每个结局≤6 个）、高偏倚风险（8 项研究中有 6 项符合高风险标准）和研究设计和 SRT 管理的异质性的背景下进行解释。只有少数研究（n≤3）提供了随访结果，这阻碍了对长期效果的评估。SRT 在短期内有效改善失眠严重程度和睡眠连续性；需要更多的研究来评估在长期随访（>3m）中是否持续存在效果。治疗后效应大小与多成分 CBT-I 一样大。为了降低偏倚风险，未来的研究应该考虑测试 SRT 对非特异性治疗效果相匹配的对照组的效果。还需要大规模的实用试验来测试 SRT 是否在临床实践中有效，并量化其对白天功能和生活质量的影响。
