Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada.
Evidence-Based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, China.
Sleep Med Rev. 2022 Aug;64:101648. doi: 10.1016/j.smrv.2022.101648. Epub 2022 May 31.
This review compared the efficacy and acceptability of different delivery formats for cognitive behavioral therapy for insomnia (CBT-I) in insomnia. We searched five databases for randomized clinical trials that compared one CBT-I delivery format against another format or control conditions for insomnia in adults. We used pairwise meta-analyses and frequentist network meta-analyses with the random-effects model to synthesize data. A total of 61 unique trials including 11,571 participants compared six CBT-I delivery formats with four control conditions. At post-intervention, with low to high certainty evidence, individual, group, guided self-help, digital assisted, and unguided self-help CBT-I could significantly increase sleep efficiency and total sleep time (TST) and reduce sleep onset latency (SOL), wake after sleep onset (WASO), and insomnia severity compared with treatment as usual (MD range for sleep efficiency: 7.81%-12.45%; MD range for TST: 16.14-33.96 min; MD range for SOL: -22.42 to -13.81 min; MD range for WASO: -40.84 to -19.48 min; MD range for insomnia severity: -6.40 to -3.93) and waitlist (MD range for sleep efficiency: 7.68%-12.32%; MD range for TST: 12.67-30.49 min; MD range for SOL: -19.07 to -10.46 min; MD range for WASO: -47.10 to -19.15 min; MD range for insomnia severity: -7.59 to -5.07). The effects of different CBT-I formats persisted at short-term follow-up (4 wk-6 mo). Individual, group, and digital assisted CBT-I delivery formats would be the more appropriate choices for insomnia in adults, based on post-intervention and short-term effects. Further trials are needed to investigate the long-term effects of different CBT-I formats.
本综述比较了不同形式的认知行为疗法治疗失眠（CBT-I）在失眠中的疗效和可接受性。我们在五个数据库中检索了比较 CBT-I 一种形式与另一种形式或成人失眠对照条件的随机临床试验。我们使用成对的荟萃分析和基于随机效应模型的频率网络荟萃分析来综合数据。共有 61 项独特的试验，包括 11571 名参与者，将六种 CBT-I 交付格式与四种对照条件进行了比较。在干预后，低到高确定性证据表明，个体、小组、指导自助、数字辅助和无指导自助 CBT-I 可显著提高睡眠效率和总睡眠时间（TST），并减少睡眠潜伏期（SOL）、睡眠后觉醒（WASO）和失眠严重程度与常规治疗（睡眠效率的 MD 范围：7.81%-12.45%；TST 的 MD 范围：16.14-33.96 分钟；SOL 的 MD 范围：-22.42 至-13.81 分钟；WASO 的 MD 范围：-40.84 至-19.48 分钟；失眠严重程度的 MD 范围：-6.40 至-3.93）和候补名单（睡眠效率的 MD 范围：7.68%-12.32%；TST 的 MD 范围：12.67-30.49 分钟；SOL 的 MD 范围：-19.07 至-10.46 分钟；WASO 的 MD 范围：-47.10 至-19.15 分钟；失眠严重程度的 MD 范围：-7.59 至-5.07）。不同 CBT-I 形式的效果在短期随访（4 周-6 个月）中持续存在。基于干预后和短期效果，个体、小组和数字辅助 CBT-I 交付格式可能是治疗成人失眠的更合适选择。需要进一步的试验来研究不同 CBT-I 形式的长期效果。
