癌症患者失眠的认知行为疗法：系统评价和网络荟萃分析。

Cognitive behavior therapy for insomnia in cancer patients: a systematic review and network meta-analysis.

机构信息

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.

出版信息

J Evid Based Med. 2022 Sep;15(3):216-229. doi: 10.1111/jebm.12485. Epub 2022 Aug 22.

DOI:10.1111/jebm.12485

PMID:35996803

Abstract

OBJECTIVE

The aim of this study was to examine the most effective delivery format of cognitive behavioral therapy for insomnia (CBT-I) on insomnia in cancer patients.

METHODS

We searched five databases up to February 2021 for randomized clinical trials that compared CBT-I with inactive or active controls for insomnia in cancer patients. Outcomes were insomnia severity, sleep efficiency, sleep onset latency (SOL), wake after sleep onset (WASO), and total sleep time (TST). Pairwise meta-analyses and frequentist network meta-analyses with the random-effects model were applied for data analyses.

RESULTS

Sixteen unique trials including 1523 participants met inclusion criteria. Compared with inactive control, CBT-I could significantly reduce insomnia severity (mean differences [MD] = -4.98 points, 95% confidence interval [CI]: -5.82 to -4.14), SOL (MD = -12.29 min, 95%CI: -16.48 to -8.09), and WASO (MD = -16.58 min, 95%CI: -22.00 to -11.15), while increasing sleep efficiency (MD = 7.62%, 95%CI: 5.82% to 9.41%) at postintervention. Compared with active control, CBT-I could significantly reduce insomnia severity (MD = -2.75 points, 95%CI: -4.28 to -1.21), SOL (MD = -13.56 min, 95%CI: -18.93 to -8.18), and WASO (MD = -6.99 min, 95%CI: -11.65 to -2.32) at postintervention. These effects diminished in short-term follow-up and almost disappeared in long-term follow-up. Most of the results were rated as "moderate" to "low" certainty of evidence. Network meta-analysis showed that group CBT-I had an increase in sleep efficiency of 10.61%, an increase in TST of 21.98 min, a reduction in SOL of 14.65 min, and a reduction in WASO of 24.30 min, compared with inactive control at postintervention, with effects sustained at short-term follow-up.

CONCLUSIONS

CBT-I is effective for the management of insomnia in cancer patients postintervention, with diminished effects in short-term follow-up. Group CBT-I is the preferred choice based on postintervention and short-term effects. The low quality of evidence and limited sample size demonstrate the need for robust evidence from high-quality, large-scale trials providing long-term follow-up data.

摘要

目的

本研究旨在探讨针对癌症患者失眠症的认知行为疗法（CBT-I）的最有效传递形式。

方法

我们检索了截至 2021 年 2 月的 5 个数据库，以寻找比较 CBT-I 与癌症患者失眠症的非活动对照或活性对照的随机临床试验。结局指标为失眠严重程度、睡眠效率、睡眠潜伏期（SOL）、睡眠后觉醒时间（WASO）和总睡眠时间（TST）。采用配对荟萃分析和随机效应模型的频率网络荟萃分析进行数据分析。

结果

纳入的 16 项独特试验共纳入了 1523 名参与者。与非活动对照组相比，CBT-I 可显著降低失眠严重程度（平均差异 [MD] = -4.98 分，95%置信区间 [CI]：-5.82 至-4.14）、SOL（MD = -12.29 分钟，95%CI：-16.48 至-8.09）和 WASO（MD = -16.58 分钟，95%CI：-22.00 至-11.15），同时增加睡眠效率（MD = 7.62%，95%CI：5.82%至 9.41%）。与活性对照组相比，CBT-I 可显著降低失眠严重程度（MD = -2.75 分，95%CI：-4.28 至-1.21）、SOL（MD = -13.56 分钟，95%CI：-18.93 至-8.18）和 WASO（MD = -6.99 分钟，95%CI：-11.65 至-2.32）。这些影响在短期随访时减弱，在长期随访时几乎消失。大多数结果的证据质量被评为“中度”到“低”。网络荟萃分析显示，与非活动对照组相比，CBT-I 组的睡眠效率提高了 10.61%，TST 增加了 21.98 分钟，SOL 缩短了 14.65 分钟，WASO 缩短了 24.30 分钟，且这些影响在短期随访时仍然存在。