Reynolds Amy C, Sweetman Alexander, Crowther Meagan E, Paterson Jessica L, Scott Hannah, Lechat Bastien, Wanstall Sian E, Brown Brandon Wj, Lovato Nicole, Adams Robert J, Eastwood Peter R
Flinders Health and Medical Research Institute (Sleep Health), Flinders University, Bedford Park, South Australia, Australia.
Flinders Health and Medical Research Institute (Sleep Health), Flinders University, Bedford Park, South Australia, Australia.
Sleep Med Rev. 2023 Feb;67:101716. doi: 10.1016/j.smrv.2022.101716. Epub 2022 Nov 21.
Shift workers commonly report insomnia symptoms. Cognitive behavioral therapy for insomnia (CBTi) is the first line treatment for insomnia, however efficacy in shift workers is not well understood. This systematic review and meta-analysis evaluates existing trials of CBTi in shift working populations. A systematic literature search was conducted across seven electronic databases (n = 2120). Fifty-two full-text articles were reviewed and of these, nine studies (across ten publications with a total of 363 participants) were deemed suitable for inclusion. Heterogeneity was considerable between studies, with variability in study design, style and delivery of intervention, and follow-up times. Small sample sizes were common and attrition was high. Some studies modified aspects of CBTi for use in shift workers, while others were limited to psycho-education as part of larger intervention studies. Mean differences (MD) pre and post CBTi were modest for both the insomnia severity index (ISI; MD: -3.08, 95% CI: -4.39, -1.76) and the Pittsburgh sleep quality index (PSQI; MD: -2.38, 95% CI: -3.55, -1.21). Neither difference was of a magnitude considered to reflect a clinically significant improvement. Tailored approaches to CBTi are needed for shift workers to improve efficacy, ideally including co-production with workers to ensure interventions meet this population's needs.
轮班工作者普遍报告有失眠症状。失眠的认知行为疗法（CBTi）是失眠的一线治疗方法，然而其在轮班工作者中的疗效尚不清楚。本系统评价和荟萃分析评估了现有关于轮班工作人群的CBTi试验。在七个电子数据库中进行了系统的文献检索（n = 2120）。对52篇全文进行了审查，其中9项研究（来自10篇出版物，共363名参与者）被认为适合纳入。研究之间的异质性相当大，在研究设计、干预方式和实施以及随访时间方面存在差异。样本量小很常见，损耗率高。一些研究对CBTi的某些方面进行了修改以用于轮班工作者，而其他研究则仅限于作为更大干预研究一部分的心理教育。CBTi前后的平均差异（MD）对于失眠严重程度指数（ISI；MD：-3.08，95%CI：-4.39，-1.76）和匹兹堡睡眠质量指数（PSQI；MD：-2.38，95%CI：-3.55，-1.21）均不显著。轮班工作者需要采用量身定制的CBTi方法来提高疗效，理想情况下包括与工作者共同制定，以确保干预措施满足该人群的需求。
