Adelaide Institute for Sleep Health, Flinders University, Adelaide, South Australia, Australia.
School of Psychological Sciences and Health, University of Strathclyde, Glasgow, UK.
J Sleep Res. 2023 Dec;32(6):e13847. doi: 10.1111/jsr.13847. Epub 2023 Mar 5.
Comorbid insomnia and sleep apnoea (COMISA) is a highly prevalent and debilitating sleep disorder. Cognitive behavioural therapy for insomnia (CBTi) may be an appropriate treatment for COMISA; however, no previous study has systematically reviewed and meta-analysed literature reporting on the effect of CBTi in people with COMISA. A systematic literature search was conducted across PsychINFO and PubMed (n = 295). In all, 27 full-text records were independently reviewed by at least two authors. Forward- and backward-chain referencing, and hand-searches were used to identify additional studies. Authors of potentially eligible studies were contacted to provide COMISA subgroup data. In total, 21 studies, including 14 independent samples of 1040 participants with COMISA were included. Downs and Black quality assessments were performed. A meta-analysis including nine primary studies measuring the Insomnia Severity Index indicated that CBTi is associated with a large improvement in insomnia severity (Hedges' g = -0.89, 95% confidence interval [CI] -1.35, -0.43). Subgroup meta-analyses indicated that CBTi is effective in samples with untreated obstructive sleep apnoea (OSA) (five studies, Hedges' g = -1.19, 95% CI -1.77, -0.61) and treated OSA (four studies, Hedges' g = -0.55, 95% CI -0.75, -0.35). Publication bias was evaluated by examining the Funnel plot (Egger's regression p = 0.78). Implementation programmes are required to embed COMISA management pathways in sleep clinics worldwide that currently specialise in the management of OSA alone. Future research should investigate and refine CBTi interventions in people with COMISA, including identifying the most effective CBTi components, adaptations, and developing personalised management approaches for this highly prevalent and debilitating condition.
共病性失眠和睡眠呼吸暂停（COMISA）是一种高发且使人虚弱的睡眠障碍。认知行为疗法治疗失眠症（CBTi）可能是治疗 COMISA 的一种合适方法；然而，以前没有研究系统地综述和荟萃分析了 CBTi 对 COMISA 患者的疗效的文献。我们对 PsychINFO 和 PubMed 进行了系统的文献检索（n=295）。总共对 27 篇全文记录进行了至少由两名作者进行的独立审查。采用前向和后向连锁引用以及手工检索的方法来确定其他研究。联系了可能符合条件的研究的作者，以获取 COMISA 亚组数据。共有 21 项研究，包括 14 项独立的 COMISA 患者样本，共 1040 名参与者被纳入研究。对 Downs 和 Black 质量评估进行了评估。纳入了 9 项主要研究来测量失眠严重程度指数的元分析表明，CBTi 与失眠严重程度的显著改善相关（Hedges'g=-0.89，95%置信区间 [CI] -1.35，-0.43）。亚组元分析表明，CBTi 在未经治疗的阻塞性睡眠呼吸暂停（OSA）（五项研究，Hedges'g=-1.19，95% CI -1.77，-0.61）和治疗过的 OSA（四项研究，Hedges'g=-0.55，95% CI -0.75，-0.35）样本中是有效的。通过检查漏斗图（Egger 回归 p=0.78）评估发表偏倚。需要在全球范围内的睡眠诊所实施将 COMISA 管理途径嵌入其中的实施方案，这些诊所目前专门治疗单独的 OSA。未来的研究应调查和改进 COMISA 患者的 CBTi 干预措施，包括确定最有效的 CBTi 成分、调整措施，并为这种高发且使人虚弱的疾病制定个性化的管理方法。
