Department of Medicine, State University of Santa Cruz, Ilhéus, Bahia, Brazil.
Department of Medicine, Federal University of Campina Grande, Campina Grande, Paraíba, Brazil.
Sleep Med. 2024 Oct;122:171-176. doi: 10.1016/j.sleep.2024.08.003. Epub 2024 Aug 3.
The current literature lacks a clear evaluation of the effectiveness of Cognitive Behavioral Therapy for Insomnia (CBT-I) on acute insomnia. Our study aims to address this issue through a systematic review and meta-analysis of Randomized Controlled Trials (RCTs).
We systematically searched PubMed, Embase, and Cochrane Library in April 2024 for RCTs comparing patients with clinically significant insomnia symptoms for less than 6 months (ie, acute insomnia) assigned to 1-6 weeks of CBT-I versus no CBT-I.
We included four RCTs comprising 327 patients with acute insomnia, of whom 162 (49.5 %) were randomized to CBT-I. CBT-I significantly reduced the Insomnia Severity Index score (MD -5.28; 95 % CI -6.01, -4.56; p < 0.00001; I = 18 %), the incidence of chronic insomnia (MD 0.50; 95 % CI 0.35, 0.70; p < 0.0001; I = 0 %), and the sleep latency (MD -11.04; 95 % CI -18.46, -3.61; p = 0.004; I = 0 %).
These findings provide preliminary evidence that minimal CBT-I may be a feasible and effective preventive measure against chronic insomnia. However, future RCTs and effectiveness trials are necessary to validate, with greater statistical power, the hypothesis that CBT-I can prevent transition from acute to chronic insomnia, given the limited number of studies in our meta-analysis.
目前的文献缺乏对认知行为疗法治疗失眠(CBT-I)对急性失眠疗效的明确评估。我们的研究旨在通过对随机对照试验(RCT)的系统评价和荟萃分析来解决这个问题。
我们于 2024 年 4 月系统地检索了 PubMed、Embase 和 Cochrane Library,以比较接受 CBT-I 治疗 1-6 周与不接受 CBT-I 治疗的 6 个月内(即急性失眠)有临床显著失眠症状的患者的 RCT。
我们纳入了四项 RCT,共 327 例急性失眠患者,其中 162 例(49.5%)被随机分配至 CBT-I 组。CBT-I 显著降低了失眠严重指数评分(MD-5.28;95%CI-6.01,-4.56;p<0.00001;I²=18%)、慢性失眠发生率(MD0.50;95%CI0.35,0.70;p<0.0001;I²=0%)和睡眠潜伏期(MD-11.04;95%CI-18.46,-3.61;p=0.004;I²=0%)。
这些发现初步提供了证据,表明最低剂量的 CBT-I 可能是预防慢性失眠的可行且有效的措施。然而,鉴于我们的荟萃分析中研究数量有限,未来需要进行更多具有更大统计效力的 RCT 和有效性试验来验证 CBT-I 可以预防急性失眠向慢性失眠转变的假设。