Objectives/Introduction: Insomnia is a highly prevalent disorder worldwide. Besides nocturnal symptoms, insomnia patients also experience diurnal symptoms. In fact, diurnal symptoms are often the reason insomnia patients seek help. Nevertheless, it is not clear whether standard treatments for insomnia are effective on daytime symptoms. The aim of this systematic review and network meta‐analysis is to provide evidence on the efficacy of cognitive and behavior therapies for insomnia for daytime symptoms of insomnia. Methods: PubMed, PsycINFO, PsycARTICLES, MEDLINE, CINAHL and Web of Science were searched from 1987 (data of publication of DSM‐III‐R) to March 2017 to identify randomized controlled trials investigating the effect of cognitive and behavior therapies for insomnia on daytime symptoms such as fatigue, sleepiness, quality of life, mood disturbance and reduced cognitive functions. Eight classes of treatments (behavioral or cognitive‐behavioral therapy for insomnia administered either face‐to‐face individually or in group setting or through self‐help/internet) and 8 classes of control interventions (waiting list, treatment as usual, active contact control, sleep hygiene education, pharmacological interventions for insomnia or other condition, pharmacological placebo, psychological placebo, behavioral and psychological interventions) were identified in the network. Risk of bias was assessed through the Cochrane Collaboration's Tool. Cohen′s d at 95% confidence interval (CI) was calculated to assess the effect sizes of each class as compared with waiting list. Results: Fifty‐eight studies met inclusion criteria. Risk of bias assessment indicated a possible high risk of attrition bias in our sample of studies. For fatigue as outcome, no significant effect was found (for all comparisons in the network p > 0.05). Results showed significant effects for self‐help cognitive‐behavioral therapy for insomnia on quality of life (d = 0.25, 95% CI: 0.07; 0.42) and depressive symptoms (d = ‐0.24, 95% CI: ‐0.45; ‐0.02) and individual faceto‐face behavioral therapy for insomnia on depressive symptoms (d = ‐0.73, 95% CI: ‐1.45; ‐0.02). Conclusions: Preliminary findings suggest potential effects of individual face‐to‐face behavioral therapy on depressive symptoms and potential effects of self‐help cognitive‐behavioral therapy on depressive symptoms and quality of life. Disclosure: Nothing to disclose.
The efficacy of cognitive and behavior therapies for insomnia on daytime symptoms: a systematic review and network meta‐analysis
Baglioni C
2018-01-01
Abstract
Objectives/Introduction: Insomnia is a highly prevalent disorder worldwide. Besides nocturnal symptoms, insomnia patients also experience diurnal symptoms. In fact, diurnal symptoms are often the reason insomnia patients seek help. Nevertheless, it is not clear whether standard treatments for insomnia are effective on daytime symptoms. The aim of this systematic review and network meta‐analysis is to provide evidence on the efficacy of cognitive and behavior therapies for insomnia for daytime symptoms of insomnia. Methods: PubMed, PsycINFO, PsycARTICLES, MEDLINE, CINAHL and Web of Science were searched from 1987 (data of publication of DSM‐III‐R) to March 2017 to identify randomized controlled trials investigating the effect of cognitive and behavior therapies for insomnia on daytime symptoms such as fatigue, sleepiness, quality of life, mood disturbance and reduced cognitive functions. Eight classes of treatments (behavioral or cognitive‐behavioral therapy for insomnia administered either face‐to‐face individually or in group setting or through self‐help/internet) and 8 classes of control interventions (waiting list, treatment as usual, active contact control, sleep hygiene education, pharmacological interventions for insomnia or other condition, pharmacological placebo, psychological placebo, behavioral and psychological interventions) were identified in the network. Risk of bias was assessed through the Cochrane Collaboration's Tool. Cohen′s d at 95% confidence interval (CI) was calculated to assess the effect sizes of each class as compared with waiting list. Results: Fifty‐eight studies met inclusion criteria. Risk of bias assessment indicated a possible high risk of attrition bias in our sample of studies. For fatigue as outcome, no significant effect was found (for all comparisons in the network p > 0.05). Results showed significant effects for self‐help cognitive‐behavioral therapy for insomnia on quality of life (d = 0.25, 95% CI: 0.07; 0.42) and depressive symptoms (d = ‐0.24, 95% CI: ‐0.45; ‐0.02) and individual faceto‐face behavioral therapy for insomnia on depressive symptoms (d = ‐0.73, 95% CI: ‐1.45; ‐0.02). Conclusions: Preliminary findings suggest potential effects of individual face‐to‐face behavioral therapy on depressive symptoms and potential effects of self‐help cognitive‐behavioral therapy on depressive symptoms and quality of life. Disclosure: Nothing to disclose.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
