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Efficacy of cognitive behavioral therapy for comorbid insomnia: a meta-analysis

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Abstract

Although cognitive behavioral therapy (CBT-I) has been recommended for the treatment of insomnia comorbid with psychiatric disorders and medical diseases, the effectiveness of CBT-I in such cases remains to be established. To fill this gap in the literature, we conducted a meta-analysis on the efficacy of CBT-I in the remediation of insomnia severity, important disease-related symptoms, and quality of life (QoL) in comorbid insomnia. A comprehensive literature search identified 30 randomized controlled trials (RCT) that were eligible for inclusion in the final analyses. Effect sizes were computed with Hedges’g, and study quality was evaluated using the Jadad scale. Analysis revealed that the effect sizes of the treatment were medium to large for important disease-related symptoms (g = 0.60), insomnia severity (g = 0.94), subjective and objective sleep onset latency (g = 0.65 and g = 0.51, respectively), subjective waking after sleep onset (g = 0.61), subjective and objective sleep efficiency (g = 0.83 and g = 0.48, respectively), and sleep quality (g = 0.80), but was small for health-related QoL (g = 0.34) compared with a control group. At follow-up, the effect sizes of CBT-I were large for all outcome variables, but several large and significant heterogeneities were confirmed. CBT-I is an effective treatment for reducing the severity of insomnia and important disease-related symptoms of comorbid insomnia.

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Authors and Affiliations

  1. Faculty of Human Sciences, Waseda University, 2-579-15 Mikashima, Tokorozawa, 359-1192, Saitama, Japan

    Isa Okajima

  2. Japan Somnology Center, Institute of Neuropsychiatry, Tokyo, Japan

    Yuichi Inoue

  3. Department of Somnology, Tokyo Medical University, Tokyo, Japan

    Yuichi Inoue

  4. Yoyogi Sleep Disorder Center, Tokyo, Japan

    Yuichi Inoue

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  1. Isa Okajima
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  2. Yuichi Inoue
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Correspondence to Isa Okajima.

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Funding

This work was partially supported by a Grant-in-Aid for Scientific Research (C) (KAKENHI) awarded by the Japan Society for the Promotion of Science (JSPS, Grant Number 16K04388). The study was not registered as a clinical trial.

Ethical approval

This study was registered on the UMIN-CTR website (No. UMIN000015172) to meet this criterion of the International Committee of Medical Journal Editors (ICMJE).

Research involving human participants

This study is to review the published literatures involving human participants. The study was not registered as a clinical trial.

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The authors have no disclosures or conflicts of interest to declare.

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Okajima, I., Inoue, Y. Efficacy of cognitive behavioral therapy for comorbid insomnia: a meta-analysis. Sleep Biol. Rhythms 16, 21–35 (2018). https://doi.org/10.1007/s41105-017-0124-8

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