Internet-Delivered Cognitive Behavioral Therapy to Treat Insomnia: A Systematic Review and Meta-Analysis.
Internet-Delivered Cognitive Behavioral Therapy to Treat Insomnia: A Systematic Review and Meta-Analysis.
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DOI：
10.1371/journal.pone.0149139
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发表时间：
2016
期刊：
影响因子：
3.7
通讯作者：
Rogers MA
中科院分区：
文献类型：
--
作者：
Seyffert M;Lagisetty P;Landgraf J;Chopra V;Pfeiffer PN;Conte ML;Rogers MA
健康是公共卫生的重要组成部分。虽然认知行为疗法是有益的，但面对面的治疗往往是不可用的。我们评估了互联网提供的认知行为疗法对失眠的有效性。主要目的是确定失眠的在线认知行为疗法是否可以提高睡眠效率并降低成人失眠的严重程度。次要结果包括睡眠质量、总睡眠时间、卧床时间、入睡潜伏期、入睡后觉醒时间和夜间觉醒次数。我们检索了PubMed/MEDLINE、护理和相关健康文献累积索引、PsycInfo、科克伦图书馆、Embase和Web of Science中的随机试验。如果研究是在成人中进行的随机对照试验，报告了通过互联网提供的认知行为疗法对失眠症的应用，则这些研究是合格的。使用随机效应荟萃分析的Hartung-Knapp-Sidik-Jonkman方法计算睡眠指标改善的平均差异。我们发现了15项试验，均采用了前测-后测随机对照组设计。基线时的睡眠效率为72%，与对照组相比，互联网提供的认知行为治疗改善了7.2%（95% CI：5.1%，9.3%; p<0.001）。与对照组相比，互联网提供的认知行为治疗导致失眠严重程度指数降低4.3分（95% CI：-7.1，-1.5; p = 0.017）。基线时总睡眠时间平均为5.7小时，与对照组相比，互联网治疗增加了20分钟（95% CI：9，31; p = 0.004）。与对照组相比，接受互联网提供的认知行为治疗的个体的抑郁严重程度降低了2.3分（95% CI：-2.9，-1.7; p = 0.013）。在治疗后评估后4至48周，通过互联网提供的认知行为疗法，睡眠效率、失眠严重程度指数和抑郁评分的改善得以维持。在睡眠效率、总睡眠时间和失眠严重程度指数方面，互联网治疗与接受过培训的治疗师亲自治疗之间没有统计学显著差异。总之，互联网提供的认知行为疗法在改善成人失眠症患者的睡眠方面是有效的。应努力教育公众，扩大获得这种疗法的机会。注册号，Prospero：CRD 42015017622
Insomnia is of major public health importance. While cognitive behavioral therapy is beneficial, in-person treatment is often unavailable. We assessed the effectiveness of internet-delivered cognitive behavioral therapy for insomnia. The primary objectives were to determine whether online cognitive behavioral therapy for insomnia could improve sleep efficiency and reduce the severity of insomnia in adults. Secondary outcomes included sleep quality, total sleep time, time in bed, sleep onset latency, wake time after sleep onset, and number of nocturnal awakenings. We searched PubMed/MEDLINE, the Cumulative Index to Nursing and Allied Health Literature, PsycInfo, Cochrane Library, Embase, and the Web of Science for randomized trials. Studies were eligible if they were randomized controlled trials in adults that reported application of cognitive behavioral therapy for insomnia via internet delivery. Mean differences in improvement in sleep measures were calculated using the Hartung-Knapp-Sidik-Jonkman method for random effects meta-analysis. We found 15 trials, all utilizing a pretest-posttest randomized control group design. Sleep efficiency was 72% at baseline and improved by 7.2% (95% CI: 5.1%, 9.3%; p<0.001) with internet-delivered cognitive behavioral therapy versus control. Internet-delivered cognitive behavioral therapy resulted in a decrease in the insomnia severity index by 4.3 points (95% CI: -7.1, -1.5; p = 0.017) compared to control. Total sleep time averaged 5.7 hours at baseline and increased by 20 minutes with internet-delivered therapy versus control (95% CI: 9, 31; p = 0.004). The severity of depression decreased by 2.3 points (95% CI: -2.9, -1.7; p = 0.013) in individuals who received internet-delivered cognitive behavioral therapy compared to control. Improvements in sleep efficiency, the insomnia severity index and depression scores with internet-delivered cognitive behavioral therapy were maintained from 4 to 48 weeks after post-treatment assessment. There were no statistically significant differences between sleep efficiency, total sleep time, and insomnia severity index for internet-delivered versus in-person therapy with a trained therapist. In conclusion, internet-delivered cognitive behavioral therapy is effective in improving sleep in adults with insomnia. Efforts should be made to educate the public and expand access to this therapy. Registration Number, Prospero: CRD42015017622