Comparative efficacy and acceptability of psychotherapies, pharmacotherapies, and their combination for the treatment of adult insomnia: A systematic review and network meta-analysis

Ye Zhang; Rong Ren; Linghui Yang; Haipeng Zhang; Yuan Shi; Jie Shi; Larry D Sanford; Lin Lu; Michael V Vitiello; Xiangdong Tang

doi:10.1016/j.smrv.2022.101687

Comparative efficacy and acceptability of psychotherapies, pharmacotherapies, and their combination for the treatment of adult insomnia: A systematic review and network meta-analysis

Sleep Med Rev. 2022 Oct:65:101687. doi: 10.1016/j.smrv.2022.101687. Epub 2022 Aug 12.

Authors

Ye Zhang¹, Rong Ren², Linghui Yang¹, Haipeng Zhang¹, Yuan Shi¹, Jie Shi³, Larry D Sanford⁴, Lin Lu³, Michael V Vitiello⁵, Xiangdong Tang⁶

Affiliations

¹ Sleep Medicine Center, Department of Respiratory and Critical Care Medicine, Mental Health Center, Translational Neuroscience Center, And State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China.
² Sleep Medicine Center, Department of Respiratory and Critical Care Medicine, Mental Health Center, Translational Neuroscience Center, And State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China. Electronic address: 498880651@qq.com.
³ National Institute on Drug Dependence, Peking University Sixth Hospital, Peking University, Beijing, 100191, China.
⁴ Sleep Research Laboratory, Center for Integrative Neuroscience and Inflammatory Diseases, Department of Pathology and Anatomy, Eastern Virginia Medical School, Norfolk, VA, USA.
⁵ Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, 98195-6560, USA.
⁶ Sleep Medicine Center, Department of Respiratory and Critical Care Medicine, Mental Health Center, Translational Neuroscience Center, And State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China. Electronic address: 2372564613@qq.com.

PMID: 36027795
DOI: 10.1016/j.smrv.2022.101687

Abstract

This study aims to explore the comparative efficacy and acceptability of psychotherapies, pharmacotherapies, and their combinations for insomnia. MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, PsycINFO, CINAHL, and ClinicalTrials.gov were searched for randomized clinical trials (RCTs) examining the comparative efficacy in which a psychotherapy and a pharmacotherapy for insomnia were directly compared with each other, or in which a combination of psychotherapy and pharmacotherapy was compared with either alone. The analysis included data from 23 RCTs. In 18 of 23 studies, cognitive behavior therapy for insomnia (CBT-I) was the psychotherapy. At post-treatment, CBT-I showed higher subjective sleep efficiency (SE), and lower subjective wake time after sleep onset (WASO) and insomnia severity index (ISI) score. Compared with CBT-I plus pharmacotherapy, pharmacotherapy showed lower subjective SE, and higher subjective sleep latency (SL), PSG measured SL, subjective WASO, and ISI score. Overall, the findings derived from post-treatment data suggested that CBT-I is more beneficial in treating insomnia compared with pharmacotherapy. CBT-I combined with pharmacotherapy is beneficial in improving some sleep parameters (i.e., subjective SE, SL, WASO, and PSG measured SL) compared with pharmacotherapy alone. Daily clinical decisions should consider these findings on the relative efficacy of the principal approaches to insomnia treatment.

Keywords: Behavior therapy; Cognitive behavior therapy; Cognitive therapy; Insomnia; Pharmacotherapy; Psychotherapy.

Publication types

Meta-Analysis
Review
Systematic Review
Research Support, Non-U.S. Gov't

MeSH terms

Adult
Cognitive Behavioral Therapy*
Humans
Network Meta-Analysis
Psychotherapy
Sleep
Sleep Initiation and Maintenance Disorders* / drug therapy
Treatment Outcome