Cognitive behavioral therapy for insomnia (CBT-i) in patients with fibromyalgia: a systematic review and meta-analysis.
Level 1 - systematic review of randomized trials
Systematic review and meta-analysis of randomized controlled trials
PubMed 34297651 · doi:10.1080/09638288.2021.1954706
What was done
Authors conducted a systematic review and meta-analysis of randomized controlled trials assessing the effectiveness of cognitive behavioral therapy for insomnia (CBT-i) compared to other non-pharmacological treatments in adults with fibromyalgia. Searches were conducted across PubMed, Scopus, The Cochrane Library, WebOfKnowledge, and Psicodoc through March 2021 for studies published in English or Spanish. The primary outcomes were sleep efficiency and sleep quality; secondary outcomes were pain, depression, and anxiety.
What was found
Five RCTs were included from 226 screened records. Compared with non-pharmacological controls, CBT-i showed no statistically significant improvement in sleep efficiency (p = 0.05; standardized mean difference [SMD] 0.31, 95% CI -0.00 to 0.61). CBT-i produced significant small-to-moderate improvements in sleep quality (p = 0.009; SMD -0.53, 95% CI -0.93 to -0.13), pain (p = 0.002; SMD -0.41, 95% CI -0.67 to -0.16), anxiety (p = 0.001; SMD -0.46, 95% CI -0.74 to 0.18), and depression (p = 0.02; SMD -0.33, 95% CI -0.61 to -0.05).
Why it matters
This review indicates that insomnia-focused cognitive behavioral interventions can concurrently reduce pain and affective symptoms alongside improving sleep quality in patients with fibromyalgia.
Limits
The meta-analysis included only 5 studies and the overall evidence was rated as very low to low quality. Total participant sample size is not stated in the abstract. Improvements in sleep efficiency did not reach statistical significance, and searches were restricted to English and Spanish publications.
Cited by
- supports Cognitive Behavioral Therapy for Insomnia (CBT-I) is effective for treating insomnia in people with chronic pain, fibromyalgia, and cancer.