Cognitive Behavioral Therapy for Insomnia in People With Chronic Disease: A Systematic Review and Meta-Analysis.
Level 1 - systematic review of randomized trials
Systematic review and meta-analysis of 67 randomized clinical trials
PubMed 40982264 · doi:10.1001/jamainternmed.2025.4610
What was done
Systematic review and random-effects meta-analysis of randomized clinical trials (searches across PsycINFO, Medline, Embase, and CENTRAL up to June 5, 2025) evaluating the efficacy and acceptability of cognitive behavioral therapy for insomnia (CBT-I) in adults (≥18 years) with chronic diseases (such as cancer, chronic pain, irritable bowel syndrome, and stroke). Primary outcomes assessed using Hedges g were insomnia severity, sleep efficiency, and sleep onset latency; secondary outcomes were treatment acceptability (dropout rate) and adverse effects. Subgroup analyses evaluated delivery format, chronic condition type, and control group.
What was found
Across 67 RCTs (5,232 participants), CBT-I significantly improved: - Insomnia severity: Hedges g = 0.98 (95% CI, 0.81-1.16) - Sleep efficiency: Hedges g = 0.77 (95% CI, 0.63-0.91) - Sleep onset latency: Hedges g = 0.64 (95% CI, 0.50-0.78) Longer treatment duration predicted better outcomes for sleep efficiency and sleep onset latency. Mean dropout rate was 13.3%, and treatment-related adverse effects were rare.
Why it matters
Demonstrates that CBT-I is safe, highly acceptable, and yields moderate-to-large clinical improvements in insomnia among individuals with chronic medical comorbidities, with effect sizes comparable to general populations.
Limits
The abstract does not report specific heterogeneity (I²) values, risk of bias assessments across included trials, long-term durability of improvements, or breakdown by objective versus subjective sleep measures.
Cited by
- supports Cognitive Behavioral Therapy for Insomnia (CBT-I) is effective for treating insomnia in people with chronic pain, fibromyalgia, and cancer.