Abstract

Summary The comparative efficacy of various approaches of digital cognitive behavioral therapy for insomnia (CBTi) is still unclear. This network meta-analysis explored the comparative efficacy of digital CBTi approaches in adults with insomnia. Four electronic databases were searched from inception to June 27, 2020. Primary outcomes were self-reported total sleep time (TST), sleep onset latency (SOL), wake after sleep onset (WASO), sleep efficiency (SE), and insomnia symptoms; these were measured using sleep diaries or valid questionnaires. A random-effects network meta-analysis in a frequentist framework was used. Fifty-four randomized controlled trials comprising 11,815 participants were included. Compared with usual care, web-based CBTi with a therapist demonstrated significantly longer TST (mean difference [MD]: 23.19 min, 95% confidence interval [CI]: 18.98 to 27.39 min), shorter SOL (MD: −18.76 min, 95% CI −24.20 to –13.31 min), lower WASO (MD: −31.40 min, 95% CI: −36.26 to −26.55 min), and greater SE (MD: 10.37%, 95% CI: 8.08% to 12.65%). The surface under the cumulative ranking curve indicates that web-based CBTi with therapists is most likely to be ranked the highest among all treatments, and thus, this network meta-analysis suggests that such a treatment is the optimal intervention for improving sleep duration and SE as well as the reductions in SOL and WASO. PROSPERO registration number CRD42020171134.
Original languageEnglish
Article number101567
JournalSleep Medicine Reviews
DOIs
Publication statusPublished - Nov 2021

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