单位：[1]Lanzhou Univ, Sch Basic Med Sci, Evidence Based Med Ctr, Lanzhou 730000, Peoples R China[2]McMaster Univ, Dept Hlth Res Methods Evidence & Impact, Hamilton, ON, Canada[3]Univ Cambridge, Sch Clin Med, Dept Publ Hlth & Primary Care, Primary Care Unit, Cambridge, England[4]Lanzhou Univ, Sch Nursing, Evidence Based Nursing Ctr, Lanzhou, Peoples R China[5]Peking Univ, Sch Nursing, Beijing, Peoples R China[6]Mianyang Hosp Tradit Chinese Med, Mianyang, Sichuan, Peoples R China[7]Peking Univ, Sch Publ Hlth, Dept Epidemiol & Biostat, Beijing, Peoples R China[8]Capital Med Univ, Beijing Friendship Hosp, Natl Clin Res Ctr Digest Dis, Beijing, Peoples R China首都医科大学附属北京友谊医院[9]Univ Hong Kong, Shenzhen Hosp, Shenzhen, Peoples R China[10]Tianjin Univ Tradit Chinese Med, Evidence Based Med Ctr, Tianjin, Peoples R China[11]Cent South Univ, Dept Breast Canc, Xiangya Hosp 2, Changsha, Hunan, Peoples R China[12]Chinese Acad Med Sci & Peking Union Med Coll, Canc Hosp, Natl Clin Res Ctr Canc, Natl Canc Ctr, Beijing, Peoples R China[13]Lanzhou Univ, Clin Med Coll 1, Lanzhou, Peoples R China[14]Indiana Univ Sch Med, Melvin & Bren Simon Comprehens Canc Ctr, Dept Biochem, Indianapolis, IN 46202 USA[15]Indiana Univ Sch Med, Melvin & Bren Simon Comprehens Canc Ctr, Dept Mol Biol, Indianapolis, IN 46202 USA[16]Gansu Univ Chinese Med, Sch Publ Hlth, Epidemiol & Evidence Based Med, Lanzhou, Peoples R China[17]Lanzhou Univ, Evidence Based Social Sci Res Ctr, Sch Publ Hlth, Lanzhou 730000, Peoples R China[18]Key Lab Evidence Based Med & Knowledge Translat G, Lanzhou, Peoples R China
Objective The aim of this study was to examine the most effective delivery format of cognitive behavioral therapy for insomnia (CBT-I) on insomnia in cancer patients. Methods We searched five databases up to February 2021 for randomized clinical trials that compared CBT-I with inactive or active controls for insomnia in cancer patients. Outcomes were insomnia severity, sleep efficiency, sleep onset latency (SOL), wake after sleep onset (WASO), and total sleep time (TST). Pairwise meta-analyses and frequentist network meta-analyses with the random-effects model were applied for data analyses. Results Sixteen unique trials including 1523 participants met inclusion criteria. Compared with inactive control, CBT-I could significantly reduce insomnia severity (mean differences [MD] = -4.98 points, 95% confidence interval [CI]: -5.82 to -4.14), SOL (MD = -12.29 min, 95%CI: -16.48 to -8.09), and WASO (MD = -16.58 min, 95%CI: -22.00 to -11.15), while increasing sleep efficiency (MD = 7.62%, 95%CI: 5.82% to 9.41%) at postintervention. Compared with active control, CBT-I could significantly reduce insomnia severity (MD = -2.75 points, 95%CI: -4.28 to -1.21), SOL (MD = -13.56 min, 95%CI: -18.93 to -8.18), and WASO (MD = -6.99 min, 95%CI: -11.65 to -2.32) at postintervention. These effects diminished in short-term follow-up and almost disappeared in long-term follow-up. Most of the results were rated as "moderate" to "low" certainty of evidence. Network meta-analysis showed that group CBT-I had an increase in sleep efficiency of 10.61%, an increase in TST of 21.98 min, a reduction in SOL of 14.65 min, and a reduction in WASO of 24.30 min, compared with inactive control at postintervention, with effects sustained at short-term follow-up. Conclusions CBT-I is effective for the management of insomnia in cancer patients postintervention, with diminished effects in short-term follow-up. Group CBT-I is the preferred choice based on postintervention and short-term effects. The low quality of evidence and limited sample size demonstrate the need for robust evidence from high-quality, large-scale trials providing long-term follow-up data.
基金：
Gansu Province Science and Technology Plan Funded Project [20CX4ZA027, 20CX9ZA112]; National Key Research and Development Program of China [2019YFC1709805]
第一作者单位：[1]Lanzhou Univ, Sch Basic Med Sci, Evidence Based Med Ctr, Lanzhou 730000, Peoples R China
通讯作者：
通讯机构：[1]Lanzhou Univ, Sch Basic Med Sci, Evidence Based Med Ctr, Lanzhou 730000, Peoples R China[17]Lanzhou Univ, Evidence Based Social Sci Res Ctr, Sch Publ Hlth, Lanzhou 730000, Peoples R China[18]Key Lab Evidence Based Med & Knowledge Translat G, Lanzhou, Peoples R China[*1]The Evidence-Based Medicine Centre, School of Basic Medical Sciences,Lanzhou University, Lanzhou 730000, China.[*2]The Evidence-Based Social Science Research Center, School of Public Health,Lanzhou University, Lanzhou 730000, China.
推荐引用方式(GB/T 7714)：
Gao Ya,Liu Ming,Yao Liang,et al.Cognitive behavior therapy for insomnia in cancer patients: a systematic review and network meta-analysis[J].JOURNAL OF EVIDENCE BASED MEDICINE.2022,doi:10.1111/jebm.12485.
APA：
Gao, Ya,Liu, Ming,Yao, Liang,Yang, Zhirong,Chen, Yamin...&Tian, Jinhui.(2022).Cognitive behavior therapy for insomnia in cancer patients: a systematic review and network meta-analysis.JOURNAL OF EVIDENCE BASED MEDICINE,,
MLA：
Gao, Ya,et al."Cognitive behavior therapy for insomnia in cancer patients: a systematic review and network meta-analysis".JOURNAL OF EVIDENCE BASED MEDICINE .(2022)
