Comparative effectiveness of digital cognitive behavioral therapy for insomnia in adults: a systematic review and meta-analysis
This study aims to assess the efficacy of Digital cognitive behavioral therapy (dCBT-i) as an alternative treatment for primary insomnia patients. A systematic review of PubMed, EMBASE, and CENTRAL databases was conducted until May 2023. Randomized controlled trials comparing dCBT-i with control arms were included. Treatment effects on Insomnia Severity Index (ISI), Sleep Condition Indicator (SCI), Sleep Onset Latency (SOL), Wake After Sleep Onset (WASO), and Pittsburgh Sleep Quality Index (PSQI) scores were analyzed using pairwise meta-analysis and Bayesian network meta-analysis (NMA). Mean Difference (MD) was used to integrate the outcomes but for varying evaluation indexes such as PSQI, Standardized Mean Difference (SMD) was used. Nine studies were included in the meta-analysis, showing dCBT-i significantly reduced ISI scores (MD -3.99; 95% Confidence interval (CI) -4.85 to -3.14) and increased SCI values (4.94; 4.50 to 5.38) compared to control groups in the short-term analysis. Similarly, the long-term analysis demonstrated significant results for ISI (-3.80; -5.08 to -2.53) and SCI (5.06; 4.35 to 5.76). NMA results indicated dCBT-i significantly outperformed sleep education for ISI (-3.50; 95% Credible interval (CrI): -7.12 to -0.03) and had the highest probability of being the most effective treatment overall. DCBT-i consistently demonstrated significant improvements in insomnia treatment, suggesting its efficacy as an alternative therapy.
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