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Study Objectives: <p>Insomnia affects up to 50% of patients with cardiovascular disease and is associated with poor clinical outcomes. Cognitive behavioral therapy for insomnia (CBT-I) is the recommended first-line treatment for insomnia, but little is known about the effects of CBT-I in patients with established cardiovascular disease. We aimed to investigate the effects of CBT-I on insomnia symptom severity, sleep parameters, and daytime symptoms in patients with cardiovascular disease and comorbid insomnia.</p> Methods: <p>Medline, Embase, PsycINFO, and ClinicalTrials.gov were searched for randomized controlled and open trials up to December 2023. Study selection, data extraction, and risk of bias assessment (Cochrane’s Risk of Bias 2 tool) were independently conducted by the authors. Data were meta-analyzed using random-effects models.</p> Results: <p>In all, 1,275 records with 5 studies fulfilled the inclusion criteria (n = 352 patients). Compared with active control groups, CBT-I significantly reduced insomnia severity posttreatment (standardized mean difference = −0.90, 95% confidence interval: −1.43, −0.37; <i>P</i> &lt; .001), sleep onset latency, anxiety, and fatigue. Moreover, CBT-I significantly improved sleep quality (standardized mean difference = −0.77, 95% confidence interval: −1.10, −0.45; <i>P</i> &lt; .001) and sleep efficiency (standardized mean difference = 0.68, 95% confidence interval: 0.12–1.25; <i>P</i> &lt; .001). We regarded 3 randomized controlled trials as having low risk of bias and had some concerns with another.</p> Conclusions: <p>Evidence from our analyses indicated that CBT-I seems to be effective for alleviating insomnia symptoms among patients with cardiovascular disease, largely in line with the results of previous meta-analyses in patients with insomnia. The limited sample size encourages more robust evidence from high-quality, large-scale trials with long-term follow-up.</p> Citation: <p>Andersen SG, Sæterhagen H, Pacheco AP, et&#xa0;al. The effects of cognitive behavioral therapy for insomnia in patients with cardiovascular disease: a systematic review and meta-analysis. <i>J Clin Sleep Med.</i> 2025;21(7):1273–1284.</p>

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The effects of cognitive behavioral therapy for insomnia in patients with cardiovascular disease: a systematic review and meta-analysis

  • 期刊论文

  • 发表日期：

    2025年7月1日

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  • Silje Glenna Andersen,
  • Henrik Sæterhagen,
  • André Pekkola Pacheco,
  • Are Hugo Pripp,
  • Harald Hrubos-Strøm,
  • Costas Papageorgiou,
  • John Munkhaugen,
  • Toril Dammen

摘要

Study Objectives:

Insomnia affects up to 50% of patients with cardiovascular disease and is associated with poor clinical outcomes. Cognitive behavioral therapy for insomnia (CBT-I) is the recommended first-line treatment for insomnia, but little is known about the effects of CBT-I in patients with established cardiovascular disease. We aimed to investigate the effects of CBT-I on insomnia symptom severity, sleep parameters, and daytime symptoms in patients with cardiovascular disease and comorbid insomnia.

Methods:

Medline, Embase, PsycINFO, and ClinicalTrials.gov were searched for randomized controlled and open trials up to December 2023. Study selection, data extraction, and risk of bias assessment (Cochrane’s Risk of Bias 2 tool) were independently conducted by the authors. Data were meta-analyzed using random-effects models.

Results:

In all, 1,275 records with 5 studies fulfilled the inclusion criteria (n = 352 patients). Compared with active control groups, CBT-I significantly reduced insomnia severity posttreatment (standardized mean difference = −0.90, 95% confidence interval: −1.43, −0.37; P < .001), sleep onset latency, anxiety, and fatigue. Moreover, CBT-I significantly improved sleep quality (standardized mean difference = −0.77, 95% confidence interval: −1.10, −0.45; P < .001) and sleep efficiency (standardized mean difference = 0.68, 95% confidence interval: 0.12–1.25; P < .001). We regarded 3 randomized controlled trials as having low risk of bias and had some concerns with another.

Conclusions:

Evidence from our analyses indicated that CBT-I seems to be effective for alleviating insomnia symptoms among patients with cardiovascular disease, largely in line with the results of previous meta-analyses in patients with insomnia. The limited sample size encourages more robust evidence from high-quality, large-scale trials with long-term follow-up.

Citation:

Andersen SG, Sæterhagen H, Pacheco AP, et al. The effects of cognitive behavioral therapy for insomnia in patients with cardiovascular disease: a systematic review and meta-analysis. J Clin Sleep Med. 2025;21(7):1273–1284.