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

Abstract

Study objectives: Insomnia affects up to 50% of patients with cardiovascular diseases (CVD) 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 on the effects of CBT-I in patients with established CVD. We aimed to investigate the effects of CBT-I on insomnia symptom severity, sleep parameters, and daytime symptoms in patients with CVD 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 co-authors. Data were meta-analyzed using random-effects models.

Results: In all, 1275 records with five studies fulfilled the inclusion criteria (n=352 patients). Compared with active control groups, CBT-I significantly reduced insomnia severity post-treatment (standardized mean difference [SMD] = -0.90, 95%CI: -1.43, -0.37, p < .001), sleep onset latency (SOL), anxiety, and fatigue. Moreover, CBT-I significantly improved sleep quality (SMD = -0.77, 95%CI: -1.10, -0.45, p < .001) and sleep efficiency (SMD = 0.68, 95%CI: 0.12-1.25, p < .001). We regarded three RCTs 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 CVD patients, 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.

Systematic review registration: Registry: PROSPERO; Identifier: CRD4202448873; Title: Effects of cognitive behavioral therapy for insomnia in patients with coronary heart disease: A systematic review; URL: https://www.crd.york.ac.uk/PROSPERO/view/CRD42024488739.