成人慢性失眠症长期缓解的初始治疗选择:系统综述和网络荟萃分析。

IF 5 3区 医学 Q1 CLINICAL NEUROLOGY
Psychiatry and Clinical Neurosciences Pub Date : 2024-11-01 Epub Date: 2024-08-26 DOI:10.1111/pcn.13730
Yuki Furukawa, Masatsugu Sakata, Toshiaki A Furukawa, Orestis Efthimiou, Michael Perlis
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引用次数: 0

摘要

背景:我们旨在评估失眠认知行为疗法(CBT-I)、药物疗法及其组合疗法在慢性失眠症成人患者中的长短期疗效比较和可接受性:我们检索了截至 2023 年 12 月 27 日的多个数据库。我们纳入了对不使用催眠药的慢性失眠症成人患者进行的至少两项 CBT-I、药物疗法或其组合的比较试验。我们使用 CINeMA 对证据的可信度进行了评估。主要结果是长期缓解。次要结果包括长期的全因辍学和自我报告的睡眠连续性测量,以及短期的相同结果。我们进行了频数随机效应网络荟萃分析(CRD42024505519):我们确定了 13 项试验,包括 823 名随机参与者(平均年龄 47.8 岁;60% 为女性)。从长期来看,CBT-I比药物疗法更有益(中位持续时间为24周[范围为12至48周];缓解几率比为1.82[95%置信区间(CI)为1.15-2.87];[证据确定性:高]),而综合疗法对药物疗法的益处(1.71[95% CI,0.88-3.30:中度])证据较弱,CBT-I对综合疗法无明显差异(1.07[95% CI,0.63-1.80:中度])。与药物疗法相比,CBT-I疗法的辍学率更低。除总睡眠时间外,CBT-I 的短期疗效优于药物疗法。鉴于药物治疗启动组的平均长期缓解率为 28%,CBT-I 的长期缓解率为 41%(95% CI,31%-53%),联合治疗的长期缓解率为 40%(95% CI,25%-56%):本研究发现,对慢性失眠症采用 CBT-I 疗法比药物疗法的疗效更好。联合疗法可能优于单独的药物疗法,但与单独的 CBT-I 相比,不太可能值得增加额外的负担。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Initial treatment choices for long-term remission of chronic insomnia disorder in adults: a systematic review and network meta-analysis.

Background: We aimed to evaluate the comparative efficacy and acceptability of cognitive behavioral therapy for insomnia (CBT-I), pharmacotherapy, and their combination in the long and short terms among adults with chronic insomnia disorder.

Methods: We searched multiple databases to December 27, 2023. We included trials in hypnotic-free adults with chronic insomnia comparing at least two of CBT-I, pharmacotherapy, or their combination. We assessed the confidence in evidence using CINeMA. The primary outcome was long-term remission. Secondary outcomes included all-cause dropout and self-reported sleep continuity measures in the long term, and the same outcomes in the short term. We performed frequentist random-effects network meta-analyses (CRD42024505519).

Findings: We identified 13 trials including 823 randomized participants (mean age, 47.8 years; 60% women). CBT-I was more beneficial than pharmacotherapy in the long term (median duration, 24 weeks [range, 12 to 48 weeks]; remission odds ratio, 1.82 [95% confidence interval (CI), 1.15-2.87]; [certainty of evidence: high]), while there was weaker evidence of benefit of combination against pharmacotherapy (1.71 [95% CI, 0.88-3.30: moderate]) and no clear difference of CBT-I against combination (1.07 [95% CI, 0.63-1.80: moderate]). CBT-I was associated with fewer dropouts than pharmacotherapy. Short-term outcomes favored CBT-I over pharmacotherapy except total sleep time. Given the average long-term remission rate in the pharmacotherapy-initiating arms of 28%, CBT-I resulted in a long-term remission rate of 41% (95% CI, 31%-53%) and combination 40% (95% CI, 25%-56%).

Interpretation: The current study found that starting with CBT-I for chronic insomnia leads to better outcomes than pharmacotherapy. Combination may be better than pharmacotherapy alone, but unlikely to be worth the additional burden over CBT-I alone.

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来源期刊
CiteScore
7.40
自引率
4.20%
发文量
181
审稿时长
6-12 weeks
期刊介绍: PCN (Psychiatry and Clinical Neurosciences) Publication Frequency: Published 12 online issues a year by JSPN Content Categories: Review Articles Regular Articles Letters to the Editor Peer Review Process: All manuscripts undergo peer review by anonymous reviewers, an Editorial Board Member, and the Editor Publication Criteria: Manuscripts are accepted based on quality, originality, and significance to the readership Authors must confirm that the manuscript has not been published or submitted elsewhere and has been approved by each author
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