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

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.