Journal Article

Effectiveness of Exercise, Cognitive Behavioral Therapy, and Pharmacotherapy on Improving Sleep in Adults with Chronic Insomnia: A Systematic Review and Network Meta-Analysis of Randomized Controlled Trials

Li, Shirley X., Bernal, Joshua D. K., Yu, Danny J., Chan, Rachel N. Y., Siu, Parco M., Recchia, Francesco, Fong, Daniel Y., Hu, Xiaoqing, Yu, Angus P.

2023

Overview

Despite the well-established treatment effectiveness of exercise, cognitive behavioral therapy for insomnia (CBT-I), and pharmacotherapy on improving sleep, there have been no studies to compare their long-term effectiveness, which is of clinical importance for sustainable management of chronic insomnia. This study compared the long-term effectiveness of these three interventions on improving sleep in adults with chronic insomnia. MEDLINE, PsycINFO, Embase, and SPORTDiscus were searched for eligible reports. Trials that investigated the long-term effectiveness of these three interventions on improving sleep were included. The post-intervention follow-up of the trial had to be ≥6 months to be eligible. The primary outcome was the long-term effectiveness of the three interventions on improving sleep. Treatment effectiveness was the secondary outcome. A random-effects network meta-analysis was carried out using a frequentist approach. Thirteen trials were included in the study. After an average post-intervention follow-up period of 10.3 months, both exercise (SMD, −0.29; 95% CI, −0.57 to −0.01) and CBT-I (−0.48; −0.68 to −0.28) showed superior long-term effectiveness on improving sleep compared with control. Temazepam was the only included pharmacotherapy, which demonstrated superior treatment effectiveness (−0.80; −1.25 to −0.36) but not long-term effectiveness (0.19; −0.32 to 0.69) compared with control. The findings support the use of both exercise and CBT-I for long-term management of chronic insomnia, while temazepam may be used for short-term treatment.

• Publisher: MDPI AG,MDPI
• Subject: Aerobics / Behavior modification / Care and treatment / Clinical medicine / Clinical trials / Cognitive behavioral therapy / Cognitive therapy / Comorbidity / Drug therapy / Evaluation / Exercise / Exercise therapy / Hypnotics / Insomnia / Intervention / Medical research / Mental disorders / Meta-analysis / Physical fitness / Psychiatric research / Sedatives / Sleep / Systematic Review / Testing