Efficacy of cognitive behavioral therapy in children and adolescents with insomnia: a systematic review and meta-analysis

Insomnia is highly prevalent in children and adolescents. However, the efficacy of cognitive behavioral therapy for insomnia (CBT-i) in children and adolescents remains controversial. Therefore, this systematic review and meta-analysis aimed to assess the efficacy of CBT-i in children and adolescents. We conducted a search of PubMed, EMBASE, the Cochrane Central Register of Controlled Trials, CINAHL, and PsycINFO to select primary studies evaluating CBT-i in children and adolescents that were primarily diagnosed through standardized diagnostic criteria. The primary outcomes of the meta-analysis included sleep onset latency (SOL), wake after sleep onset (WASO), total sleep time (TST), and sleep efficiency (SE%). Six randomized controlled trials and four open-label trials met all inclusion criteria. A total of 464 participants (ranging from 5–19 years of age) were included. Based on the results from sleep logs, a significant pooled effect size was observed for SOL and SE%. However, no significant pooled effect size was found for WASO or TST. Results from actigraphy were consistent with the sleep logs. A significant pooled effect size was observed for SOL and SE%, and no significant pooled effect size was found for WASO or TST. CBT-i might be effective in the treatment of children and adolescents with insomnia.

失眠在儿童与青少年群体中具有极高的患病率。然而，针对儿童青少年群体的失眠认知行为疗法（Cognitive Behavioral Therapy for Insomnia, CBT-i）的疗效仍存在争议。为此，本系统综述与荟萃分析旨在评估CBT-i用于儿童青少年失眠的临床疗效。我们通过检索PubMed、EMBASE、Cochrane对照试验中心注册库、CINAHL及PsycINFO数据库，筛选出以标准化诊断标准确诊的、评估CBT-i用于儿童青少年失眠的原始研究。本次荟萃分析的主要结局指标包括睡眠潜伏期（Sleep Onset Latency, SOL）、睡眠后觉醒时长（Wake After Sleep Onset, WASO）、总睡眠时间（Total Sleep Time, TST）以及睡眠效率（Sleep Efficiency, SE%）。共有6项随机对照试验与4项开放标签试验符合全部纳入标准，共纳入464名年龄介于5至19岁的受试者。基于睡眠日志的分析结果显示，睡眠潜伏期与睡眠效率的合并效应量具有统计学显著性，但睡眠后觉醒时长与总睡眠时间的合并效应量未达统计学显著性。体动记录仪的检测结果与睡眠日志结果一致，同样显示睡眠潜伏期与睡眠效率的合并效应量具有统计学显著性，而睡眠后觉醒时长与总睡眠时间的合并效应量未达统计学显著性。综上提示，CBT-i或可有效治疗儿童青少年群体的失眠症状。