Do evidence based interventions for chronic fatigue syndrome improve sleep? A systematic review and narrative synthesis

Abstract

SummaryCognitive behavioural therapy (CBT) and graded exercise therapy (GET) are recommended evidence based treatments for chronic fatigue syndrome (CFS), with research supporting their effectiveness in reducing fatigue and functional impairment. However, little research has focussed on the effect of these treatments on sleep, despite high reported sleep disturbance in CFS. Using a narrative synthesis approach, we aimed to 1) Systematically identify and summarise the current evidence for the effectiveness of CBT and GET in improving sleep; 2) Consider factors influencing treatment effectiveness, including incorporation of sleep management techniques; and 3) Consider the appropriateness of sleep outcome measures used within evaluations. Studies evaluating CBT and/or GET for CFS, and including a sleep outcome were eligible for inclusion. Eight studies were identified.We found that that GET interventions can improve sleep but this effect is inconsistent across studies.For CBT the evidence is limited with only one of two evaluations demonstrating sleep-related improvements. We conclude from existing research that we know little about the effects of including sleep management components within CBT and GET interventions. We suggest that future research should explore the effectiveness of sleep components within interventions, and sleep specific interventions, using comprehensive outcome measures that fully capture the range of sleep difficulties experienced in CFS.

The Relationship Between Improvement in Insomnia Severity and Long-Term Outcomes in the Treatment of Chronic Fatigue

“…Moreover, these studies did not report analyses regarding the relationship between improvement in sleep and improvement primary outcomes. A recent systematic review focusing on the effect of CBT and GET on sleep in patients with CFS ( Russell et al, 2017 ), points to a need to further understand whether improved sleep may be one mechanism by which treatments influence symptoms and daytime functioning.…”

Digital cognitive behaviour therapy for insomnia in individuals with self‐reported insomnia and chronic fatigue: A secondary analysis of a large scale randomized controlled trial

“…Also, insomnia was determined by the ISI rather than clinical diagnostic assessment. Because most existing studies that report outcomes of sleep in participants with CF have employed a brief sleep measure (Jenkins et al, 1988; Russell et al, 2017), the ISI as an outcome measure is a strength of our study and it is a recommended outcome in insomnia research (Bastien et al, 2001; Riemann et al, 2017). Another limitation is that we did not screen participants specifically for restless legs syndrome.…”

Neurologic Manifestations of Systemic Disease: Sleep Disorders

“…One syndrome with possible autoimmune origins is chronic fatigue syndrome. Sleep disturbances, insomnia, and unrefreshing sleep are common symptoms, yet patients rarely report relief despite appropriate identification and treatment of comorbid sleep disorders [62]. Cognitive-behavioral therapy (CBT) and graded exercise therapy are commonly pursued treatment approaches [62].…”