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

Abstract

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.

Exercise therapy in the application of sleep disorders

“…Simple and brief exercise training demonstrated high acceptability and exercise adherence, proving effective in alleviating the severity of sleep disorders. Yu et al ( 88 )compared the long-term effects of exercise therapy, CBT-I, and pharmacotherapy on improving sleep in adult patients with chronic insomnia. Their findings suggested that both exercise and CBT-I manifested better long-term effects in improving sleep, while pharmacological interventions were less effective in the long run.…”

Aerobic exercise interventions to address impaired quality of life in patients with pituitary tumors

“…Furthermore, patients treated for pituitary macroadenomas or craniopharygniomas showed increased daytime somnolence despite normal sleeping patterns [26,27]. These patients may also benefit from aerobic exercise interventions, which have been shown in meta-analyses to positively impact disrupted sleep patterns in patients with chronic insomnia, as well as the elderly population as a whole [28,29]. No studies have been performed to date to analyze the impact of aerobic exercise on improvement of sleep quality after pituitary tumor surgery.…”