Telemedicine and insomnia: a comprehensive systematic review and meta-analysis

Sharafkhaneh, Amir; Salari, Nader; Khazaie, Sepideh; Ghasemi, Hooman; Darvishi, Niloofar; Hosseinian-Far, Amin; Mohammadi, Masoud; Khazaie, Habibolah

doi:10.1016/j.sleep.2022.01.016

Cited by 17 publications

(4 citation statements)

References 54 publications

(105 reference statements)

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“…Systematic reviews suggest that internet-based CBT-I has medium to large effects on sleep outcomes among youth and adults [ 30 , 31 ]. Meta-analyses indicate that digitally delivered CBT and telemedicine-based CBT are noninferior to face-to-face CBT [ 32 , 33 ]; however, only a small number of randomized controlled trials (RCTs) directly comparing 2 treatments were available to be included to pool the effects (n=4 and n=2). A recent systematic review of mobile phone sleep interventions demonstrated the effectiveness of mobile health technologies for improving sleep [ 34 ].…”

Section: Introductionmentioning

confidence: 99%

eHealth-Based Psychosocial Interventions for Adults With Insomnia: Systematic Review and Meta-analysis of Randomized Controlled Trials

Deng¹,

Kleij²,

Shen³

et al. 2023

J Med Internet Res

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Background Worldwide, insomnia remains a highly prevalent public health problem. eHealth presents a novel opportunity to deliver effective, accessible, and affordable insomnia treatments on a population-wide scale. However, there is no quantitative integration of evidence regarding the effectiveness of eHealth-based psychosocial interventions on insomnia. Objective We aimed to evaluate the effectiveness of eHealth-based psychosocial interventions for insomnia and investigate the influence of specific study characteristics and intervention features on these effects. Methods We searched PubMed, Embase, Web of Science, PsycINFO, and the Cochrane Central Register of Controlled Trials from database inception to February 16, 2021, for publications investigating eHealth-based psychosocial interventions targeting insomnia and updated the search of PubMed to December 6, 2021. We also screened gray literature for unpublished data. Eligible studies were randomized controlled trials of eHealth-based psychosocial interventions targeting adults with insomnia. Random-effects meta-analysis models were used to assess primary and secondary outcomes. Primary outcomes were insomnia severity and sleep quality. Meta-analyses were performed by pooling the effects of eHealth-based psychosocial interventions on insomnia compared with inactive and in-person conditions. We performed subgroup analyses and metaregressions to explore specific factors that affected the effectiveness. Secondary outcomes included sleep diary parameters and mental health–related outcomes. Results Of the 19,980 identified records, 37 randomized controlled trials (13,227 participants) were included. eHealth-based psychosocial interventions significantly reduced insomnia severity (Hedges g=−1.01, 95% CI −1.12 to −0.89; P<.001) and improved sleep quality (Hedges g=−0.58, 95% CI −0.75 to −0.41; P<.001) compared with inactive control conditions, with no evidence of publication bias. We found no significant difference compared with in-person treatment in alleviating insomnia severity (Hedges g=0.41, 95% CI −0.02 to 0.85; P=.06) and a significant advantage for in-person treatment in enhancing sleep quality (Hedges g=0.56, 95% CI 0.24-0.88; P<.001). eHealth-based psychosocial interventions had significantly larger effects (P=.01) on alleviating insomnia severity in clinical samples than in subclinical samples. eHealth-based psychosocial interventions that incorporated guidance from trained therapists had a significantly greater effect on insomnia severity (P=.05) and sleep quality (P=.02) than those with guidance from animated therapists or no guidance. Higher baseline insomnia severity and longer intervention duration were associated with a larger reduction in insomnia severity (P=.004). eHealth-based psychosocial interventions significantly improved each secondary outcome. Conclusions eHealth interventions for insomnia are effective in improving sleep and mental health and can be considered a promising treatment for insomnia. Our findings support the wider dissemination of eHealth interventions and their further promotion in a stepped-care model. Offering blended care could improve treatment effectiveness. Future research needs to elucidate which specific intervention components are most important to achieve intervention effectiveness. Blended eHealth interventions may be tailored to benefit people with low socioeconomic status, limited access to health care, or lack of eHealth literacy.

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Section: Introductionmentioning

confidence: 99%

eHealth-Based Psychosocial Interventions for Adults With Insomnia: Systematic Review and Meta-analysis of Randomized Controlled Trials

Deng¹,

Kleij²,

Shen³

et al. 2023

J Med Internet Res

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“…Our analyses and current evidence [14][15][16][17] indicate that guided and unguided iCBT-I should be considered to improve the dissemination of CBT-I in routine care. In line with the literature, medium effect sizes were found for most subjective sleep-related outcomes for guided and unguided iCBT-I.…”

Section: Discussionmentioning

confidence: 80%

“…These proposed settings range from self-help programs, such as internet-delivered CBT-I (iCBT-I) or bibliotherapy to settings where patients and therapists communicate via video or chat. Pairwise meta-analyses provide preliminary support for some of these alternative settings [14][15][16][17] . However, evidence comparing alternative CBT-I settings to the first-line way of providing CBT-I in an individual onsite setting is scarce.…”

mentioning

confidence: 92%

Comparative efficacy of onsite, digital, and other settings for cognitive behavioral therapy for insomnia: a systematic review and network meta-analysis

Simon

Steinmetz

Feige

et al. 2023

Sci Rep

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Given the limited availability and accessibility of onsite cognitive behavioral therapy for insomnia (CBT-I), other CBT-I settings, such as internet-delivered CBT-I (iCBT-I), have been proposed. The primary aim of the study was to compare the efficacy of available CBT-I settings on insomnia severity. A systematic review and frequentist network meta-analysis of available CBT-I settings was performed. PsycINFO, PsycARTICLES, MEDLINE, PubMed, and CINAHL were searched for randomized controlled trials (RCTs) investigating any CBT-I settings in adults with insomnia disorder. The systematic literature search (3851 references) resulted in 52 RCTs. For the primary outcome insomnia severity, all examined CBT-I settings except smartphone-delivered CBT-I yielded significant effects when compared to WL. Large standardized mean differences were found for individual onsite CBT-I (− 1.27;95%CI − 1.70, − 0.84), group-delivered CBT-I (− 1.00;95%CI − 1.42. − 0.59), telehealth (− 1.28;95%CI − 2.06, − 0.50), and guided bibliotherapy (− 0.99;95%CI − 1.67, − 0.32). Both guided iCBT-I (− 0.71;95%CI − 1.18, − 0.24) and unguided iCBT-I (− 0.78;95%CI − 1.18, − 0.38) yielded medium effect sizes. The results underline that health care systems should intensify their efforts to provide synchronously-delivered CBT-I (individual onsite, group-delivered, and telehealth), and particularly individual onsite CBT-I, given its solid evidence base. Medium to large effect sizes for iCBT-I and guided bibliotherapy indicate that self-help settings may be a viable alternative when synchronously-delivered CBT-I is not available.

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“…Therefore, insomnia disorder and insomnia symptoms are two different concepts, however, they are often confusingly referred to as "patients with insomnia". Indeed, there are several RCT and SR abstracts in which readers cannot determine whether participants had insomnia disorder or insomnia symptoms (insomnia concept) [5,6,[12][13][14][15][16][17][18]. When the study description provided in the abstract is unclear, the abstract results may be misinterpreted.…”

Section: Introductionmentioning

confidence: 99%

Unclear Insomnia Concept in Randomized Controlled Trials and Systematic Reviews: A Meta-Epidemiological Study

Banno

Tsujimoto

Kohmura³

et al. 2022

IJERPH

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There are two possible ways to conceptualize the term “insomnia”: insomnia disorder and insomnia symptoms, which are often poorly reported. The purpose of this study was to examine the proportion of randomized controlled trials (RCTs) and systematic reviews (SRs) that mention insomnia in their abstracts and cannot distinguish between insomnia disorder and insomnia symptoms from the abstract. We included RCT and SR articles that included the word “insomnia” in the methods or results sections of their structured abstracts, published after 2010. We searched PubMed using English language restrictions on 10 March 2022. From 1580 PubMed articles, we obtained 100 random samples each for eligible RCTs and SRs. The unclear insomnia concept accounted for 88% of the RCT abstracts and 94% of the SR abstracts. Among the RCT and SR abstracts with unclearness, the concept of insomnia was unclear in 27% of RCTs and 57% of SRs after investigating the full text. The concept of insomnia has been unclear in many RCTs and SRs abstracts. The authors of RCTs and SRs are recommended to state “insomnia disorder” or “insomnia symptoms” in the methods and results sections of their abstracts.

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Telemedicine and insomnia: a comprehensive systematic review and meta-analysis

Cited by 17 publications

References 54 publications

eHealth-Based Psychosocial Interventions for Adults With Insomnia: Systematic Review and Meta-analysis of Randomized Controlled Trials

eHealth-Based Psychosocial Interventions for Adults With Insomnia: Systematic Review and Meta-analysis of Randomized Controlled Trials

Comparative efficacy of onsite, digital, and other settings for cognitive behavioral therapy for insomnia: a systematic review and network meta-analysis

Unclear Insomnia Concept in Randomized Controlled Trials and Systematic Reviews: A Meta-Epidemiological Study

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