Cognitive behavioral therapy for insomnia (CBT-i) in patients with fibromyalgia: a systematic review and meta-analysis

Abstract

Purpose

We aimed to evaluate the effectiveness of CBT-i in patients with fibromyalgia in comparison with other non-pharmacological treatments.

Methods

Randomized controlled trials assessing the effects of CBT-i in adults with fibromyalgia, published in English or Spanish, were eligible. Electronic searches were performed using PubMed, Scopus, The Cochrane Library, WebOfKnowledge and Psicodoc databases in March 2021. The main outcome measures were sleep efficiency and sleep quality. Secondary outcomes included pain, depression, and anxiety.

Results

Of 226 studies reviewed, five were included in the meta-analysis. CBT-i compared with non-pharmacological treatments showed no significant improvements in sleep efficiency (p = 0.05; standardized mean difference (SMD) [95% CI] 0.31 [−0.00 to 0.61]). CBT-i showed significant improvements in sleep quality (p = 0.009; SMD [95% CI] − 0.53 [−0.93 to −0.13]), pain (p = 0.002; SMD [95% CI] − 0.41 [−0.67 to −0.16]), anxiety (p = 0.001; SMD [95% CI] − 0.46 [−0.74 to 0.18]) and depression (p = 0.02; SMD [95% CI] − 0.33 [−0.61 to −0.05]), compared to non-pharmacological treatments. Effect sizes ranged from small to moderate.

Conclusions

CBT-i was associated with a significant improvement in sleep quality, pain, anxiety, and depression, although these results are retrieved from very few studies with only very low to low quality evidence. Trial registration: The review protocol was registered with PROSPERO (Record ID = CRD42016030161).

IMPLICATIONS FOR REHABILITATION

• CBT-i has been proven to improve sleep quality, pain, anxiety and depression, although with small effect sizes.

• Implementing hybrid CBT for pain and sleep or combining CBT and mindfulness may improve symptoms in people diagnosed with FM.

• This meta-analysis results highlight the need to enhance sleep management skills among people suffering from this health condition.

Keywords:

• Fibromyalgia
• insomnia
• sleep
• poor sleep quality
• cognitive behavioral therapy for insomnia
• systematic review

Acknowledgements

This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

Disclosure statement

No potential conflict of interest was reported by the author(s).