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

Zhong-Rui Ma,Ming-Hong Deng,Li-Jun Shi

doi:10.1590/1414-431x20187070

Abstract

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.

Highlights

Insomnia is highly prevalent in children and adolescents and has been associated with depression, anxiety, inattention problems, and poor school performance [1,2,3,4,5,6]
A significant pooled effect size was observed for sleep onset latency (SOL) (MD=–12.28, 95%confidence intervals (CIs), –20.85 to –3.72, P=0.005, I2=45%, Figure 2) and SE% (MD= 5.54, 95%CI, 0.98 to 10.09, P=0.0003, I2=68%, Figure 3), and no significant pooled effect sizes were found for wake after sleep onset (WASO) (MD=–2.86, 95%CI, –6.46 to 0.74, P=0.12, I2=0%, Figure 4) or total sleep time (TST) (MD=9.56, 95%CI, –5.78 to 24.90, P=0.22, I2=0%, Figure 5)
In this systematic review and meta-analysis, we identified seven eligible studies that assessed cognitive behavioral therapy for insomnia (CBT-i) on children and adolescents with insomnia

Summary

Introduction

Insomnia is highly prevalent in children and adolescents and has been associated with depression, anxiety, inattention problems, and poor school performance [1,2,3,4,5,6]. Recent studies suggest that 5–30% of primary schoolaged children, and 4–13% of adolescents experience symptoms of insomnia [3,7,8,9]. Chronic insomnia might result in deleterious effects on cognitive development, mood regulation, and attention, and produce negative effects on school performance [6,11]. In the newest ICSD-III, behavioral insomnia during childhood is included in the chronic insomnia disorder diagnosis, and the specific aspects of children are discussed within the text, such as limit-setting and sleep-onset association issues [13]. Therapeutic approaches for primary insomnia involve sleep hygiene routines, psychotherapy, and pharmacological treatment. Non-pharmacologic treatment options for insomnia in children and adolescents have become more important

Methods

Results

Conclusion