Psychology Research and Behavior Management (Mar 2024)

The Effectiveness of Cognitive Behavioral Therapy-Based Intervention on Improving Sleep-Related Outcomes for People with Diabetes: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

  • Wang H,
  • Li R,
  • Ge L,
  • Xu F,
  • Wiley JA,
  • Tang S,
  • Sun M

Journal volume & issue
Vol. Volume 17
pp. 957 – 972

Abstract

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Hongjuan Wang,1 Rongzhi Li,1 Lin Ge,2 Fan Xu,1 James Allen Wiley,3 Siyuan Tang,1 Mei Sun1,4 1Xiangya School of Nursing, Central South University, Changsha, Hunan Province, People’s Republic of China; 2Department of Alcohol Addiction and Internet Addiction, Brain Hospital of Hunan Province (The Second People’s Hospital of Hunan Province), Changsha, Hunan Province, People’s Republic of China; 3Department of Family and Community Medicine and Institute for Health Policy Research, University of California, San Francisco, CA, USA; 4School of Nursing, Changsha Medical University, Changsha, Hunan Province, People’s Republic of ChinaCorrespondence: Siyuan Tang; Mei Sun, Xiangya School of Nursing, Central South University, Changsha, Hunan Province, 410013, People’s Republic of China, Email [email protected]; [email protected]: Sleep-related outcomes in people with diabetes are poor, which is closely linked to reducing the development of diabetes. Cognitive behavioral therapy (CBT) based intervention presents innovative solutions that can help improve sleep-related outcomes.Aim: This synthesis aims to assess the effectiveness of CBT-based intervention compared to controls in Randomized Controlled Trials (RCTs) for sleep-related outcomes among people with diabetes.Methods: Eight electronic databases were systematically searched: PubMed, EMBASE, Cochrane library, Web of Science, PsycINFO, CINAHL, China National Knowledge Infrastructure (CNKI), and Wan Fang database. We examined CBT-based intervention’s effectiveness on sleep-related outcomes in people with diabetes in RCTs identified in these databases from their inception to 1st November 2023, and updated on 15 January 2024. The risk of bias was assessed using the Cochrane Risk of Bias tool by two reviewers. The meta-analysis of included studies was conducted by RevMan 5.3 software.Results: Seven studies in total (n = 2633 participants) were included in this systematic review based on our inclusion criteria. The systematic review found CBT-based intervention significantly improved sleep quality (Pittsburgh Sleep Quality Index, PSQI scores) at immediate post-intervention [95% CI=(− 1.31 to -0.32), p = 0.001], six months [95% CI=(− 0.75 to − 0.22), p = 0.0003], and 12 months [95% CI=(− 0.72 to − 0.24), < 0.0001], compared to control groups. Furthermore, our findings demonstrated that six sessions [95% CI= (− 0.38 to − 0.13), p < 0.0001] or more than six sessions [95% CI=(− 1.76 to − 0.02), p = 0.05] of CBT-based intervention could improve sleep quality compared to controls (I2=0%). Interestingly, CBT-based intervention improves total sleep time at post-intervention in people with diabetes compared to the control group [95% CI= (− 0.57 to − 0.12), p = 0.003]. However, there was no significant that CBT-based intervention is beneficial to time to fall asleep [95% CI (− 1.89 to 0.43), p = 0.22] and sleep efficiency [95% CI (− 1.27 to 0.27), p = 0.20] after intervention, compared to control group.Conclusion: CBT-based intervention appears to have a beneficial effect on improving sleep quality and total sleep time among people with diabetes. CBT-based intervention could be considered a strategy among healthcare providers to enhance sleep quality and total sleep time for people with diabetes. More RCTs with rigorous designs and long-term follow-up are warranted to provide conclusive evidence of the CBT-based intervention on sleep-related outcomes and to explore the mechanisms by which the CBT-based interventions improve sleep-related outcomes.Keywords: diabetes, cognitive behavioral therapy, sleep, systematic review, meta-analysis

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