We recommend that clinicians use multi-component cognitive behavioral therapy for insomnia for the treatment of chronic insomnia disorder in adults. A "conditional" recommendation is one that requires that the clinician use clinical knowledge and experience, and to strongly consider the patient's values and preferences to determine the best course of action. A "strong" recommendation (ie, "We recommend…") is one that clinicians should follow under most circumstances. Each recommendation statement is assigned a strength ("strong" or "conditional"). The following recommendations are intended as a guide for clinicians in choosing a specific behavioral and psychological therapy for the treatment of chronic insomnia disorder in adult patients. The AASM Board of Directors approved the final recommendations.
The task force evaluated a summary of the relevant literature and the quality of evidence, the balance of clinically relevant benefits and harms, patient values and preferences, and resource use considerations that underpin the recommendations. The American Academy of Sleep Medicine (AASM) commissioned a task force of experts in sleep medicine to develop recommendations and assign strengths based on a systematic review of the literature and an assessment of the evidence using Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology. This guideline establishes clinical practice recommendations for the use of behavioral and psychological treatments for chronic insomnia disorder in adults. More research is needed, especially with respect to different medical and mental disorders and instructions accompanying the OLP administration as well as the role of expectations and mindsets. Thus, OLPs appear to be a promising treatment in different conditions but the respective research is in its infancy. We found a significant overall effect (standardized mean difference = 0.72, 95% Cl 0.39–1.05, p < 0.0001, I² = 76%) of OLP. Risk of bias was moderate among all studies. These trials assessed effects of OLPs on back pain, cancer-related fatigue, attention deficit hyperactivity disorder, allergic rhinitis, major depression, irritable bowel syndrome and menopausal hot flushes. Eleven trials were eligible for meta-analysis. 1246 records were screened and thirteen studies were included into the systematic review. Data extraction and risk of bias rating were independently assessed. Randomized controlled trials of any medical condition or mental disorder comparing OLPs to no treatment were included. A systematic literature search was carried out in February 2020. The objective of our study is to systematically review and analyze the effect of OLPs in comparison to no treatment in clinical trials. Open-label placebos (OLPs) are placebos without deception in the sense that patients know that they are receiving a placebo. Therefore, well-designed RCTs with larger sample sizes are required to confirm the clinical effects of MBSR in adults with sleep disturbances. In addition, more than half of the RCTs included in this review had small sample sizes and were vulnerable to performance and detection biases. MBSR might be ineffective for improving sleep quality in patients with chronic insomnia and cancers. The overall risk of bias included in this review was a concern because of performance and detection bias. In addition, MBSR compared with active control did not improve the sleep-related daytime impairments including depression, anxiety, stress, fatigue and quality of life. However, MBSR versus waitlist control might have been effective in improving subjective sleep quality, but with substantial heterogeneity (standardised mean difference=−0.32 95% CI: −0.56 to –0.08 I ² =71%). In the subgroup analysis, MBSR did not improve objective or subjective sleep quality in chronic insomnia and cancers. Of the 7516 records searched, 20 RCTs and 21 reports were included. Two researchers independently selected relevant studies, assessed the risk of bias and extracted the data.
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The final search update was performed in June 2022.
Systematic review and meta-analysis of randomised controlled trials (RCTs).Ī comprehensive search was conducted using the following databases: Ovid MEDLINE, AMED, Ovidembase, PsycINFO, Cochrane Library, CINAHL, and four domestic databases: KoreaMed, KISS, KMbase and NDSL. Therefore, this contemporary systematic review aimed to elucidate the clinical effects of MBSR on sleep quality and sleep-related daytime impairment in adults with sleep disturbances, including chronic insomnia disorders.
However, it is currently used to alleviate sleep disturbances. Mindfulness-based stress reduction (MBSR) is a meditation-based therapy originally recommended for stress management.
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