The effectiveness of CBT-based interventions for sleep outcomes in people living with HIV: a systematic review and meta-analysis of randomized controlled trials

Abstract

To examine the effectiveness of CBT-based interventions in reducing the severity of insomnia, improving sleep quality, and increasing sleep efficiency among people living with HIV. A systematic search was conducted across PubMed, Web of Science, Embase, PsycINFO, Scopus, CINAHL, and the Cochrane Central Register of Controlled Trials from inception to 5 July 2024. The Cochrane risk-of-bias tool for randomized trials (RoB 2.0) was used to examine the methodological quality of the included studies. Sensitivity analysis was conducted by using a leave-one-out approach to test the rigor of the results. The certainty of evidence was assessed by the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach. Six studies met eligibility criteria and were included. CBT-based interventions may have potential benefits for improving subjective sleep quality, as measured by the Pittsburgh Sleep Quality Index in people living with HIV (MD = − 3.62, 95% CI: −5.72 to − 1.51, P < 0.001), reducing the subjective severity of insomnia, as measured by the Insomnia Severity Index in people living with HIV (MD = − 6.23, 95% CI: −9.92 to − 2.55, P < 0.001), and improving sleep efficiency derived from sleep diary measures (improving the ratio of total sleep time to time spent in bed) in people living with HIV (MD = 2.80, 95% CI: 0.70 to 4.90, P = 0.009). CBT-based interventions may have potential effects on reducing the severity of insomnia, improving sleep quality, and increasing sleep efficiency among people living with HIV.