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The effects of cognitive behavioral therapy for insomnia in patients with cardiovascular disease: a systematic review

Silje Glenna Andersen1, Henrik Sæterhagen1, André Pekkola Pacheco1,2

  • 1Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.

Journal of Clinical Sleep Medicine : JCSM : Official Publication of the American Academy of Sleep Medicine
|March 21, 2025
PubMed

Insights

Cognitive Behavioral Therapy for Insomnia (CBT-I) effectively reduces insomnia severity, anxiety, and fatigue in cardiovascular disease (CVD) patients. This therapy also improves sleep quality and efficiency, offering a valuable non-pharmacological treatment option for this population.

Area of Science:

  • Cardiology
  • Sleep Medicine
  • Psychiatry

Background:

  • Insomnia is prevalent in up to 50% of cardiovascular disease (CVD) patients, correlating with adverse clinical outcomes.
  • Cognitive Behavioral Therapy for Insomnia (CBT-I) is the primary recommended treatment for insomnia.
  • Limited data exists on CBT-I's efficacy in patients with established CVD.

Purpose of the Study:

  • To evaluate the impact of CBT-I on insomnia symptom severity in CVD patients.
  • To assess changes in sleep parameters and daytime symptoms following CBT-I treatment.
  • To synthesize existing evidence on CBT-I for insomnia in the context of cardiovascular disease.

Main Methods:

  • A systematic review and meta-analysis of randomized controlled and open trials.
  • Searches conducted across Medline, Embase, PsycINFO, and ClinicalTrials.gov up to December 2023.
  • Data extraction and risk of bias assessment using Cochrane's risk of bias 2 tool, with meta-analysis via random-effects models.

Main Results:

  • Five studies with 352 patients met inclusion criteria.
  • CBT-I significantly reduced insomnia severity (SMD = -0.90), anxiety, and fatigue compared to active controls.
  • Significant improvements observed in sleep quality (SMD = -0.77) and sleep efficiency (SMD = 0.68).

Conclusions:

  • CBT-I demonstrates effectiveness in alleviating insomnia symptoms in patients with CVD.
  • Findings align with previous meta-analyses on insomnia treatment.
  • Further large-scale trials with long-term follow-up are recommended to strengthen evidence.
Abstract

Keywords:
CBT-Icognitive behavioral therapy for insomniacoronary heart diseaseinsomniameta-analysissystematic review

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