Dismantling cognitive-behavioral therapy for chronic insomnia: a protocol for a systematic review and component network meta-analysis

IntroductionInsomnia is highly prevalent and disabling. Clinical practice guidelines recommend cognitive-behavioral therapy for insomnia (CBTI) as the first-line treatment. However, CBTI includes various combinations of many different components and its clinical benefits have been shown as a package, whereas the effect of each component remains unclear. In this study, we will explore the effect of each component of CBTI with the use of component network meta-analysis. Methods and analysisWe will include all randomized controlled trials that compared any form of CBTI against another form of CBTI or a control condition in the treatment of adults with chronic insomnia. Concomitant treatments will be allowed as long as they are equally distributed among the arms. We will include both primary and secondary insomnia. The primary outcome of interest in this study is (1) treatment efficacy (remission defined as reaching a satisfactory state at endpoint measured by any validated self-reported scale) at four weeks post-treatment or at its closest time point. Secondary outcomes are (2) acceptability, (3) sleep diary measures and (4) efficacy at long-term follow-up. We will systematically search in PubMed, CENTRAL, PsycINFO and WHO International Clinical Trials Registry Platform. We will assess risk of bias using Cochrane Risk of Bias 2.0 tool. We will conduct component network meta-analysis with the netmeta package in R. Ethics and disseminationThis study will use published data and does not require ethical approval. Findings will be disseminated in a peer-reviewed journal. PROSPEROCRD42022324233.