Symptoms of depression include depressive mood, decreased interest, lack of motivation, and fatigue. And insomnia always combines with depression. In fact, comorbid insomnia is commonly seen in clinical practice. And any harm associated with CBT-I is likely to be mild, so CBT-I was recommended as the first-line treatment by the ACP Clinical Guidelines Committee. Moderate-quality evidence showed that CBT-I improved sleep outcomes in the general population, including reduced sleep onset latency and wake after sleep onset, and improved sleep efficiency and sleep quality. Complementary and alternative therapy for insomnia includes acupuncture and Chinese herbal medicine. Pharmacologic therapy for insomnia includes benzodiazepines (triazolam, estazolam, temazepam, flurazepam, and quazepam), nonbenzodiazepine hypnotics (zaleplon, zolpidem, and eszopiclone). Treatments for insomnia included cognitive behavioral therapy, pharmacologic therapy, and complementary and alternative therapy. Insomnia increases the risk of many health problems including suicidal ideation and behavior, cardiovascular diseases, depressive disorder, arterial hypertension, myocardial infarction, chronic heart failure, type 2 diabetes, and cognitive impairment, which would place a heavy burden on society and individuals. Several studies have shown that 6% to 10% of adults suffered from insomnia, and 10–15% of insomnia patients tended to develop into chronic course. Insomnia patients have difficulty initiating, maintaining sleep or returning to sleep. Insomnia is a kind of sleep disorder, and people with insomnia are unsatisfied with their sleep time and sleep quality. Online GRADEpro was used to assess the quality of evidence. Review Manager 5.3 software was used for meta-analysis. Cochrane Reviewer's Handbook was used for evaluating the risk of bias of included studies. Randomized controlled trials that compared CBT-I to no treatment or hypnotics (zopiclone, estazolam, and benzodiazepine agonist) for insomnia comorbid with depression and reported both insomnia scales and depression scales. Seven electronic databases, including China National Knowledge Infrastructure (CNKI), Wanfang Database, China Science Technology Journal Database, SinoMed Database, PubMed, the Cochrane Library, and EMBASE, as well as grey literature, were searched from the beginning of each database to July 1, 2019. Therefore, we conducted this meta-analysis of randomized controlled trials to assess the clinical effectiveness and safety of CBT-I for insomnia comorbid with depression. CBT-I has been recommended as the first-line treatment for insomnia whether it is also effective for comorbidity of insomnia and depression is still unknown. However, there is lack of effective treatment for such comorbidity.
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