수면장애 대상자를 위한 표준화된 마음챙김 기반 중재법의 임상적 효과성: 체계적 문헌고찰

Abstract

ABSTRACT Effects of standardized mindfulness-based interventions for sleep disturbance: A systematic review

Background Sleep disturbance has a prevalence of approximately 30% in the world population and has negative effects on the health of the affected individual. Sleep disturbance results in physical and psychological disease and has been associated with decreased quality of life. Standardized mindfulness-based interventions allow individuals to focus on the mental and physical states that lead to a positive response to sleep, and avoid reacting in a negative way to sleep disturbances. They can be potentially effective interventions for addressing sleep problems.

Objectives To assess the effects of standardized mindfulness-based interventions including a mindfulness-based stress reduction (MBSR) program, mindfulness-based cognitive therapy (MBCT) program, and mindfulness-based therapy for insomnia (MBTI) program on sleep duration and sleep quality for people with sleep disturbance or insomnia.

Search methods We searched Ovid MEDLINE, Allied and Alternative Medicine (AMED), Ovid EMBASE, PsycINFO, the Cochrane Central Register of Controlled Trials (CENTRAL), the Cumulative Index to Nursing, Allied Health Literature (CINAHL), and four Korean databases (KoreaMed, Korean Studies Information Service System, Korean Medical Database, and National Digital Science Library) (16 June 2015). Reference lists of relevant studies and reviews were also screened.

Selection criteria Randomized controlled trials (RCTs) comparing standardized mindfulness-based interventions such as the MBSR program, MBCT program, or MBTI program with control groups for adults with sleep disturbance, and studies reporting primary outcomes such as sleep duration and sleep quality were selected. Additionally, non-randomized controlled trials (NRTs) carried out in Korea were included to collate the local evidence

Data collection and analysis Two review authors independently screened the title and abstracts. They independently assessed the risk of bias of the studies and extracted the data. Disagreements were resolved through discussion with the third author. A narrative synthesis was performed because of the clinical diversity of participants of the studies included in this review.

Main results Of the 4,067 records assessed, 19 trials with 1,731 participants met the inclusion criteria: 15 in RCTs and 4 in NRTs; 16 studies of MBSR, 2 studies of MBCT, and 1 study of MBTI. The overall risk of bias of the RCTs included in this review was rated as ‘moderate’. The overall quality of NRTs was assessed as ‘low’ quality. Regarding sleep duration, MBSR has a beneficial effect in one study of patients with insomnia and two studies of patients with cancers. Regarding sleep quality, 13 of the 16 studies reported that MBSR has a beneficial effect on improving sleep quality for insomnia, cancer, chronic physical conditions, and healthy people. Whereas there were a limited number of studies to determine whether MBCT or MBTI had any clinical effects on people with sleep disturbance or insomnia, although MBCT and MBTI were reported to have positive effects on sleep disturbances.

Authors’ conclusions MBSR showed promising benefits in improving sleep duration and quality for people suffering from sleep disturbance or insomnia, although additional RCTs are needed to confirm these conclusions. The included studies on MBCT and MBTI for participants with sleep disturbance provided insufficient evidence to decide definitively on their clinical effects. Therefore, well-designed randomized trials are required to assess the effects of MBCT and MBTI for sleep disturbance or insomnia.