Combination treatment for chronic insomnia disorder in adults: an American Academy of Sleep Medicine systematic review, meta-analysis, and GRADE assessment

Introduction: This systematic review provides supporting evidence for the accompanying clinical practice guideline on combination treatment for chronic insomnia disorder in adults. Methods: The American Academy of Sleep Medicine (AASM) commissioned a task force (TF) of sleep medicine experts. A systematic review was conducted to identify studies that compared the use of combination treatment (behavioral-psychological treatment used concurrently with pharmacological treatment) to therapy with behavioral-psychological or pharmacological treatments. Statistical analyses were performed to determine the clinical meaningfulness of using various interventions to treat chronic insomnia in adults. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) process was used to assess the evidence for making recommendations. Results: The literature search resulted in 1,179 articles, out of which 15 articles provided data suitable for meta-analyses. The TF provided a detailed summary of the evidence along with the certainty of evidence, the balance of benefits and harms, patient values and preferences, and resource use considerations.