Effectiveness of digital cognitive behavioral therapy for insomnia on professional activity: A systematic review and meta-analysis of randomized controlled trials

This meta-analytic review aimed to assess the effectiveness of digital cognitive behavioral therapy for insomnia (dCBT-I) on professional activity. We systematically explored PubMed, Web of Science and PsycINFO until August 2023. We targeted randomized controlled trials using dCBT-I and assessing professional activity. We used the standardized mean difference (SMD), and the Der Simonian-Laird random effects model, and followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. From the 494 papers initially identified, 11 were finally selected, including 4723 participants from Europe, Japan, and North America. People treated with dCBT-I had lower scores for work-related rumination (SMD = -3.28; 95 % CI: -6.18; -0.39), lower costs of lost productivity due to presenteeism (SMD = -0.55; 95 % CI: -0.77; -0.33), and lower presenteeism scores (SMD = -1.05; 95 % CI: -1.79; -0.31). Three studies displayed a high risk of bias, while eight were classified as "some concern". Publication bias could not be assessed due to the small number of studies, and the certainty of evidence was low or very low. This review provides positive results regarding the effectiveness of dCBT-I on the professional activity of people with insomnia symptoms or disorder. However, further studies are needed to reinforce our findings.