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. 2025 Aug 28;8:554. doi: 10.1038/s41746-025-01946-y

Table 1.

Characteristics of included studies

First Author Year Studies n Population Intervention Comparator Outcome Analysis grouping Model Effect Size Value(95% CI)
Faizul Hasan29 2022 54 11,815 Adults with insomnia MCBTi TAU Insomnia Severity (ISI, PSQI, SCI, HSDQ, Sleep-50) Overall REM SMD −0.6 (−1.34 to 0.13)
WBCBTi TAU Overall REM SMD −0.87 (−1.08 to −0.66)
TCBTi TAU Overall REM SMD −0.68 (−1.05 to −0.31)
WBCBTiT TAU Overall REM SMD −0.87 (−1.08 to −0.66)
MCBTi FTFCBTi Overall REM SMD 0.88 (0.08 to 1.67)
WBCBTi FTFCBTi Overall REM SMD 0.61 (0.12 to 1.1)
TCBTi FTFCBTi Overall REM SMD 0.8 (0.2 to 1.4)
WBCBTiT FTFCBTi Overall REM SMD 0.86 (0.14 to 1.87)
Laura Simon30 2023 52 12544 Adults with insomnia guided iCBT-I WL Insomnia severity (ISI, AIS) Overall REM SMD −0.71 (−1.18 to −0.24)
unguided iCBT-I WL Overall REM SMD −0.78 (−1.18 to −0.38)
TCBT-I WL Overall REM SMD −1.28 (−2.06 to −0.5)
SCBT-I WL Overall REM SMD −1.07 (−2.43 to 0.28)
guided iCBT-I WL SQ Overall REM SMD 0.57 (0.38 to 0.76)
unguided iCBT-I WL SQ Overall REM SMD 0.45 (0.22 to 0.69)
TCBT-I WL SQ Overall REM SMD 0.63 (0.22 to 1.05)
SCBT-I WL SQ Overall REM SMD 0.68 (0.14 to 1.21)
guided iCBT-I WL TST Overall REM SMD 0.21 (0.12 to 0.3)
unguided iCBT-I WL TST Overall REM SMD 0.09 (−0.03 to 0.2)
TCBT-I WL TST Overall REM SMD 0.07 (−0.16 to 0.3)
guided iCBT-I WL SE Overall REM SMD 0.45 (0.2 to 0.69)
unguided iCBT-I WL SE Overall REM SMD 0.43 (0.19 to 0.68)
TCBT-I WL SE Overall REM SMD 0.52 (0.07 to 0.96)
guided iCBT-I WL SOL Overall REM SMD −0.28 (−0.38 to −0.18)
unguided iCBT-I WL SOL Overall REM SMD −0.25 (−0.36 to −0.13)
TCBT-I WL SOL Overall REM SMD −0.45 (−0.68 to −0.22)
guided iCBT-I WL WASO Overall REM SMD −0.4 (−0.61 to −0.18)
unguided iCBT-I WL WASO Overall REM SMD −0.42 (−0.63 to −0.21)
TCBT-I WL WASO Overall REM SMD −0.61 (−1.05 to −0.16)
Sammy K. Cheng35 2012 6 433 Adults with insomnia CCBT-I WL, AT SOL Overall FEM SMD −0.55 (−0.8 to −0.3)
CCBT-I WL, AT NWAK Overall FEM SMD −0.45 (−0.7 to −0.2)
CCBT-I WL, AT WASO Overall FEM SMD −0.18 (−0.43 to 0.06)
CCBT-I WL, AT TST Overall FEM SMD 0.22 (−0.03 to 0.46)
CCBT-I WL, AT TIB Overall FEM SMD −0.25 (−0.57 to 0.07)
CCBT-I WL, AT SE Overall FEM SMD 0.4 (0.15 to 0.64)
CCBT-I WL, AT SQ Overall FEM SMD 0.41 (0.16 to 0.65)
CCBT-I WL, AT ISI Overall FEM SMD −0.86 (−1.18 to −0.53)
Suonaa Lee21 2023 22 10,486 Adults with insomnia dCBT-I ActCon, WL, TAU Insomnia severity (ISI, SCI, PSQI) Overall REM SMD −0.76 (−0.953 to −0.567)
9 SE Overall REM SMD 0.528 (0.275 to 0.781)
9 TST Overall REM SMD 0.263 (0.036 to 0.49)
8 SOL Overall REM SMD −0.645 (−1.14 to −0.15)
5 WASO Overall REM SMD −1.48 (−2.763 to −0.196)
19 ISI Overall REM SMD −0.81 (−0.968 to −0.652)
Nan Bai26 2024 7 1864 Adults with insomnia dCBT-I Mixed Control
7 1783 ISI PTE REM SMD −0.94 (−1.24 to −0.64)
4 215 SOL PTE REM SMD −0.46 (−0.73 to −0.18)
3 174 WASO PTE REM SMD −0.81 (−1.12 to −0.5)
4 217 TST PTE REM SMD 0.35 (0.08 to 0.62)
4 217 SE PTE REM SMD 0.32 (0.05 to 0.59)
6 954 ISI FUE REM SMD −0.5 (−0.86 to −0.15)
3 353 ISI Subgroup 3 months REM SMD −0.22 (−0.43 to 0)
4 676 ISI Subgroup 6 months REM SMD −0.66 (−1 to −0.31)
Hsin-Jung Tsai31 2022 4 3970 Adolescents or active college students dCBT-I Mixed Control SQ PTE REM Hedge’s g 0.58 (0.13 to 1.03)
3 SQ FUE REM Hedge’s g 0.68 (−0.13 to 1.5)
2 SE Overall REM Hedge’s g 0.64 (−0.27 to 1.55)
2 TST Overall REM Hedge’s g 0.34 (−0.02 to 0.7)
2 SQ PTE REM Hedge’s g 0.96 (0.38 to 1.53)
2 SQ FUE REM Hedge’s g 1.13 (0.16 to 2.1)
2 SQ PTE REM Hedge’s g 0.11 (−0.73 to 0.95)
Omid Amani45 2023 27 8728 Adults with insomnia iCBT-I Mixed Control
23 7560 ISI PTE MD −4.32 (−6.15 to −2.48)
11 3790 ISI FUE MD −2.92 (−4.87 to −0.97)
14 1935 SE PTE MD 8.5 (5.38 to 11.65)
7 1227 SE FUE MD 6.42 (1.38 to 11.46)
13 1790 TST PTE MD 16.52 (9.62 to 21.42)
6 1076 TST FUE MD 11.5 (8.25 to 17.21)
12 1603 SOL PTE MD −15.09 (−22.33 to −8.04)
6 987 SOL FUE MD −14.26 (−28.03 to −0.49)
10 1337 WASO PTE MD −20.37 (−28.03 to −12.7)
4 800 WASO FUE MD −21.8 (−51.64 to 8.02)
7 1106 NWAK PTE MD −0.28 (−0.44 to −0.11)
3 721 NWAK FUE MD −0.06 (−0.24 to −0.01)
Songee Jung36 2024 7 10,139 General Population CBT-based sleep applications WL
3 334 PSQI Overall REM MD −1.25 (−2.17 to −0.33)
2 96 ISI Overall REM MD −0.41 (−0.94 to 0.11)
Huijing Zhang37 2023 20 3860 Adults with insomnia digital sleep interventions Mixed Control
8 SQ Overall REM SMD 0.49 (0.127 to 0.853)
2 ISI, AIS Overall FEM SMD −0.941 (−1.182 to −0.699)
Hui Ling Soh38 2020 33 9364 Adults with insomnia dCBT-I Mixed Control ISI
25 5540 Mixed Control ISI PTE REM MD −5 (−5.68 to −4.33)
11 3451 Mixed Control ISI FUE REM MD −3.99 (−4.82 to −3.16)
3 772 Mixed Control ISI FUE REM MD −3.48 (−4.21 to −2.76)
4 218 FTFCBTi ISI PTE REM MD 3.07 (1.18 to 4.95)
19 2073 Mixed Control SOL PTE REM MD −13.38 (−16.34 to −10.43)
16 1838 Mixed Control WASO PTE REM MD −16.27 (−21.75 to −10.79)
13 1418 Mixed Control NWAK PTE REM MD −0.39 (−0.54 to −0.24)
22 2665 Mixed Control SE PTE REM MD 7.2 (5.65 to 8.76)
19 2073 Mixed Control TST PTE REM MD 14.63 (8.95 to 20.31)
7 748 Mixed Control SOL FUE REM MD −12.8 (−16.95 to −8.66)
5 634 Mixed Control WASO FUE REM MD −16.2 (−22.83 to −9.57)
8 1049 Mixed Control SE FUE REM MD 7.1 (4.5 to 9.69)
7 748 Mixed Control TST FUE REM MD 6.34 (−3.49 to 16.16)
4 457 Mixed Control NWAK FUE REM MD −0.34 (−0.71 to 0.04)
4 209 FTFCBTi SOL Overall REM MD 1.87 (−5.28 to 9.03)
4 208 FTFCBTi SE Overall REM MD −2.21 (−6.23 to 1.81)
4 209 FTFCBTi TST Overall REM MD −2.34 (−18.11 to 13.42)
3 171 FTFCBTi NWAK Overall REM MD 0.02 (−0.29 to 0.32)
3 171 FTFCBTi WASO Overall REM MD 9.38 (1.39 to 17.37)
17 Mixed Control ISI PTE REM MD −5.05 (−5.8 to −4.31)
8 Mixed Control ISI PTE REM MD −4.96 (−6.63 to −3.3)
Sofie Mogelberg Knutzen32 2024 17 1068 Adults and adolescents (aged ≥12 years) eCBTI ipCBTI sleep disturbance REM Hedge’s g 0.32 (0.11 to 0.53)
11 897 ISI PTE REM Hedge’s g 0.37 (0.15 to 0.6)
5 279 PSQI PTE REM Hedge’s g 0.26 (−0.15 to 0.67)
11 779 SE PTE REM Hedge’s g 0.17 (0.03 to 0.31)
10 719 SOL PTE REM Hedge’s g 0.07 (−0.08 to 0.21)
8 621 WASO PTE REM Hedge’s g 0.09 (−0.08 to 0.26)
11 779 TST PTE REM Hedge’s g 0.05 (−0.09 to 0.19)
10 817 ISI FUE REM Hedge’s g 0.27 (0.04 to 0.5)
5 279 PSQI FUE REM Hedge’s g 0.21 (−0.16 to 0.58)
10 700 SE FUE REM Hedge’s g 0.25 (0.03 to 0.47)
9 640 SOL FUE REM Hedge’s g 0.14 (−0.04 to 0.32)
7 542 WASO FUE REM Hedge’s g −0.02 (−0.24 to 0.2)
10 700 TST FUE REM Hedge’s g 0.08 (−0.11 to 0.28)
Robert Zachariae39 2016 11 1460 Adults with insomnia iCBT-I Mixed Control
8 1071 ISI PTE REM Hedge’s g 1.09 (0.74 to 1.45)
10 1220 SE PTE REM Hedge’s g 0.58 (0.36 to 0.81)
10 1114 SOL PTE REM Hedge’s g 0.41 (0.29 to 0.53)
7 944 WASO PTE REM Hedge’s g 0.45 (0.25 to 0.66)
6 640 NWAK PTE REM Hedge’s g 0.21 (0.05 to 0.37)
10 1114 TST PTE REM Hedge’s g 0.29 (0.17 to 0.42)
4 464 TIB PTE REM Hedge’s g 0.17 (−0.02 to 0.18)
8 801 SQ PTE REM Hedge’s g 0.49 (0.3 to 0.68)
5 864 ISI FUE REM Hedge’s g 0.86 (0.42 to 1.3)
4 706 SE FUE REM Hedge’s g 0.57 (0.14 to 1.01)
4 706 SOL FUE REM Hedge’s g 0.36 (−0.01 to 0.74)
4 706 WASO FUE REM Hedge’s g 0.55 (−0.04 to 1.13)
4 706 TST FUE REM Hedge’s g 0.14 (−0.02 to 0.29)
3 501 SQ FUE REM Hedge’s g 0.58 (0.19 to 0.97)
Hang Yu40 2021 14 2263 Patients with insomnia iCBT-I Mixed Control
12 2103 SOL Overall REM MD −12.27 (−14.63 to −9.9)
14 2263 TST Overall FEM MD 38.67 (34.7 to 42.65)
12 2103 SE Overall REM MD 13.28 (10.49 to 16.06)
10 1511 WASO Overall REM MD −16.91 (−19.89 to −13.94)
6 1092 TIB Overall FEM MD −16.94 (−24.16 to −9.71)
8 1361 NWAK Overall FEM OR 0.33 (0.17 to 0.67)
8 1326 ISI Overall REM MD −6.34 (−8.24 to −4.44)
Dawei Xu41 2024 42 10,496 Adults with insomnia RCBT Mixed Control
34 9420 ISI PTE REM SMD −1.45 (−2.13 to −0.78)
14 1798 PSQI PTE REM SMD −1.46 (−2.24 to −0.68)
25 4461 TST PTE REM SMD 0.69 (0.1 to 1.28)
25 4403 SE PTE REM SMD 1.26 (0.57 to 1.96)
23 4314 SOL PTE REM SMD −0.95 (−1.38 to −0.51)
18 3871 WASO PTE REM SMD −1.96 (−3.52 to −0.4)
10 1084 NWAK PTE REM SMD −0.37 (−0.64 to −0.1)
23 6937 ISI FUE REM SMD −1.34 (−1.96 to −0.72)
15 1858 PSQI FUE REM SMD −1.26 (−2.02 to −0.49)
21 4005 TST FUE REM SMD 0.36 (0.14 to 0.59)
20 3918 SE FUE REM SMD 1.03 (0.49 to 1.57)
19 3858 SOL FUE REM SMD −0.85 (−1.28 to −0.41)
15 3495 WASO FUE REM SMD −1.93 (−3.7 to −0.15)
7 809 NWAK FUE REM SMD −0.53 (−0.98 to −0.07)
20 ISI Subgroup ≤ 3 months REM SMD −1.1 (−1.61 to −0.58)
14 ISI Subgroup å 3 months REM SMD −1.98 (−3.48 to −0.48)
10 PSQI Subgroup ≤ 3 months REM SMD −1.41 (−2.37 to −0.45)
4 PSQI Subgroup å 3 months REM SMD −1.58 (−3.12 to −0.05)
16 TST Subgroup ≤ 3 months REM SMD 0.89 (−0.03 to 1.81)
9 TST Subgroup å 3 months REM SMD 0.37 (−0.06 to 0.8)
16 SE Subgroup ≤ 3 months REM SMD 1.19 (0.57 to 1.81)
9 SE Subgroup å 3 months REM SMD 1.4 (−0.27 to 3.07)
15 SOL Subgroup ≤ 3 months REM SMD −0.87 (−1.36 to −0.39)
8 SOL Subgroup å 3 months REM SMD −1.09 (−1.98 to −0.2)
12 WASO Subgroup ≤ 3 months REM SMD −2.27 (−4.48 to −0.05)
6 WASO Subgroup å 3 months REM SMD −1.38 (−3.19 to 0.43)
21 ISI Subgroup Unguided REM SMD −1.27 (−2.16 to −0.38)
13 ISI Subgroup Guided REM SMD −1.75 (−2.81 to −0.69)
7 PSQI Subgroup Unguided REM SMD −0.79 (−0.91 to −0.67)
7 PSQI Subgroup Guided REM SMD −2.13 (−3.6 to −0.67)
15 TST Subgroup Unguided REM SMD 1.01 (0.02 to 1.99)
10 TST Subgroup Guided REM SMD 0.25 (−0.01 to 0.52)
14 SE Subgroup Unguided REM SMD 1.6 (0.44 to 2.76)
11 SE Subgroup Guided REM SMD 0.85 (0.27 to 1.44)
13 SOL Subgroup Unguided REM SMD −1.04 (−1.72 to −0.37)
10 SOL Subgroup Guided REM SMD −0.83 (−1.32 to −0.33)
13 WASO Subgroup Unguided REM SMD −2.42 (−4.56 to −0.27)
5 WASO Subgroup Guided REM SMD −0.85 (−1.68 to −0.02)
Wenrui Deng42 2023 37 13,227 Adults with insomnia eHealth-based psychosocial interventions
29 8772 InActCon ISI Overall REM Hedge’s g −1.01 (−1.12 to −0.89)
15 2226 InActCon PSQI Overall REM Hedge’s g −0.58 (−0.75 to −0.41)
4 240 ipCBTI ISI Overall REM Hedge’s g 0.41 (−0.02 to 0.85)
3 175 ipCBTI PSQI Overall REM Hedge’s g 0.56 (0.24 to 0.88)
21 4084 ipCBTI, InActCon SOL Overall REM Hedge’s g −0.37 (−0.46 to −0.29)
20 4079 ipCBTI, InActCon TST Overall REM Hedge’s g −0.21 (−0.31 to −0.1)
16 3856 ipCBTI, InActCon WASO Overall REM Hedge’s g −0.46 (−0.59 to −0.32)
10 1326 ipCBTI, InActCon NWAK Overall REM Hedge’s g −0.27 (−0.39 to −0.16)
20 4078 ipCBTI, InActCon SE Overall REM Hedge’s g −0.56 (−0.67 to −0.46)
13 1664 InActCon ISI Subgroup Guided REM Hedge’s g −1.19 (−1.45 to −0.92)
8 3850 InActCon ISI Subgroup Guided REM Hedge’s g −0.96 (−1.15 to −0.78)
10 3258 InActCon ISI Subgroup Unguided REM Hedge’s g −0.83 (−0.96 to −0.7)
11 1246 InActCon PSQI Subgroup Guided REM Hedge’s g −0.75 (−1 to −0.5)
2 230 InActCon PSQI Subgroup Guided REM Hedge’s g −0.5 (−0.76 to −0.24)
5 750 InActCon PSQI Subgroup Unguided REM Hedge’s g −0.33 (−0.48 to −0.18)
Yuan-yuan Ye46 2016 14 1604 Adults with insomnia ICBT-I Mixed Control
13 2010 SOL Overall REM MD −18.41 (−23.21 to −13.6)
13 2009 TST Overall REM MD 22.3 (16.38 to 28.23)
13 2009 SE Overall REM MD 9.58 (7.3 to 11.85)
10 1655 WASO Overall REM MD −22.31 (−31.11 to −13.5)
Michael Seyffert33 2016 9 Adults with insomnia ICBT-I WL SE Overall REM MD 7.22 (5.13 to 9.32)
8 WL TST Overall REM MD 19.57 (8.56 to 30.58)
7 WL SOL Overall REM MD −10.68 (−16 to −5.37)
6 WL WASO Overall REM MD −20.44 (−34.87 to −6.01)
4 WL ISI Overall REM MD −4.29 (−7.12 to −1.46)
5 WL SE FUE REM MD 4.42 (1.84 to 7)
5 WL TST FUE REM MD 8.52 (−2.34 to 19.38)
4 WL ISI FUE REM MD −3.74 (−7.1 to −0.39)
2 ipCBTI ISI Overall REM MD 1.07 (−6.23 to 8.38)
2 ipCBTI SE Overall REM MD −1.21 (−49 to 46.6)
2 ipCBTI TST Overall REM MD 0.73 (−311.8 to 313.3)
Felicia Forma47 2022 20 5659 Adults with insomnia PDT placebo ISI Overall REM MD −5.77 (−8.53 to −3.07)
placebo WASO Overall REM MD −17.97 (−28.44 to −10.34)
placebo SOL Overall REM MD 0.27 (−15.21 to 15.81)
CBT-I ISI Overall REM MD −1.48 (−4.81 to 1.9)
CBT-I + SH ISI Overall REM MD −3.6 (−9.15 to 1.82)
Eszopiclone ISI Overall REM MD −1.16 (−7.19 to 4.78)
CBT-I WASO Overall REM MD 2.29 (−11.65 to 13.73)
Eszopiclone WASO Overall REM MD 9.92 (−12.01 to 29.95)
Anna Mae Scott43 2023 4 239 Patients with insomnia telehealth FTFCBT-I
3 164 ISI PTE REM MD 1.13 (−0.29 to 2.55)
3 145 ISI FUE REM MD 1.79 (−0.01 to 3.59)
2 71 PSQI PTE REM MD 0.8 (−1.2 to 2.79)
2 51 PSQI FUE REM MD 0.93 (−1.45 to 3.31)
SOL PTE REM MD 0.8 (−6 to 7.6)
SOL FUE REM MD 1.7 (−7 to 10.4)
WASO PTE REM MD 2.4 (−11.6 to 16.4)
WASO FUE REM MD −2.5 (−17.2 to 12.2)
TST FUE REM MD 0 (−0.46 to 0.46)
TST FUE REM MD 0.6 (−0.25 to 1.45)
SE PTE REM MD −1 (−4.3 to 2.3)
SE FUE REM MD 0.7 (−2.9 to 4.3)
Amir Sharafkhaneh48 2022 16 Patients with insomnia Mean score of insomnia (ISI、DBAS-16、PSQI)
2 telemedicine Overall REM SMD 5.469 (1.607 to 12.546)
2 Overall REM SMD 2.545 (1.965 to 3.124)
Jake Linardon44 2024 13 SCBT-I WL, TAU, Placebo Insomnia symptoms(ISI、RIS、AIS) Overall REM Hedge’s g 0.6 (0.44 to 0.76)
4 Placebo Overall REM Hedge’s g 0.52 (0.06 to 0.98)
4 WL, TAU, Placebo Subgroup ≤ 4 weeks REM Hedge’s g 0.61 (0.22 to 1.01)
9 WL, TAU, Placebo Subgroup > 4 weeks REM Hedge’s g 0.58 (0.43 to 0.72)
Wenyao Lin34 2023 7 5779 Adults with insomnia dCBT-I TAU, Placebo, No treatment ISI PTE REM SMD −0.85 (−1 to −0.69)
4 2262 ISI FUE REM SMD −0.71 (−0.99 to −0.44)

CBT-I cognitive behavioral therapy for insomnia, eCBT-I electronically delivered eHealth CBTI, MCBTi Mobile-app-based cognitive behavioral therapy for insomnia, WBCBTi Web-based cognitive behavioral therapy for insomnia, TCBTi Telephone-based cognitive behavioral therapy for insomnia, WBCBTiT Web-based cognitive behavioral therapy for insomnia with therapists, FTFCBTi Face-to-face cognitive behavioral therapy for insomnia, iCBT‑I internet‑delivered CBT‑I, TCBT-I Telehealth-delivered CBT-I, SCBT-I Smartphone-delivered CBT-I, CCBT-I Computerised cognitive behavioural therapy for insomnia, dCBT-I digital cognitive behavioral therapy for insomnia, RCBT Remote Cognitive Behavioural Therapy; ipCBTI in-person–delivered CBT, ICT information and communication technologiesfor insomnia, PDT prescription digital therapeutic, CBT-I + SH cognitive behavioral therapy- insomnia plus self-help, PTE Post-treatment effects, FUE Follow-up effects, InActCon inactive controls, TAU Treatment as usual, AT alternative treatment groups, WL Waiting list, ISI Insomnia Severity Index, TST Total sleep time, SQ sleep quality, SE sleep efficiency, SOL sleep onset latency, WASO wake after sleep onset, NWAK Number of Awakenings, TIB Time in bed, SCI Sleep Condition Indicator, HSDQ Holland Sleep Disorders Questionnaire, AIS Athens Insomnia Scale, DBAS-16, Dysfunctional Beliefs and Attitudes about Sleep Scale-16, REM Random Effect Model, FEM Fixed Effect Model.