Background: The prevalence of insomnia in cancer survivors is estimated to be around 30-60%, with approximately 20% meeting the diagnostic criteria for insomnia disorder. Cognitive-behavioral therapy for insomnia (CBT-I) is considered the gold standard treatment for insomnia. However, the effectiveness of different delivery modes of CBT-I in improving insomnia in cancer survivors is still unknown.
Purpose: To systematically reviewed and conducted a network meta-analysis to investigate the treatment efficacy of different delivery modes of CBT-I for managing insomnia in cancer survivors.
Methods: This was a systematic review and network meta-analysis of randomized clinical trials. Only randomized clinical trials comparing different delivery modes of CBT-I with other non-pharmacological treatments to improve insomnia in cancer survivors were included. Electronic databases including Cochrane Library, Embase, PubMed, and CINAHL were searched, with no restrictions on publication year or language. Two independent reviewers assessed the quality of the included studies using The Cochrane Collaboration's tool for assessing risk of bias 2.0. The statistical analysis was conducted using the random effects model network meta-analysis method with STATA 14 software.
Results: Sixteen randomized clinical trials with an average age of 56.6 years were included, and the main cancer type was breast cancer. The results showed that compared to the usual care group, individual CBT-I significantly reduced the severity of insomnia as measured by Insomnia Severity Index (-11.95, 95% confidence interval: -10.24 to -2.73), increased total sleep time (139.67, 25.94 to 253.40), and improved sleep efficiency (26.99, 5.56 to 48.41). Group CBT-I significantly reduced sleep onset latency (-11.95, -20.97 to -2.94) and wake after sleep onset (-19.83, -36.02 to -3.64) compared to the usual care group. Self-helf CBT-I significantly reduced the severity of insomnia as measured by the insomnia severity scale (-5.62, -6.67 to -4.56) compared to the usual care group. There were no statistically significant differences in treatment outcomes among individual CBT-I, group CBT-I, self-help CBT-I, and stepped care CBT-I. The cumulative ranking curve analysis showed that individual CBT-I was the most effective treatment for changes in insomnia severity and sleep efficiency (89.8% and 81%, respectively), while group CBT-I was the most effective treatment for changes in subjective sleep onset latency and wake after sleep onset (92.8% and 90.3%, respectively).
Conclusion: Individual and group CBT-I delivery modes may have better efficacy for insomnia in cancer survivors. Self-help CBT-I can improve the severity of insomnia in cancer survivors and can be considered an alternative treatment option to address the proximity and supply-demand issues of CBT-I.

中文摘要 ........................................... I
英文摘要 ........................................... III
目 錄
圖表目次 ............................................... VII
圖目次 ....................................... VII
表目次 ....................................... VIII
第一章 緒論
第一節 研究背景與動機 ..................... 1
第二節 研究目的 ............................. 4
第三節 名詞定義 ............................. 5
第二章 文獻查證
第一節 失眠概論 ............................. 7
第二節 癌症病患之失眠 ............................ 22
第三節失眠之藥物與非藥物治療 ..................... 26
第四節 認知行為療法對於癌症失眠之療效.............. 33
第三章 研究方法
第一節 研究設計 ............................. 41
第二節 定義文獻回顧之問題及納入研究條件............ 42
第三節 文獻檢索 ............................. 44
第四節 文獻選擇及蒐集 ............................ 45
第五節 文獻品質評估 ............................. 46
第六節 資料分析 ............................. 50
第四章 研究結果
第一節 資料檢索 ............................. 53
第二節文章品質分析 ............................. 60
第三節 網絡圖 ............................. 62
第四節 成對比較之列聯表........................... 70
第五節 治療之累積排名............................. 77
第六節 不一致性................................... 84
第七節 出版偏差................................... 88
第五章 討論 ....................................... 91
第六章 結論..........................................
第一節 研究限制與優勢............................. 95
第二節 未來建議................................... 96
第三節 結論....................................... 97
參考資料 .............................................. 98


圖表目次
圖目次
圖一 3P模型理論 ………………………………………….15
圖二 Morin微觀分析模型 ………………………………………….16
圖三 不同治療對於失眠嚴重度量表比較之網絡圖 …………………….69
圖四 不同治療對於主觀入睡潛伏期比較之網絡圖 …………………….70
圖五 不同治療對於主觀入睡後清醒時間比較之網絡圖 …………………….71
圖六 不同治療對於主觀睡眠總時間比較之網絡圖 …………………….72
圖七 不同治療對於睡眠效率比較之網絡圖 …………………….73
圖八 失眠嚴重指數治療效果之累積排名圖 …………………….83
圖九 主觀入睡潛伏期治療效果之累積排名圖 …………………….84
圖十 主觀入睡後清醒時間治療效果之累積排名圖 ………………….85
圖十一 主觀睡眠總時間治療效果之累積排名圖 ………86
圖十二 睡眠效率治療效果之累積排名圖 ……………… 87
圖十三 Egger’s test 出版偏差檢定 ……………………..94

表目次
表一 失眠診斷工具 ………………………………………….8
表二 常見主觀性失眠及睡眠量表 .………………………………………….20
表三 癌症失眠常見導因 ……………………………………. 24
表四FDA核准即常見處方失眠藥物 ………………………29
表五CBT-I 之治療內容 ……………………………………. 33
表六CBT-I對於癌症失眠療效之系統性回顧或統合分析文章整理………………………….41
表七 網絡統合分析中治療與控制組組別定義 ……………. 46
表八 納入文獻族群屬性及相關介入措施與測量結果………………………………………….59
表九 納入文獻品質分析（ROB 2.0） ……………………...65
表十失眠嚴重指數之列聯表 ………………………………... 76
表十一 主觀測量結果之睡眠參數列聯表 ………………….77
表十二 迴圈的不一致性（Loop inconsistency ） ………….89
表十三 Side-splitting 模型之不一致性檢定 …………………….90
表十四 Egger’s test 出版偏差檢定 ……………………….93


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