University of Manchester



Title: Does cognitive behavioural therapy for insomnia improve cognitive performance? A systematic review and narrative synthesis Authors: V. Herbert1 MSc, ClinPsyD, S.D. Kyle2 PhD, & D. Pratt1 PhD, ClinPsyDDivision of Psychology and Mental Health, School of Health Sciences, University of Manchester, UKSleep and Circadian Neuroscience Institute (SCNi), Nuffield Department of Clinical Neurosciences, University of Oxford, UKCorrespondence to:Daniel Pratt, Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Zochonis Building, Brunswick Street, Manchester M13 9PL, U.K. email: daniel.pratt@manchester.ac.uk Simon D. Kyle, Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, Sir William Dunn School of Pathology, South Parks Road, Oxford, OX1 3RE. email: simon.kyle@ndcn.ox.ac.ukWord count: 8310Acknowledgements: The authors would like to thank Sara Bardsley for her assistance with quality assessment.Conflict of interest statement: The authors report no conflicts of interest relating to material presented in this review. SummaryIndividuals with insomnia report difficulties pertaining to their cognitive functioning. Cognitive behavioural therapy for insomnia (CBT-I) is associated with robust, long-term improvements in sleep parameters, however less is known about the impact of CBT-I on the daytime correlates of the disorder. A systematic review and narrative synthesis was conducted in order to summarise and evaluate the evidence regarding the impact of CBT-I on cognitive functioning. Reference databases were searched and studies were included if they assessed cognitive performance as an outcome of CBT-I, using either self-report questionnaires or cognitive tests. Eighteen studies met inclusion criteria, comprising 923 individuals with insomnia symptoms. The standardised mean difference was calculated at post-intervention and follow-up. We found preliminary evidence for small to moderate effects of CBT-I on subjective measures of cognitive functioning. Few of the effects were statistically significant, likely due to small sample sizes and limited statistical power. There is a lack of evidence with regards to the impact of CBT-I on objective cognitive performance, primarily due to the small number of studies that administered an objective measure (n=4). We conclude that adequately powered randomised controlled trials (RCT), utilising both subjective and objective measures of cognitive functioning are required. Keywords: Insomnia, cognitive behavioural therapy, CBT-I, cognitive functioning, narrative synthesisAbbreviationsAFIattentional function indexANT-Iattentional network test – interactions taskATautogenic trainingBBTIbrief behavioural treatment for insomniaBPTbehavioural placebo treatmentCBT-Icognitive behavioural therapy for insomniaCBT-I ADcognitive behavioural therapy for insomnia in recovering alcohol dependent patientsCBTI-Phonetelephone delivered cognitive behavioural therapy for insomnia CTcognitive therapyDSM-IVdiagnostic and statistical manual of mental disorders, fourth editionDSM-Vdiagnostic and statistical manual of mental disorders, fifth editionEEGelectroencephalogramICinformation controlIPCinformation pamphlet controlISIinsomnia severity indexLM1logical memory test immediate recallLM2logical memory test delayed recallmCBTminimal CBT-IMFI-20multidimensional fatigue inventoryMFSI-SFmultidimensional fatigue symptom inventory – short formMMSEmini-mental state examinationNRnot reportedNRTnon-randomised trialPMRprogressive muscle relaxationPSGpolysomnographyQRquality ratingRCTrandomised controlled trialRLrelaxationRTreaction timePSQIPittsburgh sleep quality indexRCTrandomised controlled trialSATswitching Attention TestSCstimulus controlSHsleep hygieneSHUTisleep healthy using the internetSMDstandardised mean differenceSRsleep restrictionSRTsleep restriction therapyTONItest of nonverbal intelligenceTSTtotal sleep timeUSAUnited States of AmericaUTuncontrolled trialWASOwake time after sleep onsetWLCwait list controlWMS-CRWechsler memory scale – Chinese revisionIntroductionInsomnia is characterised by persistent difficulties with sleep initiation and/or maintenance. Insomnia is recognised as a 24-hour disorder, with impairments in daytime functioning and distress attributed to poor sleep being one of the core diagnostic criteria PEVuZE5vdGU+PENpdGU+PFllYXI+MjAwNTwvWWVhcj48UmVjTnVtPjM3PC9SZWNOdW0+PERpc3Bs

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ADDIN EN.CITE.DATA (3) and is an independent risk factor for the development of cardiovascular disease ADDIN EN.CITE <EndNote><Cite><Author>Javaheri</Author><Year>2017</Year><RecNum>669</RecNum><DisplayText>(4)</DisplayText><record><rec-number>669</rec-number><foreign-keys><key app="EN" db-id="5prwe5sa1sz2speefwr5tx0oxdw9szzxpasr">669</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Javaheri, S.</author><author>Redline, S.</author></authors></contributors><auth-address>Brigham and Women&apos;s Hospital, Boston, MA. Electronic address: sjavaheri@.&#xD;Brigham and Women&apos;s Hospital, Boston, MA; Beth Israel Deaconess Medical Center, Boston, MA.</auth-address><titles><title>Insomnia and risk of cardiovascular disease</title><secondary-title>Chest</secondary-title><alt-title>Chest</alt-title></titles><edition>2017/02/06</edition><dates><year>2017</year><pub-dates><date>Jan 30</date></pub-dates></dates><isbn>1931-3543 (Electronic)&#xD;0012-3692 (Linking)</isbn><accession-num>28153671</accession-num><work-type>Review</work-type><urls><related-urls><url>;(4) and diabetes PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5Bbm90aGFpc2ludGF3ZWU8L0F1dGhvcj48WWVhcj4yMDE2

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ADDIN EN.CITE.DATA (6, 7). Impairments in cognitive abilities are among the most commonly reported daytime symptoms of insomnia ADDIN EN.CITE <EndNote><Cite><Author>Roth</Author><Year>1999</Year><RecNum>130</RecNum><DisplayText>(8)</DisplayText><record><rec-number>130</rec-number><foreign-keys><key app="EN" db-id="5prwe5sa1sz2speefwr5tx0oxdw9szzxpasr">130</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Roth, T.</author><author>Ancoli-Israel, S.</author></authors></contributors><auth-address>National Sleep Foundation.</auth-address><titles><title>Daytime consequences and correlates of insomnia in the United States: results of the 1991 National Sleep Foundation Survey. II</title><secondary-title>Sleep</secondary-title><alt-title>Sleep</alt-title></titles><periodical><full-title>Sleep</full-title><abbr-1>Sleep</abbr-1></periodical><alt-periodical><full-title>Sleep</full-title><abbr-1>Sleep</abbr-1></alt-periodical><pages>S354-8</pages><volume>22 Suppl 2</volume><edition>1999/07/08</edition><keywords><keyword>Accidents, Traffic</keyword><keyword>Adolescent</keyword><keyword>Adult</keyword><keyword>Automobile Driving</keyword><keyword>Chronic Disease</keyword><keyword>Circadian Rhythm/*physiology</keyword><keyword>*Health Surveys</keyword><keyword>Humans</keyword><keyword>Memory Disorders/diagnosis/etiology</keyword><keyword>Middle Aged</keyword><keyword>Quality of Life</keyword><keyword>Severity of Illness Index</keyword><keyword>Sleep Initiation and Maintenance Disorders/complications/diagnosis/*epidemiology</keyword><keyword>Time Factors</keyword><keyword>United States/epidemiology</keyword><keyword>Wakefulness</keyword></keywords><dates><year>1999</year><pub-dates><date>May 1</date></pub-dates></dates><isbn>0161-8105 (Print)&#xD;0161-8105 (Linking)</isbn><accession-num>10394607</accession-num><work-type>Research Support, Non-U.S. Gov&apos;t&#xD;Research Support, U.S. Gov&apos;t, Non-P.H.S.&#xD;Research Support, U.S. Gov&apos;t, P.H.S.</work-type><urls><related-urls><url>;(8). Individuals with insomnia describe deficits in attention, concentration and memory which impact on decision making, social functioning and performance at work PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5MaW50b248L0F1dGhvcj48WWVhcj4yMDAwPC9ZZWFyPjxS

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ADDIN EN.CITE.DATA (9, 10) and leave individuals with insomnia feeling as though they are “struggling through the day” ADDIN EN.CITE <EndNote><Cite><Author>Kyle</Author><Year>2010</Year><RecNum>140</RecNum><DisplayText>(11)</DisplayText><record><rec-number>140</rec-number><foreign-keys><key app="EN" db-id="5prwe5sa1sz2speefwr5tx0oxdw9szzxpasr">140</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Kyle, S. D.</author><author>Espie, C. A.</author><author>Morgan, K.</author></authors></contributors><auth-address>Faculty of Medicine, University of Glasgow Sleep Centre, Sackler Institute of Psychobiological Research, University of Glasgow, Scotland, UK. s.d.kyle@clinmed.gla.ac.uk</auth-address><titles><title>&quot;...Not just a minor thing, it is something major, which stops you from functioning daily&quot;: quality of life and daytime functioning in insomnia</title><secondary-title>Behav Sleep Med</secondary-title><alt-title>Behavioral sleep medicine</alt-title></titles><periodical><full-title>Behav Sleep Med</full-title><abbr-1>Behavioral sleep medicine</abbr-1></periodical><alt-periodical><full-title>Behav Sleep Med</full-title><abbr-1>Behavioral sleep medicine</abbr-1></alt-periodical><pages>123-40</pages><volume>8</volume><number>3</number><edition>2010/06/29</edition><keywords><keyword>Adult</keyword><keyword>Behavioral Symptoms/*complications</keyword><keyword>Female</keyword><keyword>Focus Groups</keyword><keyword>Humans</keyword><keyword>Male</keyword><keyword>Medical Records</keyword><keyword>Middle Aged</keyword><keyword>Qualitative Research</keyword><keyword>Quality of Life/*psychology</keyword><keyword>Sleep Initiation and Maintenance Disorders/complications/*psychology</keyword></keywords><dates><year>2010</year></dates><isbn>1540-2010 (Electronic)&#xD;1540-2002 (Linking)</isbn><accession-num>20582756</accession-num><urls><related-urls><url>;(11). Interestingly, subjective reports of cognitive deficits have not been consistently corroborated by objective measurements and a body of research assessing cognitive performance in people with insomnia compared to normal sleepers is marked by discrepant findings PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5TaGVrbGV0b248L0F1dGhvcj48WWVhcj4yMDEwPC9ZZWFy

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ADDIN EN.CITE.DATA (12). A recent meta-analysis which combined the results of studies with small sample sizes concluded that insomnia is associated with mild to moderate impairments on tasks assessing working memory, episodic memory, problem solving, choice reaction time, information processing and selective attention ADDIN EN.CITE <EndNote><Cite><Author>Fortier-Brochu</Author><Year>2012</Year><RecNum>172</RecNum><DisplayText>(13)</DisplayText><record><rec-number>172</rec-number><foreign-keys><key app="EN" db-id="5prwe5sa1sz2speefwr5tx0oxdw9szzxpasr">172</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Fortier-Brochu, E.</author><author>Beaulieu-Bonneau, S.</author><author>Ivers, H.</author><author>Morin, C. M.</author></authors></contributors><auth-address>Ecole de Psychologie, Universite Laval, Quebec, Canada. emilie.fortier-brochu.1@ulaval.ca</auth-address><titles><title>Insomnia and daytime cognitive performance: a meta-analysis</title><secondary-title>Sleep Med Rev</secondary-title><alt-title>Sleep medicine reviews</alt-title></titles><periodical><full-title>Sleep Med Rev</full-title><abbr-1>Sleep medicine reviews</abbr-1></periodical><alt-periodical><full-title>Sleep Med Rev</full-title><abbr-1>Sleep medicine reviews</abbr-1></alt-periodical><pages>83-94</pages><volume>16</volume><number>1</number><edition>2011/06/04</edition><keywords><keyword>Adult</keyword><keyword>*Cognition</keyword><keyword>Cognition Disorders/etiology</keyword><keyword>Humans</keyword><keyword>Neuropsychological Tests</keyword><keyword>Psychomotor Performance</keyword><keyword>Sleep Initiation and Maintenance Disorders/complications/*psychology</keyword></keywords><dates><year>2012</year><pub-dates><date>Feb</date></pub-dates></dates><isbn>1532-2955 (Electronic)&#xD;1087-0792 (Linking)</isbn><accession-num>21636297</accession-num><label>*</label><work-type>Meta-Analysis&#xD;Research Support, Non-U.S. Gov&apos;t</work-type><urls><related-urls><url>;(13). This review also highlighted the need for studies with greater statistical power and the assessment of a wider range of cognitive functions in order to improve our understanding of the nature and extent of cognitive impairment in insomnia. Uncertainty about the impact of insomnia on objective cognitive performance contrasts with research into the effects of experimental sleep loss, where findings have been more robust. Specifically, chronic sleep deprivation has been associated with deleterious effects across several cognitive domains, including memory and attention ADDIN EN.CITE <EndNote><Cite><Author>Lim</Author><Year>2010</Year><RecNum>506</RecNum><DisplayText>(14)</DisplayText><record><rec-number>506</rec-number><foreign-keys><key app="EN" db-id="5prwe5sa1sz2speefwr5tx0oxdw9szzxpasr">506</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Lim, J.</author><author>Dinges, D. F.</author></authors></contributors><auth-address>Division of Sleep and Chronobiology, Department of Psychiatry, University of Pennsylvania School of Medicine, 423 Guardian Drive, Philadelphia, PA 19104, USA. julianzl@sas.upenn.edu</auth-address><titles><title>A meta-analysis of the impact of short-term sleep deprivation on cognitive variables</title><secondary-title>Psychol Bull</secondary-title><alt-title>Psychological bulletin</alt-title></titles><periodical><full-title>Psychol Bull</full-title><abbr-1>Psychological bulletin</abbr-1></periodical><alt-periodical><full-title>Psychol Bull</full-title><abbr-1>Psychological bulletin</abbr-1></alt-periodical><pages>375-89</pages><volume>136</volume><number>3</number><keywords><keyword>Adult</keyword><keyword>Analysis of Variance</keyword><keyword>*Attention</keyword><keyword>Humans</keyword><keyword>*Memory, Short-Term</keyword><keyword>Neuropsychological Tests</keyword><keyword>*Problem Solving</keyword><keyword>*Reaction Time</keyword><keyword>Sleep Deprivation/*psychology</keyword></keywords><dates><year>2010</year><pub-dates><date>May</date></pub-dates></dates><isbn>1939-1455 (Electronic)&#xD;0033-2909 (Linking)</isbn><accession-num>20438143</accession-num><urls><related-urls><url>;(14). Evidence from prospective longitudinal studies indicates that chronic insomnia is an independent risk factor for cognitive decline PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5DcmljY288L0F1dGhvcj48WWVhcj4yMDAxPC9ZZWFyPjxS

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ADDIN EN.CITE.DATA (19, 20). The majority of evidence for this comes from animal models of chronic sleep deprivation, which have demonstrated reductions in hippocampal cell proliferation and generation of new neurons (for review see ADDIN EN.CITE <EndNote><Cite><Author>Kreutzmann</Author><Year>2015</Year><RecNum>513</RecNum><DisplayText>(19)</DisplayText><record><rec-number>513</rec-number><foreign-keys><key app="EN" db-id="5prwe5sa1sz2speefwr5tx0oxdw9szzxpasr">513</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Kreutzmann, J. C.</author><author>Havekes, R.</author><author>Abel, T.</author><author>Meerlo, P.</author></authors></contributors><auth-address>Center for Behavior and Neurosciences, University of Groningen, The Netherlands; Department of Biology, University of Pennsylvania, Philadelphia, United States.&#xD;Department of Biology, University of Pennsylvania, Philadelphia, United States.&#xD;Center for Behavior and Neurosciences, University of Groningen, The Netherlands. Electronic address: P.Meerlo@rug.nl.</auth-address><titles><title>Sleep deprivation and hippocampal vulnerability: changes in neuronal plasticity, neurogenesis and cognitive function</title><secondary-title>Neuroscience</secondary-title><alt-title>Neuroscience</alt-title></titles><periodical><full-title>Neuroscience</full-title><abbr-1>Neuroscience</abbr-1></periodical><alt-periodical><full-title>Neuroscience</full-title><abbr-1>Neuroscience</abbr-1></alt-periodical><pages>173-90</pages><volume>309</volume><dates><year>2015</year><pub-dates><date>Nov 19</date></pub-dates></dates><isbn>1873-7544 (Electronic)&#xD;0306-4522 (Linking)</isbn><accession-num>25937398</accession-num><urls><related-urls><url>;(19)). In humans, brain imaging studies have reported smaller hippocampi in those suffering from chronic insomnia PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5Kb288L0F1dGhvcj48WWVhcj4yMDE0PC9ZZWFyPjxSZWNO

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ADDIN EN.CITE.DATA (21, 23), highlighting a potential pathway through which chronically disturbed sleep leads to cognitive deficits. Other studies report cortical atrophy in insomnia that might confer a risk for cognitive impairment ADDIN EN.CITE <EndNote><Cite><Author>Spiegelhalder</Author><Year>2015</Year><RecNum>658</RecNum><DisplayText>(24)</DisplayText><record><rec-number>658</rec-number><foreign-keys><key app="EN" db-id="5prwe5sa1sz2speefwr5tx0oxdw9szzxpasr">658</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Spiegelhalder, K.</author><author>Regen, W.</author><author>Baglioni, C.</author><author>Nissen, C.</author><author>Riemann, D.</author><author>Kyle, S. D.</author></authors></contributors><auth-address>Department of Psychophysiology/Sleep Medicine, University Medical Center Freiburg, Hauptstrasse 5, 79104, Freiburg, Germany, Kai.Spiegelhalder@uniklinik-freiburg.de.</auth-address><titles><title>Neuroimaging insights into insomnia</title><secondary-title>Curr Neurol Neurosci Rep</secondary-title><alt-title>Current neurology and neuroscience reports</alt-title></titles><periodical><full-title>Curr Neurol Neurosci Rep</full-title><abbr-1>Current neurology and neuroscience reports</abbr-1></periodical><alt-periodical><full-title>Curr Neurol Neurosci Rep</full-title><abbr-1>Current neurology and neuroscience reports</abbr-1></alt-periodical><pages>9</pages><volume>15</volume><number>3</number><keywords><keyword>Humans</keyword><keyword>Neuroimaging/*methods</keyword><keyword>Sleep Initiation and Maintenance Disorders/*pathology/*physiopathology</keyword></keywords><dates><year>2015</year><pub-dates><date>Mar</date></pub-dates></dates><isbn>1534-6293 (Electronic)&#xD;1528-4042 (Linking)</isbn><accession-num>25687698</accession-num><urls><related-urls><url>;(24).CBT-I is a psychological treatment which aims to change the patterns of maladaptive thinking and behaviour which are proposed to maintain sleep difficulties ADDIN EN.CITE <EndNote><Cite><Author>Morin</Author><Year>2003</Year><RecNum>472</RecNum><DisplayText>(25, 26)</DisplayText><record><rec-number>472</rec-number><foreign-keys><key app="EN" db-id="5prwe5sa1sz2speefwr5tx0oxdw9szzxpasr">472</key></foreign-keys><ref-type name="Book">6</ref-type><contributors><authors><author>Morin, Charles M.</author><author>Espie, Colin A.</author></authors></contributors><titles><title>Insomnia : a clinical guide to assessment and treatment</title></titles><keywords><keyword>Insomnia.</keyword></keywords><dates><year>2003</year></dates><pub-location>New York ; London</pub-location><publisher>Kluwer Academic/Plenum</publisher><isbn>0306477505 : ?32.00</isbn><accession-num>bA417852</accession-num><call-num>616.84982 22&#xD;British Library HMNTS YK.2004.a.3917</call-num><urls></urls></record></Cite><Cite><Author>Edinger</Author><Year>2008</Year><RecNum>477</RecNum><record><rec-number>477</rec-number><foreign-keys><key app="EN" db-id="5prwe5sa1sz2speefwr5tx0oxdw9szzxpasr">477</key></foreign-keys><ref-type name="Book">6</ref-type><contributors><authors><author>Edinger, Jack D.</author><author>Carney, Colleen</author></authors></contributors><titles><title>Overcoming insomnia : a cognitive-behavioral therapy approach : therapist guide</title></titles><keywords><keyword>Insomnia Treatment Popular works.</keyword><keyword>Cognitive therapy.</keyword><keyword>Sleep Initiation and Maintenance Disorders therapy.</keyword><keyword>Cognitive Therapy methods.</keyword></keywords><dates><year>2008</year></dates><pub-location>Oxford ; New York</pub-location><publisher>Oxford University Press</publisher><isbn>9780195365894 (pbk. : alk. paper)&#xD;0195365895 (pbk. : alk. paper)</isbn><accession-num>(OCoLC)ocn182613540</accession-num><call-num>616.8498206 22&#xD;British Library HMNTS YK.2016.b.83</call-num><urls><related-urls><url>Table of contents only ;(25, 26). Multiple reviews and meta-analyses support the efficacy of CBT-I in creating long lasting improvements in various indices of sleep, including sleep efficiency, sleep onset latency and wake-time after sleep onset (WASO) PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5UcmF1ZXI8L0F1dGhvcj48WWVhcj4yMDE1PC9ZZWFyPjxS

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ADDIN EN.CITE.DATA (29, 30). It seems that medical advice is sought once a certain level of daytime dysfunction is reached, in the hope that treatment will remedy perceived impairments ADDIN EN.CITE <EndNote><Cite><Author>Henry</Author><Year>2008</Year><RecNum>165</RecNum><DisplayText>(31)</DisplayText><record><rec-number>165</rec-number><foreign-keys><key app="EN" db-id="5prwe5sa1sz2speefwr5tx0oxdw9szzxpasr">165</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Henry, D.</author><author>McClellen, D.</author><author>Rosenthal, L.</author><author>Dedrick, D.</author><author>Gosdin, M.</author></authors></contributors><auth-address>University of North Texas, Denton, TX 76203, USA. dhenry@pacs.unt.edu</auth-address><titles><title>Is sleep really for sissies? Understanding the role of work in insomnia in the US</title><secondary-title>Soc Sci Med</secondary-title></titles><pages>715-26</pages><volume>66</volume><number>3</number><edition>2007/11/17</edition><keywords><keyword>Adult</keyword><keyword>Aged</keyword><keyword>Female</keyword><keyword>Humans</keyword><keyword>Male</keyword><keyword>Middle Aged</keyword><keyword>Qualitative Research</keyword><keyword>*Sleep</keyword><keyword>Sleep Initiation and Maintenance Disorders/*etiology</keyword><keyword>United States</keyword><keyword>*Work</keyword></keywords><dates><year>2008</year><pub-dates><date>Feb</date></pub-dates></dates><isbn>0277-9536 (Print)&#xD;0277-9536 (Linking)</isbn><accession-num>18006129</accession-num><urls><related-urls><url>;(31). Accordingly, treatment options for insomnia should aim to improve not only the sleep deficits, but also the daytime symptoms that contribute to the burden of the disorder ADDIN EN.CITE <EndNote><Cite><Author>Wade</Author><Year>2010</Year><RecNum>1</RecNum><DisplayText>(32)</DisplayText><record><rec-number>1</rec-number><foreign-keys><key app="EN" db-id="5prwe5sa1sz2speefwr5tx0oxdw9szzxpasr">1</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Wade, A. G.</author></authors></contributors><auth-address>CPS Research, Todd Campus, 3 Acre Rd, Glasgow, G20 0XA, Scotland. alangwade@fastmail.fm</auth-address><titles><title>The societal costs of insomnia</title><secondary-title>Neuropsychiatr Dis Treat</secondary-title><alt-title>Neuropsychiatric disease and treatment</alt-title></titles><periodical><full-title>Neuropsychiatr Dis Treat</full-title><abbr-1>Neuropsychiatric disease and treatment</abbr-1></periodical><alt-periodical><full-title>Neuropsychiatr Dis Treat</full-title><abbr-1>Neuropsychiatric disease and treatment</abbr-1></alt-periodical><pages>1-18</pages><volume>7</volume><edition>2011/02/18</edition><dates><year>2010</year></dates><isbn>1178-2021 (Electronic)&#xD;1176-6328 (Linking)</isbn><accession-num>21326650</accession-num><urls><related-urls><url>;(32). However, relatively little is known about the effects of CBT-I on daytime symptoms. Recent reviews have concluded that psychological treatment for insomnia is associated with improvements in quality of life PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5LeWxlPC9BdXRob3I+PFllYXI+MjAxMDwvWWVhcj48UmVj

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ADDIN EN.CITE.DATA (11, 33). However, quality of life is a broad concept, encompassing aspects of physical and psychological wellbeing. Moreover, quality of life is usually assessed using instruments which were not developed specifically for use in insomnia populations. Therefore, the impact of treatment on those aspects of daytime functioning which are known to be of particular concern in insomnia is not clear. The aim of the current review was to conduct a systematic appraisal of the literature and evaluate the evidence for the effects of CBT-I on cognitive functioning. We chose to focus on cognition because impairments in this area are one of the most commonly endorsed daytime complaints PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5Fc3BpZTwvQXV0aG9yPjxZZWFyPjIwMTI8L1llYXI+PFJl

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ADDIN EN.CITE.DATA (37). METHODAs part of the review, quantitative data regarding effect sizes are presented. The standardised mean difference (SMD) was used as a measure of effect size and was calculated for studies utilising an RCT design, providing the necessary post-treatment and follow-up data. A meta-analysis was not considered appropriate for the current review due to the small number of studies available and the considerable heterogeneity in the methodology and outcomes of included studies.Search strategy and selectionOnline databases EMBASE, PsycINFO, MEDLINE, MEDLINE In-Process, All EBM Reviews, CINAHL and the Cochrane Library were searched from inception to 19th March 2016. The review used a title and abstract word strategy, which included the following terms: (sleeplessness OR insomnia* OR “sleep initiation” OR “sleep maintenance” OR “sleep disorder*” OR dysomnia* OR “poor sleep*” OR “sleep problem*” OR “sleep disturbance*”) AND (“cognitive behav* therap*” OR “behav* therap*” OR CBT OR CBT-I OR ICBT OR “self-help” OR “sleep hygiene” OR “stimulus control” OR “sleep restriction” OR relaxation OR “behav* modification” OR “cognitive therap*” OR imagery OR psychotherap*). Reference lists of published meta-analyses and systematic reviews of CBT-I trials were also searched to locate additional papers PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5UcmF1ZXI8L0F1dGhvcj48WWVhcj4yMDE1PC9ZZWFyPjxS

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ADDIN EN.CITE.DATA (27, 38).Citations were exported to reference management software and duplicates were removed. Titles and abstracts were reviewed. If the abstract indicated that the study evaluated a psychological treatment for insomnia, the full text was acquired to identify if cognitive functioning was measured as a treatment outcome. Relevant articles were then assessed against the inclusion and exclusion criteria. For each of the articles identified, the reference list was searched and the article was entered into the “similar articles” search tool in PUBMED, in order to find additional relevant articles. Reviews, opinions, editorials, grey literature and conference abstracts were not included. Criteria for inclusion of research articlesEmpirical studies were included if they recruited an adult sample (18 years and over) with insomnia at either the disorder or symptom level, as defined by the diagnostic and statistical manual for mental disorders (e.g. DSM-V) ADDIN EN.CITE <EndNote><Cite><RecNum>3</RecNum><DisplayText>(7)</DisplayText><record><rec-number>3</rec-number><foreign-keys><key app="EN" db-id="5prwe5sa1sz2speefwr5tx0oxdw9szzxpasr">3</key></foreign-keys><ref-type name="Book">6</ref-type><contributors><authors><author>American Psychiatric Association</author></authors></contributors><titles><title>Diagnostic and statistical manual of mental disorders : DSM-5</title><alt-title>Dsm-5</alt-title></titles><edition>Fifth edition.</edition><keywords><keyword>Mental illness Diagnosis Handbooks, manuals, etc.</keyword><keyword>Mental illness Statistics.</keyword><keyword>Mental Disorders classification.</keyword><keyword>Mental Disorders diagnosis.</keyword><keyword>Diagnostic and statistical manual of mental disorders. 5th ed.</keyword></keywords><dates><year>2013</year></dates><pub-location>Arlington, VA</pub-location><publisher>American Psychiatric Publishing</publisher><isbn>9780890425541 (Hardcover)&#xD;9780890425558 (Paperback)</isbn><accession-num>(DNLM)101604226</accession-num><call-num>616.89075 23&#xD;British Library DSC m13/.15124&#xD;British Library STI (B) 616.89075&#xD;British Library STI (B) 616.89075 Enquiry Desk Science 2</call-num><urls></urls></record></Cite></EndNote>(7) , the international classification of sleep disorders ADDIN EN.CITE <EndNote><Cite><Year>2005</Year><RecNum>37</RecNum><DisplayText>(1)</DisplayText><record><rec-number>37</rec-number><foreign-keys><key app="EN" db-id="5prwe5sa1sz2speefwr5tx0oxdw9szzxpasr">37</key></foreign-keys><ref-type name="Book">6</ref-type><contributors></contributors><titles><title>The international classification of sleep disorders : diagnostic &amp; coding manual</title></titles><edition>2nd ed.</edition><dates><year>2005</year></dates><pub-location>Westchester, Ill.</pub-location><publisher>American Academy of Sleep Medicine</publisher><isbn>0965722023 (pbk.)</isbn><call-num>British Library DSC m06/.34596</call-num><urls></urls></record></Cite></EndNote>(1), research criteria for insomnia ADDIN EN.CITE <EndNote><Cite><Author>Edinger</Author><Year>2004</Year><RecNum>134</RecNum><DisplayText>(2)</DisplayText><record><rec-number>134</rec-number><foreign-keys><key app="EN" db-id="5prwe5sa1sz2speefwr5tx0oxdw9szzxpasr">134</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Edinger, J. D.</author><author>Bonnet, M. H.</author><author>Bootzin, R. R.</author><author>Doghramji, K.</author><author>Dorsey, C. M.</author><author>Espie, C. A.</author><author>Jamieson, A. O.</author><author>McCall, W. V.</author><author>Morin, C. M.</author><author>Stepanski, E. J.</author></authors></contributors><auth-address>VA Medical Center, Durham, NC, USA.</auth-address><titles><title>Derivation of research diagnostic criteria for insomnia: report of an American Academy of Sleep Medicine Work Group</title><secondary-title>Sleep</secondary-title><alt-title>Sleep</alt-title></titles><periodical><full-title>Sleep</full-title><abbr-1>Sleep</abbr-1></periodical><alt-periodical><full-title>Sleep</full-title><abbr-1>Sleep</abbr-1></alt-periodical><pages>1567-96</pages><volume>27</volume><number>8</number><edition>2005/02/03</edition><keywords><keyword>Diagnostic and Statistical Manual of Mental Disorders</keyword><keyword>Humans</keyword><keyword>Reference Values</keyword><keyword>Reproducibility of Results</keyword><keyword>Sleep Initiation and Maintenance Disorders/classification/*diagnosis</keyword></keywords><dates><year>2004</year><pub-dates><date>Dec 15</date></pub-dates></dates><isbn>0161-8105 (Print)&#xD;0161-8105 (Linking)</isbn><accession-num>15683149</accession-num><work-type>Consensus Development Conference&#xD;Research Support, Non-U.S. Gov&apos;t&#xD;Review</work-type><urls><related-urls><url>;(2) or measures of insomnia severity, such as the insomnia severity index (ISI) ADDIN EN.CITE <EndNote><Cite><Author>Bastien</Author><Year>2001</Year><RecNum>213</RecNum><DisplayText>(39)</DisplayText><record><rec-number>213</rec-number><foreign-keys><key app="EN" db-id="5prwe5sa1sz2speefwr5tx0oxdw9szzxpasr">213</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Bastien, C. H.</author><author>Vallieres, A.</author><author>Morin, C. M.</author></authors></contributors><auth-address>Ecole de Psychologie and Centre d&apos;Etude des Troubles du Sommeil, Universite Laval, Ste-Foy, G1K 7P4, Quebec, Canada</auth-address><titles><title>Validation of the Insomnia Severity Index as an outcome measure for insomnia research</title><secondary-title>Sleep Med</secondary-title><alt-title>Sleep medicine</alt-title></titles><periodical><full-title>Sleep Med</full-title><abbr-1>Sleep medicine</abbr-1></periodical><alt-periodical><full-title>Sleep Med</full-title><abbr-1>Sleep medicine</abbr-1></alt-periodical><pages>297-307</pages><volume>2</volume><number>4</number><edition>2001/07/05</edition><dates><year>2001</year><pub-dates><date>Jul</date></pub-dates></dates><isbn>1878-5506 (Electronic)&#xD;1389-9457 (Linking)</isbn><accession-num>11438246</accession-num><urls><related-urls><url>;(39) and the Pittsburgh sleep quality index (PSQI) ADDIN EN.CITE <EndNote><Cite><Author>Buysse</Author><Year>1989</Year><RecNum>220</RecNum><DisplayText>(40)</DisplayText><record><rec-number>220</rec-number><foreign-keys><key app="EN" db-id="5prwe5sa1sz2speefwr5tx0oxdw9szzxpasr">220</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Buysse, D. J.</author><author>Reynolds, C. F., 3rd</author><author>Monk, T. H.</author><author>Berman, S. R.</author><author>Kupfer, D. J.</author></authors></contributors><auth-address>Department of Psychiatry, University of Pittsburgh School of Medicine, PA.</auth-address><titles><title>The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research</title><secondary-title>Psychiatry Res</secondary-title><alt-title>Psychiatry research</alt-title></titles><periodical><full-title>Psychiatry Res</full-title><abbr-1>Psychiatry research</abbr-1></periodical><alt-periodical><full-title>Psychiatry Res</full-title><abbr-1>Psychiatry research</abbr-1></alt-periodical><pages>193-213</pages><volume>28</volume><number>2</number><edition>1989/05/01</edition><keywords><keyword>Adult</keyword><keyword>Aged</keyword><keyword>Aged, 80 and over</keyword><keyword>Depression/*psychology</keyword><keyword>Female</keyword><keyword>Humans</keyword><keyword>Male</keyword><keyword>Middle Aged</keyword><keyword>*Psychological Tests</keyword><keyword>Psychometrics</keyword><keyword>Sleep Initiation and Maintenance Disorders/*diagnosis/psychology</keyword><keyword>*Sleep Stages</keyword></keywords><dates><year>1989</year><pub-dates><date>May</date></pub-dates></dates><isbn>0165-1781 (Print)&#xD;0165-1781 (Linking)</isbn><accession-num>2748771</accession-num><work-type>Research Support, U.S. Gov&apos;t, P.H.S.</work-type><urls><related-urls><url>;(40). Studies using samples where insomnia was comorbid with, or secondary to, a health or psychiatric condition were eligible for inclusion. The treatment for insomnia was required to incorporate at least two of the five most widely accepted components of CBT-I ADDIN EN.CITE <EndNote><Cite><Author>Morin</Author><Year>2012</Year><RecNum>221</RecNum><DisplayText>(41)</DisplayText><record><rec-number>221</rec-number><foreign-keys><key app="EN" db-id="5prwe5sa1sz2speefwr5tx0oxdw9szzxpasr">221</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Morin, C. M.</author><author>Benca, R.</author></authors></contributors><auth-address>Universite Laval, Quebec City, QC, Canada. cmorin@psy.ulaval.ca</auth-address><titles><title>Chronic insomnia</title><secondary-title>Lancet</secondary-title></titles><periodical><full-title>Lancet</full-title><abbr-1>Lancet</abbr-1></periodical><pages>1129-41</pages><volume>379</volume><number>9821</number><edition>2012/01/24</edition><keywords><keyword>Arousal/physiology</keyword><keyword>Brain/physiopathology</keyword><keyword>Chronic Disease</keyword><keyword>*Cognitive Therapy</keyword><keyword>Comorbidity</keyword><keyword>Drug Therapy, Combination</keyword><keyword>GABA-A Receptor Agonists/*therapeutic use</keyword><keyword>Humans</keyword><keyword>Prognosis</keyword><keyword>Sleep Initiation and Maintenance Disorders/epidemiology/physiopathology/*therapy</keyword><keyword>Treatment Outcome</keyword></keywords><dates><year>2012</year><pub-dates><date>Mar 24</date></pub-dates></dates><isbn>1474-547X (Electronic)&#xD;0140-6736 (Linking)</isbn><accession-num>22265700</accession-num><work-type>Research Support, N.I.H., Extramural&#xD;Research Support, Non-U.S. Gov&apos;t&#xD;Review</work-type><urls><related-urls><url>(11)60750-2</electronic-resource-num><language>eng</language></record></Cite></EndNote>(41); a cognitive therapeutic component (e.g., cognitive restructuring), stimulus control, sleep restriction, sleep hygiene and relaxation. There was no requirement for the treatment to combine cognitive and behavioural components and we did not specify inclusion criteria on the basis of delivery modality or duration of treatment. Treatments which were modified for a particular population and/or comorbid condition were eligible. Studies in which the treatment comprised therapies from other treatment modalities (e.g. bright light therapy or hypnotic medication) were not included. In order to be eligible the study was required to assess cognitive functioning as a treatment outcome. Studies were classified as having assessed cognitive functioning if they administered a measure which probed one of the following domains: attention, concentration, perception, memory, verbal functions, construction, concept formation, reasoning, executive functions or motor performance ADDIN EN.CITE <EndNote><Cite><Author>Lezak</Author><Year>2004</Year><RecNum>225</RecNum><DisplayText>(42)</DisplayText><record><rec-number>225</rec-number><foreign-keys><key app="EN" db-id="5prwe5sa1sz2speefwr5tx0oxdw9szzxpasr">225</key></foreign-keys><ref-type name="Book">6</ref-type><contributors><authors><author>Lezak, Muriel Deutsch</author><author>Howieson, Diane B.</author><author>Loring, David W.</author></authors></contributors><titles><title>Neuropsychological assessment</title></titles><edition>4th ed. / Muriel D. Lezak, Diane B. Howieson, David W. Loring with H. Julia Hannay and Jill S. Fischer.</edition><keywords><keyword>Neuropsychological tests.</keyword></keywords><dates><year>2004</year></dates><pub-location>Oxford</pub-location><publisher>Oxford University Press</publisher><isbn>0195111214 : ?59.50</isbn><call-num>616.80475 22&#xD;British Library HMNTS YC.2016.b.866&#xD;British Library DSC m04/29607</call-num><urls></urls></record></Cite></EndNote>(42). Cognitive functioning could be assessed subjectively using standardised questionnaires or single items (e.g. visual analogue scales), or objectively using cognitive tests. Studies utilising subjective measures of cognitive functioning were jointly inspected by all three authors (VH, SDK and DP) to consider if the subjective measure adequately assessed an aspect of cognitive functioning. A consensus was required for the study to be deemed as eligible.As the literature is limited, all types of treatment evaluation study designs were included. Studies were required to be written in English and published in peer-review journals.Quality AssessmentThe Downs and Black checklist ADDIN EN.CITE <EndNote><Cite><Author>Downs</Author><Year>1998</Year><RecNum>233</RecNum><DisplayText>(43)</DisplayText><record><rec-number>233</rec-number><foreign-keys><key app="EN" db-id="5prwe5sa1sz2speefwr5tx0oxdw9szzxpasr">233</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Downs, S. H.</author><author>Black, N.</author></authors></contributors><auth-address>Department of Public Health and Policy, London School of Hygiene and Tropical Medicine.</auth-address><titles><title>The feasibility of creating a checklist for the assessment of the methodological quality both of randomised and non-randomised studies of health care interventions</title><secondary-title>J Epidemiol Community Health</secondary-title><alt-title>Journal of epidemiology and community health</alt-title></titles><pages>377-84</pages><volume>52</volume><number>6</number><edition>1998/10/09</edition><keywords><keyword>Bias (Epidemiology)</keyword><keyword>Clinical Trials as Topic/*standards</keyword><keyword>Confounding Factors (Epidemiology)</keyword><keyword>Delivery of Health Care/*standards</keyword><keyword>Epidemiologic Studies</keyword><keyword>Feasibility Studies</keyword><keyword>Humans</keyword><keyword>Pilot Projects</keyword><keyword>*Quality Assurance, Health Care/organization &amp; administration</keyword><keyword>Quality Control</keyword><keyword>Randomized Controlled Trials as Topic</keyword><keyword>Reproducibility of Results</keyword><keyword>Statistics, Nonparametric</keyword></keywords><dates><year>1998</year><pub-dates><date>Jun</date></pub-dates></dates><isbn>0143-005X (Print)&#xD;0143-005X (Linking)</isbn><accession-num>9764259</accession-num><urls><related-urls><url>;(43) was used to assess the methodological quality of included studies. It includes 27 items assessing study reporting, external validity, internal validity and power in relation to randomised and non-randomised studies. It has adequate levels of internal consistency, good inter-rater reliability and high test-retest reliability ADDIN EN.CITE <EndNote><Cite><Author>Downs</Author><Year>1998</Year><RecNum>233</RecNum><DisplayText>(43)</DisplayText><record><rec-number>233</rec-number><foreign-keys><key app="EN" db-id="5prwe5sa1sz2speefwr5tx0oxdw9szzxpasr">233</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Downs, S. H.</author><author>Black, N.</author></authors></contributors><auth-address>Department of Public Health and Policy, London School of Hygiene and Tropical Medicine.</auth-address><titles><title>The feasibility of creating a checklist for the assessment of the methodological quality both of randomised and non-randomised studies of health care interventions</title><secondary-title>J Epidemiol Community Health</secondary-title><alt-title>Journal of epidemiology and community health</alt-title></titles><pages>377-84</pages><volume>52</volume><number>6</number><edition>1998/10/09</edition><keywords><keyword>Bias (Epidemiology)</keyword><keyword>Clinical Trials as Topic/*standards</keyword><keyword>Confounding Factors (Epidemiology)</keyword><keyword>Delivery of Health Care/*standards</keyword><keyword>Epidemiologic Studies</keyword><keyword>Feasibility Studies</keyword><keyword>Humans</keyword><keyword>Pilot Projects</keyword><keyword>*Quality Assurance, Health Care/organization &amp; administration</keyword><keyword>Quality Control</keyword><keyword>Randomized Controlled Trials as Topic</keyword><keyword>Reproducibility of Results</keyword><keyword>Statistics, Nonparametric</keyword></keywords><dates><year>1998</year><pub-dates><date>Jun</date></pub-dates></dates><isbn>0143-005X (Print)&#xD;0143-005X (Linking)</isbn><accession-num>9764259</accession-num><urls><related-urls><url>;(43). Item 27 relating to power was omitted due to the fact that cognitive functioning was a secondary outcome within the majority of the included studies and therefore power calculations were not based on this variable. Quality assessment was performed by two researchers independently, for three of the included studies. There was strong levels of agreement between the researchers (Kappa = .90).Data extraction Each article was read in full in order to extract and record details of the included studies within a standardised extraction form. This form included the following information: authors and year of published report, methods (study design, assessment time points, blinding, procedure for randomisation), participant characteristics (study population, sample size, age, gender distribution), intervention details (components and mode of delivery), information about the control or comparator intervention and outcomes on a measure of cognitive functioning. Data synthesisFindings were combined and summarised in a narrative synthesis. Factors which may explain differences in the direction or size of effects across studies (e.g. study methodology) were considered and discussed, as per guidelines for conducting narrative synthesis ADDIN EN.CITE <EndNote><Cite><Author>Popay</Author><Year>2006</Year><RecNum>239</RecNum><DisplayText>(44)</DisplayText><record><rec-number>239</rec-number><foreign-keys><key app="EN" db-id="5prwe5sa1sz2speefwr5tx0oxdw9szzxpasr">239</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Popay, J.</author><author>Roberts, H.</author><author>Sowden, A.</author><author>Petticrew, M.</author><author>Arai, L.</author><author>Rodgers, M.</author><author>Britten, N.</author><author>Roen, K.</author><author>Duffy, S.</author></authors></contributors><auth-address>University of Lancaster</auth-address><titles><title>Guidance on the conduct of narrative synthesis in systematic reviews: a product from the ESRC methods programme</title></titles><dates><year>2006</year></dates><orig-pub>University of Lancaster</orig-pub><urls></urls></record></Cite></EndNote>(44) . The SMD was used as a measure of effect size and was calculated for studies utilising a RCT design, providing the necessary post-treatment and follow-up data. Additional data was sought from authors where required. The SMD was derived by subtracting the mean for the control group from the mean for the treatment group and dividing the result by the pooled standard deviation. The direction of the values for the SMD was adjusted so that a positive value indicated better cognitive functioning in the treatment group compared to the control group at the post-treatment and follow-up time points. RESULTSStudy selectionSearches of databases and bibliographies yielded 2336 potentially relevant citations, of which 436 were duplicates and 1377 were deemed ineligible on the basis of title and abstract. Full text was retrieved for 523 studies and these papers were assessed against the inclusion and exclusion criteria. A final sample of 18 studies was included in the review. A flow chart of the study selection process is presented in figure 1.[Insert figure 1 here]Description of studies included within the reviewThere were a range of study designs within the included studies; 11 RCTs PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5Bcm5lZHQ8L0F1dGhvcj48WWVhcj4yMDExPC9ZZWFyPjxS

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ADDIN EN.CITE.DATA (56-60), one non-randomised controlled trial ADDIN EN.CITE <EndNote><Cite><Author>Simeit</Author><Year>2004</Year><RecNum>279</RecNum><DisplayText>(61)</DisplayText><record><rec-number>279</rec-number><foreign-keys><key app="EN" db-id="5prwe5sa1sz2speefwr5tx0oxdw9szzxpasr">279</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Simeit, R.</author><author>Deck, R.</author><author>Conta-Marx, B.</author></authors></contributors><auth-address>Ropersbergklinik Ratzeburg, Ropersberg 47, 23909 Ratzeburg, Germany. info@rkrz.de</auth-address><titles><title>Sleep management training for cancer patients with insomnia</title><secondary-title>Support Care Cancer</secondary-title><alt-title>Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer</alt-title></titles><pages>176-83</pages><volume>12</volume><number>3</number><edition>2004/02/05</edition><keywords><keyword>Attitude to Health</keyword><keyword>Female</keyword><keyword>Health Care Surveys</keyword><keyword>Humans</keyword><keyword>Male</keyword><keyword>Middle Aged</keyword><keyword>Neoplasms/*complications/psychology</keyword><keyword>Patient Education as Topic/*methods</keyword><keyword>Program Evaluation</keyword><keyword>Quality of Life</keyword><keyword>Relaxation Therapy/*education</keyword><keyword>Sleep Initiation and Maintenance Disorders/prevention &amp; control/*rehabilitation</keyword><keyword>Surveys and Questionnaires</keyword></keywords><dates><year>2004</year><pub-dates><date>Mar</date></pub-dates></dates><isbn>0941-4355 (Print)&#xD;0941-4355 (Linking)</isbn><accession-num>14760542</accession-num><work-type>Clinical Trial&#xD;Controlled Clinical Trial&#xD;Research Support, Non-U.S. Gov&apos;t</work-type><urls><related-urls><url>;(61) and one case series ADDIN EN.CITE <EndNote><Cite><Author>Quesnel</Author><Year>2003</Year><RecNum>276</RecNum><DisplayText>(62)</DisplayText><record><rec-number>276</rec-number><foreign-keys><key app="EN" db-id="5prwe5sa1sz2speefwr5tx0oxdw9szzxpasr">276</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Quesnel, C.</author><author>Savard, J.</author><author>Simard, S.</author><author>Ivers, H.</author><author>Morin, C. M.</author></authors></contributors><auth-address>School of Psychology and Cancer Research Centre, Universite Laval, Quebec, Quebec, Canada.</auth-address><titles><title>Efficacy of cognitive-behavioral therapy for insomnia in women treated for nonmetastatic breast cancer</title><secondary-title>J Consult Clin Psychol</secondary-title><alt-title>Journal of consulting and clinical psychology</alt-title></titles><periodical><full-title>J Consult Clin Psychol</full-title></periodical><pages>189-200</pages><volume>71</volume><number>1</number><edition>2003/02/27</edition><keywords><keyword>Adult</keyword><keyword>Aged</keyword><keyword>Breast Neoplasms/*psychology</keyword><keyword>Cognitive Therapy/*methods</keyword><keyword>Female</keyword><keyword>Humans</keyword><keyword>Middle Aged</keyword><keyword>Polysomnography</keyword><keyword>Quality of Life</keyword><keyword>Sleep Initiation and Maintenance Disorders/diagnosis/*etiology/*therapy</keyword><keyword>Surveys and Questionnaires</keyword></keywords><dates><year>2003</year><pub-dates><date>Feb</date></pub-dates></dates><isbn>0022-006X (Print)&#xD;0022-006X (Linking)</isbn><accession-num>12602439</accession-num><work-type>Clinical Trial&#xD;Research Support, Non-U.S. Gov&apos;t</work-type><urls><related-urls><url>;(62). Study characteristics are presented in table 1. Study qualityThe methodological quality of studies varied, with scores ranging between 10 and 20 out of a possible 26 (mean score = 15). The uncontrolled trials and the case series scored poorly due to the high risk of bias. There were only two studies that attempted to blind participants to the intervention. Few studies used intent-to-treat analysis to limit bias from attrition. In the studies that administered cognitive tests, there was no blinding of outcome assessment. When weighing up the evidence, more weight was given to data from RCTs and higher quality studies. Full quality ratings for each of the included studies are shown in table S1.ParticipantsThe sample size of the included studies ranged from seven to 229. There were a total of 923 individuals with insomnia symptoms in the eighteen included studies. Across the studies, the mean age of participants was 50.0 years and 71.0% of participants were female. This is comparable to findings from another meta-analysis of outcomes following CBT-I ADDIN EN.CITE <EndNote><Cite><Author>Trauer</Author><Year>2015</Year><RecNum>197</RecNum><DisplayText>(27)</DisplayText><record><rec-number>197</rec-number><foreign-keys><key app="EN" db-id="5prwe5sa1sz2speefwr5tx0oxdw9szzxpasr">197</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Trauer, J. M.</author><author>Qian, M. Y.</author><author>Doyle, J. S.</author><author>Rajaratnam, S. M.</author><author>Cunnington, D.</author></authors></contributors><titles><title>Cognitive Behavioral Therapy for Chronic Insomnia: A Systematic Review and Meta-analysis</title><secondary-title>Ann Intern Med</secondary-title><alt-title>Annals of internal medicine</alt-title></titles><pages>191-204</pages><volume>163</volume><number>3</number><edition>2015/06/09</edition><keywords><keyword>Chronic Disease</keyword><keyword>*Cognitive Therapy</keyword><keyword>Humans</keyword><keyword>Relaxation Therapy</keyword><keyword>Sleep Initiation and Maintenance Disorders/psychology/*therapy</keyword><keyword>Time Factors</keyword></keywords><dates><year>2015</year><pub-dates><date>Aug 4</date></pub-dates></dates><isbn>1539-3704 (Electronic)&#xD;0003-4819 (Linking)</isbn><accession-num>26054060</accession-num><work-type>Meta-Analysis&#xD;Review</work-type><urls><related-urls><url>;(27) and is consistent with research showing that insomnia symptoms are more common in women and with advancing age PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5TaXZlcnRzZW48L0F1dGhvcj48WWVhcj4yMDA5PC9ZZWFy

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ADDIN EN.CITE.DATA (63). The criteria used to verify insomnia varied across studies. Half of the studies used the DSM-IV ADDIN EN.CITE <EndNote><Cite><Year>1994</Year><RecNum>385</RecNum><DisplayText>(64)</DisplayText><record><rec-number>385</rec-number><foreign-keys><key app="EN" db-id="5prwe5sa1sz2speefwr5tx0oxdw9szzxpasr">385</key></foreign-keys><ref-type name="Book">6</ref-type><contributors></contributors><titles><title>Diagnostic and statistical manual of mental disorders : DSM-IV</title></titles><edition>4th ed.</edition><keywords><keyword>Mental illness Classification.</keyword><keyword>Mental illness Diagnosis.</keyword></keywords><dates><year>1994</year></dates><pub-location>Washington, D.C.</pub-location><publisher>American Psychiatric Association</publisher><isbn>0890420629 (pbk)&#xD;0890420610 (cased)</isbn><accession-num>adv010031788x</accession-num><call-num>616.89/075 20&#xD;British Library DSC q94/15280&#xD;British Library HMNTS YK.1996.b.9493</call-num><urls></urls></record></Cite></EndNote>(64), DSM-V ADDIN EN.CITE <EndNote><Cite><RecNum>3</RecNum><DisplayText>(7)</DisplayText><record><rec-number>3</rec-number><foreign-keys><key app="EN" db-id="5prwe5sa1sz2speefwr5tx0oxdw9szzxpasr">3</key></foreign-keys><ref-type name="Book">6</ref-type><contributors><authors><author>American Psychiatric Association</author></authors></contributors><titles><title>Diagnostic and statistical manual of mental disorders : DSM-5</title><alt-title>Dsm-5</alt-title></titles><edition>Fifth edition.</edition><keywords><keyword>Mental illness Diagnosis Handbooks, manuals, etc.</keyword><keyword>Mental illness Statistics.</keyword><keyword>Mental Disorders classification.</keyword><keyword>Mental Disorders diagnosis.</keyword><keyword>Diagnostic and statistical manual of mental disorders. 5th ed.</keyword></keywords><dates><year>2013</year></dates><pub-location>Arlington, VA</pub-location><publisher>American Psychiatric Publishing</publisher><isbn>9780890425541 (Hardcover)&#xD;9780890425558 (Paperback)</isbn><accession-num>(DNLM)101604226</accession-num><call-num>616.89075 23&#xD;British Library DSC m13/.15124&#xD;British Library STI (B) 616.89075&#xD;British Library STI (B) 616.89075 Enquiry Desk Science 2</call-num><urls></urls></record></Cite></EndNote>(7) or research diagnostic criteria ADDIN EN.CITE <EndNote><Cite><Author>Edinger</Author><Year>2004</Year><RecNum>134</RecNum><DisplayText>(2)</DisplayText><record><rec-number>134</rec-number><foreign-keys><key app="EN" db-id="5prwe5sa1sz2speefwr5tx0oxdw9szzxpasr">134</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Edinger, J. D.</author><author>Bonnet, M. H.</author><author>Bootzin, R. R.</author><author>Doghramji, K.</author><author>Dorsey, C. M.</author><author>Espie, C. A.</author><author>Jamieson, A. O.</author><author>McCall, W. V.</author><author>Morin, C. M.</author><author>Stepanski, E. J.</author></authors></contributors><auth-address>VA Medical Center, Durham, NC, USA.</auth-address><titles><title>Derivation of research diagnostic criteria for insomnia: report of an American Academy of Sleep Medicine Work Group</title><secondary-title>Sleep</secondary-title><alt-title>Sleep</alt-title></titles><periodical><full-title>Sleep</full-title><abbr-1>Sleep</abbr-1></periodical><alt-periodical><full-title>Sleep</full-title><abbr-1>Sleep</abbr-1></alt-periodical><pages>1567-96</pages><volume>27</volume><number>8</number><edition>2005/02/03</edition><keywords><keyword>Diagnostic and Statistical Manual of Mental Disorders</keyword><keyword>Humans</keyword><keyword>Reference Values</keyword><keyword>Reproducibility of Results</keyword><keyword>Sleep Initiation and Maintenance Disorders/classification/*diagnosis</keyword></keywords><dates><year>2004</year><pub-dates><date>Dec 15</date></pub-dates></dates><isbn>0161-8105 (Print)&#xD;0161-8105 (Linking)</isbn><accession-num>15683149</accession-num><work-type>Consensus Development Conference&#xD;Research Support, Non-U.S. Gov&apos;t&#xD;Review</work-type><urls><related-urls><url>;(2) PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5Bcm5lZHQ8L0F1dGhvcj48WWVhcj4yMDEzPC9ZZWFyPjxS

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ADDIN EN.CITE.DATA (46, 50-52, 54, 55, 58, 61, 62). Six studies used scores on the ISI combined with self-report difficulties with sleep onset/maintenance PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5Bcm5lZHQ8L0F1dGhvcj48WWVhcj4yMDA3PC9ZZWFyPjxS

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ADDIN EN.CITE.DATA (45, 47, 49, 56, 59, 60). One study used scores on the PSQI ADDIN EN.CITE <EndNote><Cite><Author>Sun</Author><Year>2013</Year><RecNum>280</RecNum><DisplayText>(53)</DisplayText><record><rec-number>280</rec-number><foreign-keys><key app="EN" db-id="5prwe5sa1sz2speefwr5tx0oxdw9szzxpasr">280</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Sun, J.</author><author>Kang, J.</author><author>Wang, P.</author><author>Zeng, H.</author></authors></contributors><auth-address>School of Nursing, Central South University, Changsha, Hunan Province, China.</auth-address><titles><title>Self-relaxation training can improve sleep quality and cognitive functions in the older: a one-year randomised controlled trial</title><secondary-title>J Clin Nurs</secondary-title><alt-title>Journal of clinical nursing</alt-title></titles><pages>1270-80</pages><volume>22</volume><number>9-10</number><edition>2013/04/12</edition><keywords><keyword>Adolescent</keyword><keyword>Adult</keyword><keyword>Aged</keyword><keyword>Aged, 80 and over</keyword><keyword>Analysis of Variance</keyword><keyword>Child</keyword><keyword>*Cognition</keyword><keyword>Female</keyword><keyword>Humans</keyword><keyword>Male</keyword><keyword>Middle Aged</keyword><keyword>Patient Education as Topic/*methods</keyword><keyword>*Relaxation Therapy</keyword><keyword>*Self Care</keyword><keyword>*Sleep</keyword><keyword>Surveys and Questionnaires</keyword><keyword>Young Adult</keyword></keywords><dates><year>2013</year><pub-dates><date>May</date></pub-dates></dates><isbn>1365-2702 (Electronic)&#xD;0962-1067 (Linking)</isbn><accession-num>23574290</accession-num><work-type>Randomized Controlled Trial&#xD;Research Support, Non-U.S. Gov&apos;t</work-type><urls><related-urls><url>;(53). Two studies developed their own criteria based on DSM-IV PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5EYXZpZHNvbjwvQXV0aG9yPjxZZWFyPjIwMDE8L1llYXI+

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ADDIN EN.CITE.DATA (47, 49, 52, 57, 61, 62), two studies of adults recovering from alcohol dependence PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5Bcm5lZHQ8L0F1dGhvcj48WWVhcj4yMDA3PC9ZZWFyPjxS

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ADDIN EN.CITE.DATA (51, 53, 55), one study of women with post-partum depression ADDIN EN.CITE <EndNote><Cite><Author>Swanson</Author><Year>2013</Year><RecNum>249</RecNum><DisplayText>(59)</DisplayText><record><rec-number>249</rec-number><foreign-keys><key app="EN" db-id="5prwe5sa1sz2speefwr5tx0oxdw9szzxpasr">249</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Swanson, L. M.</author><author>Flynn, H.</author><author>Adams-Mundy, J. D.</author><author>Armitage, R.</author><author>Arnedt, J. T.</author></authors></contributors><auth-address>Department of Psychiatry, University of Michigan, USA. LMSwan@med.umich.edu</auth-address><titles><title>An open pilot of cognitive-behavioral therapy for insomnia in women with postpartum depression</title><secondary-title>Behav Sleep Med</secondary-title><alt-title>Behavioral sleep medicine</alt-title></titles><periodical><full-title>Behav Sleep Med</full-title><abbr-1>Behavioral sleep medicine</abbr-1></periodical><alt-periodical><full-title>Behav Sleep Med</full-title><abbr-1>Behavioral sleep medicine</abbr-1></alt-periodical><pages>297-307</pages><volume>11</volume><number>4</number><edition>2012/12/12</edition><keywords><keyword>Adult</keyword><keyword>*Affect</keyword><keyword>*Cognitive Therapy</keyword><keyword>Depression, Postpartum/*complications</keyword><keyword>Fatigue/complications/psychology</keyword><keyword>Female</keyword><keyword>Humans</keyword><keyword>Pilot Projects</keyword><keyword>Severity of Illness Index</keyword><keyword>*Sleep</keyword><keyword>Sleep Initiation and Maintenance Disorders/complications/psychology/*therapy</keyword><keyword>Treatment Outcome</keyword></keywords><dates><year>2013</year></dates><isbn>1540-2010 (Electronic)&#xD;1540-2002 (Linking)</isbn><accession-num>23216373</accession-num><work-type>Research Support, Non-U.S. Gov&apos;t</work-type><urls><related-urls><url>;(59), one study of pregnant women ADDIN EN.CITE <EndNote><Cite><Author>Tomfohr-Madsen</Author><Year>2016</Year><RecNum>287</RecNum><DisplayText>(60)</DisplayText><record><rec-number>287</rec-number><foreign-keys><key app="EN" db-id="5prwe5sa1sz2speefwr5tx0oxdw9szzxpasr">287</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Tomfohr-Madsen, L. M.</author><author>Clayborne, Z. M.</author><author>Rouleau, C. R.</author><author>Campbell, T. S.</author></authors></contributors><auth-address>a Department of Psychology , University of Calgary , Calgary , Alberta , Canada.&#xD;b Alberta Children&apos;s Hospital Research Institute for Child and Maternal Health , Calgary , Alberta , Canada.&#xD;c Department of Pediatrics , Alberta Children&apos;s Hospital , Calgary , Alberta , Canada.</auth-address><titles><title>Sleeping for Two: An Open-Pilot Study of Cognitive Behavioral Therapy for Insomnia in Pregnancy</title><secondary-title>Behav Sleep Med</secondary-title><alt-title>Behavioral sleep medicine</alt-title></titles><periodical><full-title>Behav Sleep Med</full-title><abbr-1>Behavioral sleep medicine</abbr-1></periodical><alt-periodical><full-title>Behav Sleep Med</full-title><abbr-1>Behavioral sleep medicine</abbr-1></alt-periodical><pages>1-17</pages><edition>2016/04/29</edition><dates><year>2016</year><pub-dates><date>Apr 28</date></pub-dates></dates><isbn>1540-2010 (Electronic)&#xD;1540-2002 (Linking)</isbn><accession-num>27124405</accession-num><urls><related-urls><url>;(60) and two studies of adults without any psychiatric or physical health comorbidities PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5Bcm5lZHQ8L0F1dGhvcj48WWVhcj4yMDEzPC9ZZWFyPjxS

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ADDIN EN.CITE.DATA (45, 47, 49, 50, 52, 55-62). Of those studies which reported the duration of insomnia symptoms (10/18), mean values for the sample ranged from 3.9-174 months, with an average duration across studies of 75.83 months.InterventionsThe majority of studies (16/18) delivered an intervention which combined cognitive, behavioural and educational components. There were two exceptions; Wilckens et al. ADDIN EN.CITE <EndNote><Cite><Author>Wilckens</Author><Year>2016</Year><RecNum>288</RecNum><DisplayText>(55)</DisplayText><record><rec-number>288</rec-number><foreign-keys><key app="EN" db-id="5prwe5sa1sz2speefwr5tx0oxdw9szzxpasr">288</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Wilckens, K. A.</author><author>Hall, M. H.</author><author>Nebes, R. D.</author><author>Monk, T. H.</author><author>Buysse, D. J.</author></authors></contributors><auth-address>a Department of Psychiatry , University of Pittsburgh School of Medicine , USA.</auth-address><titles><title>Changes in Cognitive Performance Are Associated with Changes in Sleep in Older Adults With Insomnia</title><secondary-title>Behav Sleep Med</secondary-title><alt-title>Behavioral sleep medicine</alt-title></titles><periodical><full-title>Behav Sleep Med</full-title><abbr-1>Behavioral sleep medicine</abbr-1></periodical><alt-periodical><full-title>Behav Sleep Med</full-title><abbr-1>Behavioral sleep medicine</abbr-1></alt-periodical><pages>295-310</pages><volume>14</volume><number>3</number><edition>2015/09/01</edition><dates><year>2016</year><pub-dates><date>May-Jun</date></pub-dates></dates><isbn>1540-2010 (Electronic)&#xD;1540-2002 (Linking)</isbn><accession-num>26322904</accession-num><urls><related-urls><url>;(55) incorporated only the educational and behavioural components of CBT-I (sleep hygiene, stimulus control and sleep restriction) and Sun et al. ADDIN EN.CITE <EndNote><Cite><Author>Sun</Author><Year>2013</Year><RecNum>280</RecNum><DisplayText>(53)</DisplayText><record><rec-number>280</rec-number><foreign-keys><key app="EN" db-id="5prwe5sa1sz2speefwr5tx0oxdw9szzxpasr">280</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Sun, J.</author><author>Kang, J.</author><author>Wang, P.</author><author>Zeng, H.</author></authors></contributors><auth-address>School of Nursing, Central South University, Changsha, Hunan Province, China.</auth-address><titles><title>Self-relaxation training can improve sleep quality and cognitive functions in the older: a one-year randomised controlled trial</title><secondary-title>J Clin Nurs</secondary-title><alt-title>Journal of clinical nursing</alt-title></titles><pages>1270-80</pages><volume>22</volume><number>9-10</number><edition>2013/04/12</edition><keywords><keyword>Adolescent</keyword><keyword>Adult</keyword><keyword>Aged</keyword><keyword>Aged, 80 and over</keyword><keyword>Analysis of Variance</keyword><keyword>Child</keyword><keyword>*Cognition</keyword><keyword>Female</keyword><keyword>Humans</keyword><keyword>Male</keyword><keyword>Middle Aged</keyword><keyword>Patient Education as Topic/*methods</keyword><keyword>*Relaxation Therapy</keyword><keyword>*Self Care</keyword><keyword>*Sleep</keyword><keyword>Surveys and Questionnaires</keyword><keyword>Young Adult</keyword></keywords><dates><year>2013</year><pub-dates><date>May</date></pub-dates></dates><isbn>1365-2702 (Electronic)&#xD;0962-1067 (Linking)</isbn><accession-num>23574290</accession-num><work-type>Randomized Controlled Trial&#xD;Research Support, Non-U.S. Gov&apos;t</work-type><urls><related-urls><url>;(53) combined sleep hygiene with relaxation techniques. Many of the included studies failed to provide sufficient details of the intervention components to enable replication, particularly for sleep restriction. A range of methods were used to deliver the intervention. Eight studies delivered the intervention in a group setting PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5EYXZpZHNvbjwvQXV0aG9yPjxZZWFyPjIwMDE8L1llYXI+

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ADDIN EN.CITE.DATA (47). One study utilised an online format PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5SaXR0ZXJiYW5kPC9BdXRob3I+PFllYXI+MjAxMjwvWWVh

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ADDIN EN.CITE.DATA (52). The length of treatment ranged from 3 to 9 weeks (mean length of treatment = 6 weeks). All of the studies indicated that a structured treatment protocol was used and eleven studies made explicit reference to the treatment being manualised PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5Bcm5lZHQ8L0F1dGhvcj48WWVhcj4yMDExPC9ZZWFyPjxS

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ADDIN EN.CITE.DATA (45). A study in cancer patients provided psychoeducation about how to cope with fatigue using physical activity ADDIN EN.CITE <EndNote><Cite><Author>Quesnel</Author><Year>2003</Year><RecNum>276</RecNum><DisplayText>(62)</DisplayText><record><rec-number>276</rec-number><foreign-keys><key app="EN" db-id="5prwe5sa1sz2speefwr5tx0oxdw9szzxpasr">276</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Quesnel, C.</author><author>Savard, J.</author><author>Simard, S.</author><author>Ivers, H.</author><author>Morin, C. M.</author></authors></contributors><auth-address>School of Psychology and Cancer Research Centre, Universite Laval, Quebec, Quebec, Canada.</auth-address><titles><title>Efficacy of cognitive-behavioral therapy for insomnia in women treated for nonmetastatic breast cancer</title><secondary-title>J Consult Clin Psychol</secondary-title><alt-title>Journal of consulting and clinical psychology</alt-title></titles><periodical><full-title>J Consult Clin Psychol</full-title></periodical><pages>189-200</pages><volume>71</volume><number>1</number><edition>2003/02/27</edition><keywords><keyword>Adult</keyword><keyword>Aged</keyword><keyword>Breast Neoplasms/*psychology</keyword><keyword>Cognitive Therapy/*methods</keyword><keyword>Female</keyword><keyword>Humans</keyword><keyword>Middle Aged</keyword><keyword>Polysomnography</keyword><keyword>Quality of Life</keyword><keyword>Sleep Initiation and Maintenance Disorders/diagnosis/*etiology/*therapy</keyword><keyword>Surveys and Questionnaires</keyword></keywords><dates><year>2003</year><pub-dates><date>Feb</date></pub-dates></dates><isbn>0022-006X (Print)&#xD;0022-006X (Linking)</isbn><accession-num>12602439</accession-num><work-type>Clinical Trial&#xD;Research Support, Non-U.S. Gov&apos;t</work-type><urls><related-urls><url>;(62). Both of the studies in fibromyalgia patients provided psychoeducation about the link between fibromyalgia, pain and sleep PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5MYW1pPC9BdXRob3I+PFllYXI+MjAxNjwvWWVhcj48UmVj

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ADDIN EN.CITE.DATA (50, 58). Description of control and comparative conditionsBoth passive and active control conditions were used. Two RCTs compared CBT-I to behavioural placebo treatment (BPT) PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5Bcm5lZHQ8L0F1dGhvcj48WWVhcj4yMDExPC9ZZWFyPjxS

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ADDIN EN.CITE.DATA (45, 49). One RCT compared CBT-I to Zopiclone PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5PbXZpazwvQXV0aG9yPjxZZWFyPjIwMDg8L1llYXI+PFJl

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ADDIN EN.CITE.DATA (51). Four studies used self-help information as a comparator PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5Bcm5lZHQ8L0F1dGhvcj48WWVhcj4yMDEzPC9ZZWFyPjxS

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ADDIN EN.CITE.DATA (50). One non-randomised controlled trial compared “sleep management training” delivered within a standard cancer rehabilitation treatment to the rehabilitation treatment alone ADDIN EN.CITE <EndNote><Cite><Author>Simeit</Author><Year>2004</Year><RecNum>279</RecNum><DisplayText>(61)</DisplayText><record><rec-number>279</rec-number><foreign-keys><key app="EN" db-id="5prwe5sa1sz2speefwr5tx0oxdw9szzxpasr">279</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Simeit, R.</author><author>Deck, R.</author><author>Conta-Marx, B.</author></authors></contributors><auth-address>Ropersbergklinik Ratzeburg, Ropersberg 47, 23909 Ratzeburg, Germany. info@rkrz.de</auth-address><titles><title>Sleep management training for cancer patients with insomnia</title><secondary-title>Support Care Cancer</secondary-title><alt-title>Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer</alt-title></titles><pages>176-83</pages><volume>12</volume><number>3</number><edition>2004/02/05</edition><keywords><keyword>Attitude to Health</keyword><keyword>Female</keyword><keyword>Health Care Surveys</keyword><keyword>Humans</keyword><keyword>Male</keyword><keyword>Middle Aged</keyword><keyword>Neoplasms/*complications/psychology</keyword><keyword>Patient Education as Topic/*methods</keyword><keyword>Program Evaluation</keyword><keyword>Quality of Life</keyword><keyword>Relaxation Therapy/*education</keyword><keyword>Sleep Initiation and Maintenance Disorders/prevention &amp; control/*rehabilitation</keyword><keyword>Surveys and Questionnaires</keyword></keywords><dates><year>2004</year><pub-dates><date>Mar</date></pub-dates></dates><isbn>0941-4355 (Print)&#xD;0941-4355 (Linking)</isbn><accession-num>14760542</accession-num><work-type>Clinical Trial&#xD;Controlled Clinical Trial&#xD;Research Support, Non-U.S. Gov&apos;t</work-type><urls><related-urls><url>;(61). Three RCTs compared CBT-I to no treatment PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5DYXNhdWx0PC9BdXRob3I+PFllYXI+MjAxNTwvWWVhcj48

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dGU+AG==

ADDIN EN.CITE.DATA (47, 52, 54).Description of subjective cognitive outcome measuresFourteen studies employed a subjective measure of cognitive functioning. Six studies used the mental fatigue subscale from the multidimensional fatigue inventory (MFI-20) PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5Bcm5lZHQ8L0F1dGhvcj48WWVhcj4yMDA3PC9ZZWFyPjxS

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ADDIN EN.CITE.DATA (45, 46, 52, 54, 56, 58-60). This subscale contains four items which assess cognitive symptoms of fatigue, such as difficulties concentrating (“When I am doing something, I can keep my thoughts on it”, “I can concentrate well”, “My thoughts easily wander” and “It takes a lot of effort to concentrate on things”) ADDIN EN.CITE <EndNote><Cite><Author>Smets</Author><Year>1995</Year><RecNum>425</RecNum><DisplayText>(65)</DisplayText><record><rec-number>425</rec-number><foreign-keys><key app="EN" db-id="5prwe5sa1sz2speefwr5tx0oxdw9szzxpasr">425</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Smets, E. M.</author><author>Garssen, B.</author><author>Bonke, B.</author><author>De Haes, J. C.</author></authors></contributors><auth-address>University of Amsterdam, Department of Medical Psychology, The Netherlands.</auth-address><titles><title>The Multidimensional Fatigue Inventory (MFI) psychometric qualities of an instrument to assess fatigue</title><secondary-title>J Psychosom Res</secondary-title><alt-title>Journal of psychosomatic research</alt-title></titles><periodical><full-title>J Psychosom Res</full-title><abbr-1>Journal of psychosomatic research</abbr-1></periodical><alt-periodical><full-title>J Psychosom Res</full-title><abbr-1>Journal of psychosomatic research</abbr-1></alt-periodical><pages>315-25</pages><volume>39</volume><number>3</number><edition>1995/04/01</edition><keywords><keyword>Adult</keyword><keyword>Cognition Disorders/etiology</keyword><keyword>Fatigue/complications/*diagnosis</keyword><keyword>Female</keyword><keyword>Humans</keyword><keyword>Male</keyword><keyword>Middle Aged</keyword><keyword>Motivation</keyword><keyword>Neoplasms/complications/radiotherapy</keyword><keyword>*Psychometrics</keyword><keyword>Reproducibility of Results</keyword><keyword>Surveys and Questionnaires</keyword></keywords><dates><year>1995</year><pub-dates><date>Apr</date></pub-dates></dates><isbn>0022-3999 (Print)&#xD;0022-3999 (Linking)</isbn><accession-num>7636775</accession-num><work-type>Comparative Study&#xD;Research Support, Non-U.S. Gov&apos;t</work-type><urls><related-urls><url>;(65). Two studies used the mental fatigue subscale of the multidimensional fatigue symptom inventory – short form (MFSI-SF) PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5SaXR0ZXJiYW5kPC9BdXRob3I+PFllYXI+MjAxMjwvWWVh

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ADDIN EN.CITE.DATA (52, 60). This subscale contains six items (“I have trouble remembering things”, “I am confused”, “I have trouble paying attention”, “I am unable to concentrate”, “I make more mistakes than usual” and “I am forgetful”). Four studies used the cognitive subscale from the European organisation for research and treatment of cancer QLQ-C30, which is an instrument that evaluates quality of life in cancer patients PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5DYXNhdWx0PC9BdXRob3I+PFllYXI+MjAxNTwvWWVhcj48

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ADDIN EN.CITE.DATA (47, 57, 61, 62). This subscale contains two items probing concentration and memory (“Have you had difficulties concentrating on things, like reading a newspaper or watching television” and “Have you had difficulty remembering things?”) ADDIN EN.CITE <EndNote><Cite><Author>Aaronson</Author><Year>1993</Year><RecNum>426</RecNum><DisplayText>(66)</DisplayText><record><rec-number>426</rec-number><foreign-keys><key app="EN" db-id="5prwe5sa1sz2speefwr5tx0oxdw9szzxpasr">426</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Aaronson, N. K.</author><author>Ahmedzai, S.</author><author>Bergman, B.</author><author>Bullinger, M.</author><author>Cull, A.</author><author>Duez, N. J.</author><author>Filiberti, A.</author><author>Flechtner, H.</author><author>Fleishman, S. B.</author><author>de Haes, J. C.</author><author>et al.,</author></authors></contributors><titles><title>The European Organization for Research and Treatment of Cancer QLQ-C30: a quality-of-life instrument for use in international clinical trials in oncology</title><secondary-title>J Natl Cancer Inst</secondary-title><alt-title>Journal of the National Cancer Institute</alt-title></titles><pages>365-76</pages><volume>85</volume><number>5</number><edition>1993/03/03</edition><keywords><keyword>Activities of Daily Living</keyword><keyword>Adult</keyword><keyword>Aged</keyword><keyword>Aged, 80 and over</keyword><keyword>Clinical Trials as Topic</keyword><keyword>Female</keyword><keyword>Health Status</keyword><keyword>Humans</keyword><keyword>Lung Neoplasms/*therapy</keyword><keyword>Male</keyword><keyword>Middle Aged</keyword><keyword>*Quality of Life</keyword><keyword>Reproducibility of Results</keyword><keyword>*Surveys and Questionnaires</keyword></keywords><dates><year>1993</year><pub-dates><date>Mar 3</date></pub-dates></dates><isbn>0027-8874 (Print)&#xD;0027-8874 (Linking)</isbn><accession-num>8433390</accession-num><work-type>Multicenter Study</work-type><urls><related-urls><url>;(66). One study used the attentional function index (AFI) PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5NYXR0aGV3czwvQXV0aG9yPjxZZWFyPjIwMTQ8L1llYXI+

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ADDIN EN.CITE.DATA (49), which is a measure of perceived effectiveness in common activities requiring attention and working memory. The total score on this instrument is thought to provide an overall index of attentional functioning ADDIN EN.CITE <EndNote><Cite><Author>Cimprich</Author><Year>1993</Year><RecNum>427</RecNum><DisplayText>(67)</DisplayText><record><rec-number>427</rec-number><foreign-keys><key app="EN" db-id="5prwe5sa1sz2speefwr5tx0oxdw9szzxpasr">427</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Cimprich, B.</author></authors></contributors><auth-address>University of Wisconsin, Madison 53792.</auth-address><titles><title>Development of an intervention to restore attention in cancer patients</title><secondary-title>Cancer Nurs</secondary-title><alt-title>Cancer nursing</alt-title></titles><periodical><full-title>Cancer Nurs</full-title><abbr-1>Cancer nursing</abbr-1></periodical><alt-periodical><full-title>Cancer Nurs</full-title><abbr-1>Cancer nursing</abbr-1></alt-periodical><pages>83-92</pages><volume>16</volume><number>2</number><edition>1993/04/01</edition><keywords><keyword>Adult</keyword><keyword>Aged</keyword><keyword>Aged, 80 and over</keyword><keyword>*Attention/physiology</keyword><keyword>Breast Neoplasms/nursing/*psychology/surgery</keyword><keyword>Chemotherapy, Adjuvant</keyword><keyword>Depression/psychology</keyword><keyword>Female</keyword><keyword>Humans</keyword><keyword>Leisure Activities</keyword><keyword>Mastectomy</keyword><keyword>Mastectomy, Segmental</keyword><keyword>Middle Aged</keyword><keyword>Psychological Tests</keyword><keyword>Self-Assessment</keyword><keyword>Tamoxifen/therapeutic use</keyword><keyword>Time Factors</keyword></keywords><dates><year>1993</year><pub-dates><date>Apr</date></pub-dates></dates><isbn>0162-220X (Print)&#xD;0162-220X (Linking)</isbn><accession-num>8477404</accession-num><work-type>Clinical Trial&#xD;Randomized Controlled Trial&#xD;Research Support, U.S. Gov&apos;t, P.H.S.</work-type><urls><related-urls><url>;(67). One study used a Likert scale measure of difficulties with concentration PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5KYW5zc29uPC9BdXRob3I+PFllYXI+MjAwNTwvWWVhcj48

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ADDIN EN.CITE.DATA (50). This is a computerised cognitive test which assesses three aspects of attentional functioning (orienting, alerting and executive functioning), as well as the interactions between these three networks ADDIN EN.CITE <EndNote><Cite><Author>Fan</Author><Year>2002</Year><RecNum>429</RecNum><DisplayText>(68)</DisplayText><record><rec-number>429</rec-number><foreign-keys><key app="EN" db-id="5prwe5sa1sz2speefwr5tx0oxdw9szzxpasr">429</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Fan, J.</author><author>McCandliss, B. D.</author><author>Sommer, T.</author><author>Raz, A.</author><author>Posner, M. I.</author></authors></contributors><auth-address>The Sackler Institute for Developmental Psychobiology, Department of Psychiatry, Weill Medical College of Cornell University, 1300 York Avenue, Box 140, New York, NY 10002, USA. jif2004@med.cornell.edu</auth-address><titles><title>Testing the efficiency and independence of attentional networks</title><secondary-title>J Cogn Neurosci</secondary-title><alt-title>Journal of cognitive neuroscience</alt-title></titles><pages>340-7</pages><volume>14</volume><number>3</number><edition>2002/04/24</edition><keywords><keyword>Adult</keyword><keyword>Analysis of Variance</keyword><keyword>Attention/*physiology</keyword><keyword>Cognition Disorders/*diagnosis/physiopathology</keyword><keyword>*Diagnosis, Computer-Assisted</keyword><keyword>Female</keyword><keyword>Head Injuries, Closed/*diagnosis/physiopathology</keyword><keyword>Humans</keyword><keyword>Male</keyword><keyword>Neuropsychological Tests</keyword><keyword>Orientation/physiology</keyword><keyword>Psychomotor Performance</keyword><keyword>Reproducibility of Results</keyword></keywords><dates><year>2002</year><pub-dates><date>Apr 1</date></pub-dates></dates><isbn>0898-929X (Print)&#xD;0898-929X (Linking)</isbn><accession-num>11970796</accession-num><work-type>Research Support, Non-U.S. Gov&apos;t&#xD;Research Support, U.S. Gov&apos;t, Non-P.H.S.</work-type><urls><related-urls><url>;(68). One study PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5PbXZpazwvQXV0aG9yPjxZZWFyPjIwMDg8L1llYXI+PFJl

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ADDIN EN.CITE.DATA (53, 55). The study by Wilckens et al. ADDIN EN.CITE <EndNote><Cite><Author>Wilckens</Author><Year>2016</Year><RecNum>288</RecNum><DisplayText>(55)</DisplayText><record><rec-number>288</rec-number><foreign-keys><key app="EN" db-id="5prwe5sa1sz2speefwr5tx0oxdw9szzxpasr">288</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Wilckens, K. A.</author><author>Hall, M. H.</author><author>Nebes, R. D.</author><author>Monk, T. H.</author><author>Buysse, D. J.</author></authors></contributors><auth-address>a Department of Psychiatry , University of Pittsburgh School of Medicine , USA.</auth-address><titles><title>Changes in Cognitive Performance Are Associated with Changes in Sleep in Older Adults With Insomnia</title><secondary-title>Behav Sleep Med</secondary-title><alt-title>Behavioral sleep medicine</alt-title></titles><periodical><full-title>Behav Sleep Med</full-title><abbr-1>Behavioral sleep medicine</abbr-1></periodical><alt-periodical><full-title>Behav Sleep Med</full-title><abbr-1>Behavioral sleep medicine</abbr-1></alt-periodical><pages>295-310</pages><volume>14</volume><number>3</number><edition>2015/09/01</edition><dates><year>2016</year><pub-dates><date>May-Jun</date></pub-dates></dates><isbn>1540-2010 (Electronic)&#xD;1540-2002 (Linking)</isbn><accession-num>26322904</accession-num><urls><related-urls><url>;(55) administered the logical memory test to assess episodic memory ADDIN EN.CITE <EndNote><Cite><Author>Wechsler</Author><Year>1997b</Year><RecNum>433</RecNum><DisplayText>(70)</DisplayText><record><rec-number>433</rec-number><foreign-keys><key app="EN" db-id="5prwe5sa1sz2speefwr5tx0oxdw9szzxpasr">433</key></foreign-keys><ref-type name="Book">6</ref-type><contributors><authors><author>Wechsler, D.</author></authors></contributors><titles><title>Wechsler Memory Scale (WMS-III)</title></titles><dates><year>1997b</year></dates><pub-location>San Antonio, TX</pub-location><publisher>Psychological Corporation</publisher><urls></urls></record></Cite></EndNote>(70), the test of nonverbal intelligence III (TONI) to assess abstract reasoning and figural problem solving ADDIN EN.CITE <EndNote><Cite><Author>Brown</Author><Year>1997</Year><RecNum>435</RecNum><DisplayText>(71)</DisplayText><record><rec-number>435</rec-number><foreign-keys><key app="EN" db-id="5prwe5sa1sz2speefwr5tx0oxdw9szzxpasr">435</key></foreign-keys><ref-type name="Book">6</ref-type><contributors><authors><author>Brown, R.</author><author>Sheronbenou, R.J.</author><author>Johnsen, S.K.</author></authors></contributors><titles><title>Test of nonverbal intelligence</title></titles><volume>Third Edition (TONI-3)</volume><dates><year>1997</year></dates><pub-location>San Antonio, TX</pub-location><publisher>Pearson</publisher><urls></urls></record></Cite></EndNote>(71) and the letter-number sequencing test to assess working memory ADDIN EN.CITE <EndNote><Cite><Author>Wechsler</Author><Year>1997a</Year><RecNum>436</RecNum><DisplayText>(72)</DisplayText><record><rec-number>436</rec-number><foreign-keys><key app="EN" db-id="5prwe5sa1sz2speefwr5tx0oxdw9szzxpasr">436</key></foreign-keys><ref-type name="Book">6</ref-type><contributors><authors><author>Wechsler, D.</author></authors></contributors><titles><title>Wechsler Adult Intelligence Scale (WAIS): Administration and scoring manual</title></titles><volume>3rd edition</volume><dates><year>1997a</year></dates><pub-location>San Antonio, TX</pub-location><publisher>Psychological Corporation</publisher><urls></urls></record></Cite></EndNote>(72). The study by Sun et al. ADDIN EN.CITE <EndNote><Cite><Author>Sun</Author><Year>2013</Year><RecNum>280</RecNum><DisplayText>(53)</DisplayText><record><rec-number>280</rec-number><foreign-keys><key app="EN" db-id="5prwe5sa1sz2speefwr5tx0oxdw9szzxpasr">280</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Sun, J.</author><author>Kang, J.</author><author>Wang, P.</author><author>Zeng, H.</author></authors></contributors><auth-address>School of Nursing, Central South University, Changsha, Hunan Province, China.</auth-address><titles><title>Self-relaxation training can improve sleep quality and cognitive functions in the older: a one-year randomised controlled trial</title><secondary-title>J Clin Nurs</secondary-title><alt-title>Journal of clinical nursing</alt-title></titles><pages>1270-80</pages><volume>22</volume><number>9-10</number><edition>2013/04/12</edition><keywords><keyword>Adolescent</keyword><keyword>Adult</keyword><keyword>Aged</keyword><keyword>Aged, 80 and over</keyword><keyword>Analysis of Variance</keyword><keyword>Child</keyword><keyword>*Cognition</keyword><keyword>Female</keyword><keyword>Humans</keyword><keyword>Male</keyword><keyword>Middle Aged</keyword><keyword>Patient Education as Topic/*methods</keyword><keyword>*Relaxation Therapy</keyword><keyword>*Self Care</keyword><keyword>*Sleep</keyword><keyword>Surveys and Questionnaires</keyword><keyword>Young Adult</keyword></keywords><dates><year>2013</year><pub-dates><date>May</date></pub-dates></dates><isbn>1365-2702 (Electronic)&#xD;0962-1067 (Linking)</isbn><accession-num>23574290</accession-num><work-type>Randomized Controlled Trial&#xD;Research Support, Non-U.S. Gov&apos;t</work-type><urls><related-urls><url>;(53) administered the mini mental state examination (MMSE) ADDIN EN.CITE <EndNote><Cite><Author>Folstein</Author><Year>1975</Year><RecNum>448</RecNum><DisplayText>(73)</DisplayText><record><rec-number>448</rec-number><foreign-keys><key app="EN" db-id="5prwe5sa1sz2speefwr5tx0oxdw9szzxpasr">448</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Folstein, M. F.</author><author>Folstein, S. E.</author><author>McHugh, P. R.</author></authors></contributors><titles><title>&quot;Mini-mental state&quot;. A practical method for grading the cognitive state of patients for the clinician</title><secondary-title>J Psychiatr Res</secondary-title><alt-title>Journal of psychiatric research</alt-title></titles><pages>189-98</pages><volume>12</volume><number>3</number><edition>1975/11/01</edition><keywords><keyword>Adult</keyword><keyword>Affective Symptoms/diagnosis</keyword><keyword>Aged</keyword><keyword>Bipolar Disorder/diagnosis</keyword><keyword>*Cognition</keyword><keyword>Cognition Disorders/etiology</keyword><keyword>Craniocerebral Trauma/complications</keyword><keyword>Dementia/diagnosis</keyword><keyword>Depression/diagnosis</keyword><keyword>Diagnosis, Differential</keyword><keyword>Female</keyword><keyword>Humans</keyword><keyword>Male</keyword><keyword>Mental Disorders/*diagnosis</keyword><keyword>*Mental Status Schedule</keyword><keyword>Metabolic Diseases/complications</keyword><keyword>Middle Aged</keyword><keyword>Neurotic Disorders/diagnosis</keyword><keyword>*Psychiatric Status Rating Scales</keyword><keyword>Schizophrenia/diagnosis</keyword><keyword>Substance-Related Disorders/complications</keyword><keyword>Time Factors</keyword></keywords><dates><year>1975</year><pub-dates><date>Nov</date></pub-dates></dates><isbn>0022-3956 (Print)&#xD;0022-3956 (Linking)</isbn><accession-num>1202204</accession-num><urls><related-urls><url>;(73) to assess global cognitive functioning and the Wechsler memory scale (WMS-CR) ADDIN EN.CITE <EndNote><Cite><Author>Gong</Author><Year>1989</Year><RecNum>469</RecNum><DisplayText>(74)</DisplayText><record><rec-number>469</rec-number><foreign-keys><key app="EN" db-id="5prwe5sa1sz2speefwr5tx0oxdw9szzxpasr">469</key></foreign-keys><ref-type name="Book">6</ref-type><contributors><authors><author>Gong, Y.X.</author></authors></contributors><titles><title>Handbook of Wechsler Memory Scale-Revised</title></titles><dates><year>1989</year></dates><pub-location>Changsha</pub-location><publisher>Hunan Medical College</publisher><urls></urls></record></Cite></EndNote>(74) to examine memory function. 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ADDIN EN.CITE.DATA (56-60). For one study, SMD at post-treatment and follow-up was not calculated due to non-random assignment to groups ADDIN EN.CITE <EndNote><Cite><Author>Simeit</Author><Year>2004</Year><RecNum>279</RecNum><DisplayText>(61)</DisplayText><record><rec-number>279</rec-number><foreign-keys><key app="EN" db-id="5prwe5sa1sz2speefwr5tx0oxdw9szzxpasr">279</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Simeit, R.</author><author>Deck, R.</author><author>Conta-Marx, B.</author></authors></contributors><auth-address>Ropersbergklinik Ratzeburg, Ropersberg 47, 23909 Ratzeburg, Germany. info@rkrz.de</auth-address><titles><title>Sleep management training for cancer patients with insomnia</title><secondary-title>Support Care Cancer</secondary-title><alt-title>Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer</alt-title></titles><pages>176-83</pages><volume>12</volume><number>3</number><edition>2004/02/05</edition><keywords><keyword>Attitude to Health</keyword><keyword>Female</keyword><keyword>Health Care Surveys</keyword><keyword>Humans</keyword><keyword>Male</keyword><keyword>Middle Aged</keyword><keyword>Neoplasms/*complications/psychology</keyword><keyword>Patient Education as Topic/*methods</keyword><keyword>Program Evaluation</keyword><keyword>Quality of Life</keyword><keyword>Relaxation Therapy/*education</keyword><keyword>Sleep Initiation and Maintenance Disorders/prevention &amp; control/*rehabilitation</keyword><keyword>Surveys and Questionnaires</keyword></keywords><dates><year>2004</year><pub-dates><date>Mar</date></pub-dates></dates><isbn>0941-4355 (Print)&#xD;0941-4355 (Linking)</isbn><accession-num>14760542</accession-num><work-type>Clinical Trial&#xD;Controlled Clinical Trial&#xD;Research Support, Non-U.S. Gov&apos;t</work-type><urls><related-urls><url>;(61). Two studies reported follow-up data only PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5KYW5zc29uPC9BdXRob3I+PFllYXI+MjAwNTwvWWVhcj48

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ADDIN EN.CITE.DATA (48, 53). SMD values at post-treatment and follow-up for subjective outcomes are presented in table S2 and for objective outcomes are presented in table S3. [Insert table 1 here]Narrative synthesisCurrent evidence for the effect of CBT-I on subjective measures of cognitive functioningSeven RCTs administered a subjective measure of cognitive functioning. A significant improvement following the intervention compared to control was reported in three RCTs PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5DYXNhdWx0PC9BdXRob3I+PFllYXI+MjAxNTwvWWVhcj48

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ADDIN EN.CITE.DATA (47, 48, 52). The SMD at the post-intervention time-point was calculated for two of these studies PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5DYXNhdWx0PC9BdXRob3I+PFllYXI+MjAxNTwvWWVhcj48

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ADDIN EN.CITE.DATA (47) in cancer patients, demonstrated an improvement in scores on the cognitive functioning subscale of the QLQ-C30 at post-intervention, in the group that received minimal CBT-I compared to a no treatment control group. This difference was not maintained at the 12 or 24-week follow-up, due to improvement in scores in the control group (see figure 4). The study by Ritterband et al. PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5SaXR0ZXJiYW5kPC9BdXRob3I+PFllYXI+MjAxMjwvWWVh

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ADDIN EN.CITE.DATA (52) reported a greater improvement in mental fatigue in the group that received internet delivered CBT-I (SHUTi) compared to control. Our calculations of SMD revealed no significant difference between the groups in mental fatigue at the post-intervention time-point. This discrepancy is likely due to the fact that post-intervention SMD does not take baseline scores into account. In this RCT, in spite of random allocation, there were significant differences between the groups at baseline in the variables sex and type of cancer, which were not adjusted for in the analysis. Moreover, participants in the SHUTi group displayed higher levels of mental fatigue than participants in the control group at baseline and therefore the significant improvement in the intervention group could be explained by regression towards the mean. Thus, the results from this study should be interpreted with caution.[Insert figure 2 here]The study by Jansson and Linton PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5KYW5zc29uPC9BdXRob3I+PFllYXI+MjAwNTwvWWVhcj48

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ADDIN EN.CITE.DATA (48) evaluated the impact of CBT-I on difficulties with concentration, one-year post intervention. They reported significantly greater improvements in concentration between baseline and follow-up in the CBT-I group compared to control, however our calculations of SMD revealed that the groups were not significantly different at follow-up (SMD = 0.19). Similar to the study by Ritterband et al. PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5SaXR0ZXJiYW5kPC9BdXRob3I+PFllYXI+MjAxMjwvWWVh

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ADDIN EN.CITE.DATA (52), this discrepancy is likely due to the fact that post-intervention SMD does not take baseline scores into account. In this study there was attrition between randomisation and follow-up (17.6%), which may have introduced bias. The researchers reported that individuals who dropped out were not significantly different from those who completed the study in terms of demographic or clinical data (including concentration difficulties) and there was no differential loss of participants across the groups. However, an intention-to-treat analysis of the data was not performed and therefore potential bias from attrition is possible. The lack of statistically significant differences between the groups at follow-up may be explained by low sensitivity of the measure utilised and the long period of time between intervention and follow-up, during which the impact of the intervention may have diminished (see figure 4). Four RCTs reported a non-significant difference between groups in change in subjective cognitive outcomes between baseline and post-intervention PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5NYXR0aGV3czwvQXV0aG9yPjxZZWFyPjIwMTQ8L1llYXI+

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ADDIN EN.CITE.DATA (45, 46). For both of these studies, improvements were larger in the intervention groups, however differences were not statistically significant. Finally, the study by Taylor et al PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5UYXlsb3I8L0F1dGhvcj48WWVhcj4yMDE0PC9ZZWFyPjxS

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ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5UYXlsb3I8L0F1dGhvcj48WWVhcj4yMDE0PC9ZZWFyPjxS

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ADDIN EN.CITE.DATA (54) showed no effect of CBT-I on mental fatigue in college students. The authors suggest that this may be due to possible floor effects. There were five uncontrolled trials that administered a subjective measure of cognitive functioning PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5Bcm5lZHQ8L0F1dGhvcj48WWVhcj4yMDA3PC9ZZWFyPjxS

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ADDIN EN.CITE.DATA (58-60) and one study reported a trend for improved cognitive functioning ADDIN EN.CITE <EndNote><Cite><Author>Davidson</Author><Year>2001</Year><RecNum>258</RecNum><DisplayText>(57)</DisplayText><record><rec-number>258</rec-number><foreign-keys><key app="EN" db-id="5prwe5sa1sz2speefwr5tx0oxdw9szzxpasr">258</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Davidson, J. R.</author><author>Waisberg, J. L.</author><author>Brundage, M. D.</author><author>MacLean, A. W.</author></authors></contributors><auth-address>Department of Psychology, Queen&apos;s University, Kingston, Ontario, Canada. davidsnj@post.queensu.ca</auth-address><titles><title>Nonpharmacologic group treatment of insomnia: a preliminary study with cancer survivors</title><secondary-title>Psychooncology</secondary-title><alt-title>Psycho-oncology</alt-title></titles><pages>389-97</pages><volume>10</volume><number>5</number><edition>2001/09/06</edition><keywords><keyword>Attitude to Health</keyword><keyword>Cognitive Therapy/*methods</keyword><keyword>Female</keyword><keyword>Humans</keyword><keyword>Longitudinal Studies</keyword><keyword>Male</keyword><keyword>Middle Aged</keyword><keyword>Neoplasms/*complications/psychology/therapy</keyword><keyword>Patient Education as Topic/*methods</keyword><keyword>Program Evaluation</keyword><keyword>*Relaxation Therapy</keyword><keyword>Severity of Illness Index</keyword><keyword>Sleep Initiation and Maintenance Disorders/*etiology/psychology/*therapy</keyword><keyword>*Survivors/psychology</keyword><keyword>Time Factors</keyword><keyword>Treatment Outcome</keyword></keywords><dates><year>2001</year><pub-dates><date>Sep-Oct</date></pub-dates></dates><isbn>1057-9249 (Print)&#xD;1057-9249 (Linking)</isbn><accession-num>11536417</accession-num><work-type>Clinical Trial&#xD;Controlled Clinical Trial&#xD;Research Support, Non-U.S. Gov&apos;t</work-type><urls><related-urls><url>;(57). The studies that did not find a statistically significant improvement had small samples (N = 14 and N = 7). The case series conducted by Quesnel et al. ADDIN EN.CITE <EndNote><Cite><Author>Quesnel</Author><Year>2003</Year><RecNum>276</RecNum><DisplayText>(62)</DisplayText><record><rec-number>276</rec-number><foreign-keys><key app="EN" db-id="5prwe5sa1sz2speefwr5tx0oxdw9szzxpasr">276</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Quesnel, C.</author><author>Savard, J.</author><author>Simard, S.</author><author>Ivers, H.</author><author>Morin, C. M.</author></authors></contributors><auth-address>School of Psychology and Cancer Research Centre, Universite Laval, Quebec, Quebec, Canada.</auth-address><titles><title>Efficacy of cognitive-behavioral therapy for insomnia in women treated for nonmetastatic breast cancer</title><secondary-title>J Consult Clin Psychol</secondary-title><alt-title>Journal of consulting and clinical psychology</alt-title></titles><periodical><full-title>J Consult Clin Psychol</full-title></periodical><pages>189-200</pages><volume>71</volume><number>1</number><edition>2003/02/27</edition><keywords><keyword>Adult</keyword><keyword>Aged</keyword><keyword>Breast Neoplasms/*psychology</keyword><keyword>Cognitive Therapy/*methods</keyword><keyword>Female</keyword><keyword>Humans</keyword><keyword>Middle Aged</keyword><keyword>Polysomnography</keyword><keyword>Quality of Life</keyword><keyword>Sleep Initiation and Maintenance Disorders/diagnosis/*etiology/*therapy</keyword><keyword>Surveys and Questionnaires</keyword></keywords><dates><year>2003</year><pub-dates><date>Feb</date></pub-dates></dates><isbn>0022-006X (Print)&#xD;0022-006X (Linking)</isbn><accession-num>12602439</accession-num><work-type>Clinical Trial&#xD;Research Support, Non-U.S. Gov&apos;t</work-type><urls><related-urls><url>;(62) reported a significant improvement in score on the QLQ-C30 between baseline and post-intervention, which was maintained at follow-up. The non-randomised controlled trial reported by Simeit et al. ADDIN EN.CITE <EndNote><Cite><Author>Simeit</Author><Year>2004</Year><RecNum>279</RecNum><DisplayText>(61)</DisplayText><record><rec-number>279</rec-number><foreign-keys><key app="EN" db-id="5prwe5sa1sz2speefwr5tx0oxdw9szzxpasr">279</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Simeit, R.</author><author>Deck, R.</author><author>Conta-Marx, B.</author></authors></contributors><auth-address>Ropersbergklinik Ratzeburg, Ropersberg 47, 23909 Ratzeburg, Germany. info@rkrz.de</auth-address><titles><title>Sleep management training for cancer patients with insomnia</title><secondary-title>Support Care Cancer</secondary-title><alt-title>Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer</alt-title></titles><pages>176-83</pages><volume>12</volume><number>3</number><edition>2004/02/05</edition><keywords><keyword>Attitude to Health</keyword><keyword>Female</keyword><keyword>Health Care Surveys</keyword><keyword>Humans</keyword><keyword>Male</keyword><keyword>Middle Aged</keyword><keyword>Neoplasms/*complications/psychology</keyword><keyword>Patient Education as Topic/*methods</keyword><keyword>Program Evaluation</keyword><keyword>Quality of Life</keyword><keyword>Relaxation Therapy/*education</keyword><keyword>Sleep Initiation and Maintenance Disorders/prevention &amp; control/*rehabilitation</keyword><keyword>Surveys and Questionnaires</keyword></keywords><dates><year>2004</year><pub-dates><date>Mar</date></pub-dates></dates><isbn>0941-4355 (Print)&#xD;0941-4355 (Linking)</isbn><accession-num>14760542</accession-num><work-type>Clinical Trial&#xD;Controlled Clinical Trial&#xD;Research Support, Non-U.S. Gov&apos;t</work-type><urls><related-urls><url>;(61) reported that all groups showed significant improvements in self-report cognitive functioning between baseline and follow-up. There were no significant group x time interactions. The weight of evidence from the non-randomised control trial, case series and uncontrolled trials point to positive effects of CBT-I on subjective measures of cognitive functioning. However the risk of bias in these studies is high. Evidence from the RCTs included in this review is mixed and only two RCTs PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5DYXNhdWx0PC9BdXRob3I+PFllYXI+MjAxNTwvWWVhcj48

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ADDIN EN.CITE.DATA (50) in individuals with fibromyalgia found greater improvements in two aspects of attention (alerting and executive control) in the intervention group compared to the control group. Our calculation of SMD revealed no significant difference between the groups on any aspect of performance on the ANT-I task at the post-intervention time-point. This discrepancy may be due to baseline differences between the groups in age, which were adjusted for in the statistical analysis performed by Miro et al. The study by Sun et al. ADDIN EN.CITE <EndNote><Cite><Author>Sun</Author><Year>2013</Year><RecNum>280</RecNum><DisplayText>(53)</DisplayText><record><rec-number>280</rec-number><foreign-keys><key app="EN" db-id="5prwe5sa1sz2speefwr5tx0oxdw9szzxpasr">280</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Sun, J.</author><author>Kang, J.</author><author>Wang, P.</author><author>Zeng, H.</author></authors></contributors><auth-address>School of Nursing, Central South University, Changsha, Hunan Province, China.</auth-address><titles><title>Self-relaxation training can improve sleep quality and cognitive functions in the older: a one-year randomised controlled trial</title><secondary-title>J Clin Nurs</secondary-title><alt-title>Journal of clinical nursing</alt-title></titles><pages>1270-80</pages><volume>22</volume><number>9-10</number><edition>2013/04/12</edition><keywords><keyword>Adolescent</keyword><keyword>Adult</keyword><keyword>Aged</keyword><keyword>Aged, 80 and over</keyword><keyword>Analysis of Variance</keyword><keyword>Child</keyword><keyword>*Cognition</keyword><keyword>Female</keyword><keyword>Humans</keyword><keyword>Male</keyword><keyword>Middle Aged</keyword><keyword>Patient Education as Topic/*methods</keyword><keyword>*Relaxation Therapy</keyword><keyword>*Self Care</keyword><keyword>*Sleep</keyword><keyword>Surveys and Questionnaires</keyword><keyword>Young Adult</keyword></keywords><dates><year>2013</year><pub-dates><date>May</date></pub-dates></dates><isbn>1365-2702 (Electronic)&#xD;0962-1067 (Linking)</isbn><accession-num>23574290</accession-num><work-type>Randomized Controlled Trial&#xD;Research Support, Non-U.S. Gov&apos;t</work-type><urls><related-urls><url>;(53) reported improvements in scores on the MMSE and the WMS-CR following the intervention, which became larger at subsequent follow-ups. These findings were corroborated by our calculations of SMD, which showed statistically significant differences between groups on scores on the MMSE and WMS-CR at each of the follow-up time-points (12, 24 and 52 weeks) (see figure 4). In this study, participants were provided with sleep hygiene information and were taught relaxation skills which they were encouraged to practice both individually and within groups, for a period of one year. Performance on cognitive tests was compared to a group that received sleep hygiene information only. The large effects observed in this study may be explained by non-specific effects of the intervention such as participant expectations of improvement and the increased social contact provided by group relaxation practice. In addition, researchers administering the neuropsychological tests were not blind to group assignment, which may have led to an exaggeration of treatment effects through ascertainment bias. [Insert figure 3 here][Insert figure 4 here]The study by Wilckens et al. ADDIN EN.CITE <EndNote><Cite><Author>Wilckens</Author><Year>2016</Year><RecNum>288</RecNum><DisplayText>(55)</DisplayText><record><rec-number>288</rec-number><foreign-keys><key app="EN" db-id="5prwe5sa1sz2speefwr5tx0oxdw9szzxpasr">288</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Wilckens, K. A.</author><author>Hall, M. H.</author><author>Nebes, R. D.</author><author>Monk, T. H.</author><author>Buysse, D. J.</author></authors></contributors><auth-address>a Department of Psychiatry , University of Pittsburgh School of Medicine , USA.</auth-address><titles><title>Changes in Cognitive Performance Are Associated with Changes in Sleep in Older Adults With Insomnia</title><secondary-title>Behav Sleep Med</secondary-title><alt-title>Behavioral sleep medicine</alt-title></titles><periodical><full-title>Behav Sleep Med</full-title><abbr-1>Behavioral sleep medicine</abbr-1></periodical><alt-periodical><full-title>Behav Sleep Med</full-title><abbr-1>Behavioral sleep medicine</abbr-1></alt-periodical><pages>295-310</pages><volume>14</volume><number>3</number><edition>2015/09/01</edition><dates><year>2016</year><pub-dates><date>May-Jun</date></pub-dates></dates><isbn>1540-2010 (Electronic)&#xD;1540-2002 (Linking)</isbn><accession-num>26322904</accession-num><urls><related-urls><url>;(55) examined the impact of brief behavioural treatment for insomnia (BBTI) on cognitive functioning in older adults. 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ADDIN EN.CITE.DATA (75). Therefore, the side-effects of sleep restriction may have impacted on performance on cognitive tests, contributing to null findings. In addition the time of day at which the cognitive tests were administered was not controlled for, and this may have introduced additional variance, possibly obscuring the effects of the intervention ADDIN EN.CITE <EndNote><Cite><Author>Schmidt</Author><Year>2007</Year><RecNum>489</RecNum><DisplayText>(76)</DisplayText><record><rec-number>489</rec-number><foreign-keys><key app="EN" db-id="5prwe5sa1sz2speefwr5tx0oxdw9szzxpasr">489</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Schmidt, C.</author><author>Collette, F.</author><author>Cajochen, C.</author><author>Peigneux, P.</author></authors></contributors><auth-address>Cyclotron Research Centre, University of Liege, Liege, Belgium.</auth-address><titles><title>A time to think: circadian rhythms in human cognition</title><secondary-title>Cogn Neuropsychol</secondary-title><alt-title>Cognitive neuropsychology</alt-title></titles><periodical><full-title>Cogn Neuropsychol</full-title><abbr-1>Cognitive neuropsychology</abbr-1></periodical><alt-periodical><full-title>Cogn Neuropsychol</full-title><abbr-1>Cognitive neuropsychology</abbr-1></alt-periodical><pages>755-89</pages><volume>24</volume><number>7</number><keywords><keyword>Adult</keyword><keyword>Aged</keyword><keyword>Aging/*psychology</keyword><keyword>Arousal</keyword><keyword>Attention</keyword><keyword>*Circadian Rhythm</keyword><keyword>*Cognition</keyword><keyword>Humans</keyword><keyword>Individuality</keyword><keyword>Inhibition (Psychology)</keyword><keyword>Memory</keyword><keyword>Middle Aged</keyword><keyword>Neuropsychological Tests</keyword><keyword>Problem Solving</keyword><keyword>Psychomotor Performance</keyword><keyword>Sleep</keyword><keyword>*Thinking</keyword><keyword>Wakefulness</keyword></keywords><dates><year>2007</year><pub-dates><date>Oct</date></pub-dates></dates><isbn>1464-0627 (Electronic)&#xD;0264-3294 (Linking)</isbn><accession-num>18066734</accession-num><urls><related-urls><url>;(76). The study by Omvik et al. PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5PbXZpazwvQXV0aG9yPjxZZWFyPjIwMDg8L1llYXI+PFJl

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ADDIN EN.CITE.DATA (51) reported no significant associations between change in sleep efficiency or slow wave sleep and change in performance on the vigilance task. The study by Wilckens et al. ADDIN EN.CITE <EndNote><Cite><Author>Wilckens</Author><Year>2016</Year><RecNum>288</RecNum><DisplayText>(55)</DisplayText><record><rec-number>288</rec-number><foreign-keys><key app="EN" db-id="5prwe5sa1sz2speefwr5tx0oxdw9szzxpasr">288</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Wilckens, K. A.</author><author>Hall, M. H.</author><author>Nebes, R. D.</author><author>Monk, T. H.</author><author>Buysse, D. J.</author></authors></contributors><auth-address>a Department of Psychiatry , University of Pittsburgh School of Medicine , USA.</auth-address><titles><title>Changes in Cognitive Performance Are Associated with Changes in Sleep in Older Adults With Insomnia</title><secondary-title>Behav Sleep Med</secondary-title><alt-title>Behavioral sleep medicine</alt-title></titles><periodical><full-title>Behav Sleep Med</full-title><abbr-1>Behavioral sleep medicine</abbr-1></periodical><alt-periodical><full-title>Behav Sleep Med</full-title><abbr-1>Behavioral sleep medicine</abbr-1></alt-periodical><pages>295-310</pages><volume>14</volume><number>3</number><edition>2015/09/01</edition><dates><year>2016</year><pub-dates><date>May-Jun</date></pub-dates></dates><isbn>1540-2010 (Electronic)&#xD;1540-2002 (Linking)</isbn><accession-num>26322904</accession-num><urls><related-urls><url>;(55) calculated correlations between change in performance on cognitive tests and change in WASO, delta power (absolute and relative) and sigma power (absolute and relative). They found a significant positive association between increased absolute delta power and improved abstract reasoning. In addition, decreased relative sigma power was significantly associated with improvements in abstract reasoning. Neither of these associations was moderated by treatment group. There were no significant associations between change in sleep and change in performance on delayed recall or working memory tasks. Enhanced delta power, and a corresponding decrease in sigma power, may benefit brain regions that sub-serve executive functions in older adults, however BBTI does not appear to drive these relationships. Miro et al. PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5NaXJvPC9BdXRob3I+PFllYXI+MjAxMTwvWWVhcj48UmVj

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ADDIN EN.CITE.DATA (50) calculated the association between change in sleep quality and change in performance on the ANT-I. They found a significant positive association between sleep quality and performance on the attention control index from the ANT-I, which is proposed to be a measure of executive functioning. There were no significant associations between change in sleep quality and any other index of the ANT-I. On the basis of these results, Miro et al. concluded that improvements in sleep quality are associated with better executive functioning in individuals with fibromyalgia. Associations between changes in sleep and changes in cognitive functioning were exploratory outcomes in these trials and there was, therefore, limited correction for multiple testing, which increases the chances that some of the significant associations uncovered are due to type-one error. There were no studies that conducted mediation analyses to assess whether CBT may influence cognitive outcomes via temporally-separated mediators (e.g., insomnia severity, sleep continuity). The associations reported do not provide evidence with regards to the direction of the effect and experimental manipulations are required in order to determine whether there are specific aspects of sleep architecture that are causally related to cognitive performance. In spite of these limitations, these findings do highlight possible variables to target in future treatments seeking to deliver sleep-related cognitive improvement. DiscussionSummary of evidenceThe aim of this review was to summarise the literature and evaluate evidence for the effects of CBT-I on cognitive functioning. Using broad inclusion criteria, we identified 18 relevant studies. For the majority of these studies, cognition was a secondary outcome and assessed within a general measure of self-reported daytime functioning. Only four of the included studies administered an objective measure of cognitive functioning and across these studies, the range of cognitive domains examined was limited. The lack of research into the impact of CBT-I on cognitive functioning is surprising, given that impairments in concentration and memory are among the most commonly reported and most troubling daytime symptoms of insomnia PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5LeWxlPC9BdXRob3I+PFllYXI+MjAxMzwvWWVhcj48UmVj

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ADDIN EN.CITE.DATA (35). On the basis of post-intervention and follow-up SMDs, the majority of studies showed small to moderate effects of CBT-I on cognition. Three of the included studies reported statistically significant improvements, which our calculation of SMD at post-intervention/follow-up did not corroborate. Baseline imbalances resulting from small sample sizes or failure in randomisation may have contributed to the reported significant improvements in the intervention group compared to the control group. The included studies generally had small samples with limited statistical power to detect less than large effects. There was one high quality RCT, which incorporated an active control condition, participant blinding and utilised intention-to-treat analysis to minimise bias from attrition PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5NYXR0aGV3czwvQXV0aG9yPjxZZWFyPjIwMTQ8L1llYXI+

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ADDIN EN.CITE.DATA (49). This study found a trend for a significant effect of CBT-I on self-report attentional function, with a moderate effect size. SMD at post-intervention and 12-week follow-up demonstrated a significant difference between the intervention and active control groups. On the basis of this study and other lower quality RCTs and uncontrolled trials PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5DYXNhdWx0PC9BdXRob3I+PFllYXI+MjAxNTwvWWVhcj48

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ADDIN EN.CITE.DATA (47, 48, 52, 58-60), there appears to be preliminary evidence for a small to moderate size effect of CBT-I on subjective measures of cognitive functioning. The impact of CBT-I on objective measures of cognitive functioning is more equivocal, predominantly due to lack of research. It is clear that further adequately powered RCTs, utilising both subjective and objective measures of cognitive performance are required, before firm conclusions can be drawn.In terms of maintenance of the effects, there were nine studies that conducted a follow-up assessment of cognitive functioning, three to six months following the intervention. The majority of these studies found no significant difference between post-intervention and follow-up scores, indicating that where there were initial gains, these tended to be maintained. In one study, performance on the vigilance test worsened between baseline and post-intervention but returned to baseline levels between post-intervention and follow-up PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5PbXZpazwvQXV0aG9yPjxZZWFyPjIwMDg8L1llYXI+PFJl

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ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5PbXZpazwvQXV0aG9yPjxZZWFyPjIwMDg8L1llYXI+PFJl

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ADDIN EN.CITE.DATA (51). This may be related to the sleep restriction component of the intervention, which has been associated with increased daytime sleepiness and impairments in vigilance during the acute phase of implementation PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5LeWxlPC9BdXRob3I+PFllYXI+MjAxNDwvWWVhcj48UmVj

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ADDIN EN.CITE.DATA (78) and therefore it is possible that improvements in cognitive performance also take time to be manifest. Thus the timing of assessments is an important consideration for future studies, especially where sleep restriction is part of the treatment. Study quality and sources of biasThe risk of bias from inadequate control and lack of blinding in the included studies is high. Although double-blinded placebo controlled studies are difficult to implement when evaluating psychological interventions, a sham insomnia treatment (known as BPT) has been developed ADDIN EN.CITE <EndNote><Cite><Author>Edinger</Author><Year>2001</Year><RecNum>491</RecNum><DisplayText>(79)</DisplayText><record><rec-number>491</rec-number><foreign-keys><key app="EN" db-id="5prwe5sa1sz2speefwr5tx0oxdw9szzxpasr">491</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Edinger, J. D.</author><author>Wohlgemuth, W. K.</author><author>Radtke, R. A.</author><author>Marsh, G. R.</author><author>Quillian, R. E.</author></authors></contributors><auth-address>Psychology Service (116B), VA Medical Center, 508 Fulton St, Durham, NC 27705, USA. jack.edinger@duke.edu</auth-address><titles><title>Cognitive behavioral therapy for treatment of chronic primary insomnia: a randomized controlled trial</title><secondary-title>JAMA</secondary-title><alt-title>Jama</alt-title></titles><periodical><full-title>JAMA</full-title><abbr-1>Jama</abbr-1></periodical><alt-periodical><full-title>JAMA</full-title><abbr-1>Jama</abbr-1></alt-periodical><pages>1856-64</pages><volume>285</volume><number>14</number><keywords><keyword>Adult</keyword><keyword>Aged</keyword><keyword>*Cognitive Therapy</keyword><keyword>Double-Blind Method</keyword><keyword>Female</keyword><keyword>Humans</keyword><keyword>Male</keyword><keyword>Middle Aged</keyword><keyword>Polysomnography</keyword><keyword>Relaxation Therapy</keyword><keyword>Sleep Initiation and Maintenance Disorders/*therapy</keyword><keyword>Surveys and Questionnaires</keyword></keywords><dates><year>2001</year><pub-dates><date>Apr 11</date></pub-dates></dates><isbn>0098-7484 (Print)&#xD;0098-7484 (Linking)</isbn><accession-num>11308399</accession-num><urls><related-urls><url>;(79). Indeed, BPT was utilised as a control in two of the included studies PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5NYXR0aGV3czwvQXV0aG9yPjxZZWFyPjIwMTQ8L1llYXI+

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ADDIN EN.CITE.DATA (80) and subjective perceptions of cognitive performance ADDIN EN.CITE <EndNote><Cite><Author>Schwarz</Author><Year>2015</Year><RecNum>497</RecNum><DisplayText>(81)</DisplayText><record><rec-number>497</rec-number><foreign-keys><key app="EN" db-id="5prwe5sa1sz2speefwr5tx0oxdw9szzxpasr">497</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Schwarz, K. A.</author><author>Buchel, C.</author></authors></contributors><auth-address>Department of Systems Neuroscience, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.</auth-address><titles><title>Cognition and the Placebo Effect--Dissociating Subjective Perception and Actual Performance</title><secondary-title>PLoS One</secondary-title><alt-title>PloS one</alt-title></titles><periodical><full-title>PLoS One</full-title><abbr-1>PloS one</abbr-1></periodical><alt-periodical><full-title>PLoS One</full-title><abbr-1>PloS one</abbr-1></alt-periodical><pages>e0130492</pages><volume>10</volume><number>7</number><keywords><keyword>Adult</keyword><keyword>Brain/drug effects/physiology</keyword><keyword>Central Nervous System Stimulants/pharmacology</keyword><keyword>Cognition/drug effects/*physiology</keyword><keyword>Female</keyword><keyword>Humans</keyword><keyword>Male</keyword><keyword>Nocebo Effect</keyword><keyword>Nootropic Agents/pharmacology</keyword><keyword>Perception/drug effects/*physiology</keyword><keyword>Placebo Effect</keyword><keyword>Psychomotor Performance/drug effects/*physiology</keyword><keyword>Young Adult</keyword></keywords><dates><year>2015</year></dates><isbn>1932-6203 (Electronic)&#xD;1932-6203 (Linking)</isbn><accession-num>26148009</accession-num><urls><related-urls><url>;(81). There were five uncontrolled trials and one case-series included within this review. Three of these studies reported effect sizes, all of which were large effects. Meta-analyses of outcomes following psychological interventions commonly observe that uncontrolled studies report larger effects than RCTs PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5CdXRsZXI8L0F1dGhvcj48WWVhcj4yMDA2PC9ZZWFyPjxS

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ADDIN EN.CITE.DATA (82, 83). This is likely due to biases that result from issues such as regression to the mean. Due to the high risk of bias, we gave less weight to results from the uncontrolled trials and case-series, when considering the evidence in this review. Nevertheless, the evidence from uncontrolled trials largely supports data from the RCTs, indicating positive effects of CBT-I on self-report measures of cognitive functioning. Putative MechanismsIf CBT-I does lead to improvements in cognition, it will be important to discover the mechanism through which this occurs. There is some evidence that individuals with insomnia show impairments on complex rather than simple tasks and this is thought to result from greater dependence of complex tasks on functioning of the prefrontal cortex ADDIN EN.CITE <EndNote><Cite><Author>Fortier-Brochu</Author><Year>2012</Year><RecNum>172</RecNum><DisplayText>(13)</DisplayText><record><rec-number>172</rec-number><foreign-keys><key app="EN" db-id="5prwe5sa1sz2speefwr5tx0oxdw9szzxpasr">172</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Fortier-Brochu, E.</author><author>Beaulieu-Bonneau, S.</author><author>Ivers, H.</author><author>Morin, C. M.</author></authors></contributors><auth-address>Ecole de Psychologie, Universite Laval, Quebec, Canada. emilie.fortier-brochu.1@ulaval.ca</auth-address><titles><title>Insomnia and daytime cognitive performance: a meta-analysis</title><secondary-title>Sleep Med Rev</secondary-title><alt-title>Sleep medicine reviews</alt-title></titles><periodical><full-title>Sleep Med Rev</full-title><abbr-1>Sleep medicine reviews</abbr-1></periodical><alt-periodical><full-title>Sleep Med Rev</full-title><abbr-1>Sleep medicine reviews</abbr-1></alt-periodical><pages>83-94</pages><volume>16</volume><number>1</number><edition>2011/06/04</edition><keywords><keyword>Adult</keyword><keyword>*Cognition</keyword><keyword>Cognition Disorders/etiology</keyword><keyword>Humans</keyword><keyword>Neuropsychological Tests</keyword><keyword>Psychomotor Performance</keyword><keyword>Sleep Initiation and Maintenance Disorders/complications/*psychology</keyword></keywords><dates><year>2012</year><pub-dates><date>Feb</date></pub-dates></dates><isbn>1532-2955 (Electronic)&#xD;1087-0792 (Linking)</isbn><accession-num>21636297</accession-num><label>*</label><work-type>Meta-Analysis&#xD;Research Support, Non-U.S. Gov&apos;t</work-type><urls><related-urls><url>;(13), which may be compromised in insomnia ADDIN EN.CITE <EndNote><Cite><Author>Kay</Author><Year>2017</Year><RecNum>689</RecNum><DisplayText>(84)</DisplayText><record><rec-number>689</rec-number><foreign-keys><key app="EN" db-id="5prwe5sa1sz2speefwr5tx0oxdw9szzxpasr">689</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Kay, D. B.</author><author>Buysse, D. J.</author></authors></contributors><auth-address>Department of Psychology, Brigham Young University, Provo, UT 84604, USA. daniel_kay@byu.edu.&#xD;Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA 15213, USA. buyssedj@upmc.edu.</auth-address><titles><title>Hyperarousal and Beyond: New Insights to the Pathophysiology of Insomnia Disorder through Functional Neuroimaging Studies</title><secondary-title>Brain Sci</secondary-title><alt-title>Brain sciences</alt-title></titles><volume>7</volume><number>3</number><edition>2017/03/01</edition><dates><year>2017</year><pub-dates><date>Feb 23</date></pub-dates></dates><isbn>2076-3425 (Linking)</isbn><accession-num>28241468</accession-num><work-type>Review</work-type><urls><related-urls><url>;(84). Hypo-activation of the prefrontal cortex during performance of a category fluency task in individuals with primary insomnia compared to controls has been reported and this hypo-activation was attenuated following sleep therapy (which comprised CBT-I, bright light therapy and body temperature manipulations), with concomitant improvements in phonemic fluency PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5BbHRlbmE8L0F1dGhvcj48WWVhcj4yMDA4PC9ZZWFyPjxS

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ADDIN EN.CITE.DATA (85). The study by Wilckens et al. ADDIN EN.CITE <EndNote><Cite><Author>Wilckens</Author><Year>2016</Year><RecNum>288</RecNum><DisplayText>(55)</DisplayText><record><rec-number>288</rec-number><foreign-keys><key app="EN" db-id="5prwe5sa1sz2speefwr5tx0oxdw9szzxpasr">288</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Wilckens, K. A.</author><author>Hall, M. H.</author><author>Nebes, R. D.</author><author>Monk, T. H.</author><author>Buysse, D. J.</author></authors></contributors><auth-address>a Department of Psychiatry , University of Pittsburgh School of Medicine , USA.</auth-address><titles><title>Changes in Cognitive Performance Are Associated with Changes in Sleep in Older Adults With Insomnia</title><secondary-title>Behav Sleep Med</secondary-title><alt-title>Behavioral sleep medicine</alt-title></titles><periodical><full-title>Behav Sleep Med</full-title><abbr-1>Behavioral sleep medicine</abbr-1></periodical><alt-periodical><full-title>Behav Sleep Med</full-title><abbr-1>Behavioral sleep medicine</abbr-1></alt-periodical><pages>295-310</pages><volume>14</volume><number>3</number><edition>2015/09/01</edition><dates><year>2016</year><pub-dates><date>May-Jun</date></pub-dates></dates><isbn>1540-2010 (Electronic)&#xD;1540-2002 (Linking)</isbn><accession-num>26322904</accession-num><urls><related-urls><url>;(55) found that changes in electroencephalogram (EEG) spectral power (increased delta and reduce sigma activity) were associated with better executive functioning in older adults, although this was not moderated by the BBTI intervention. One proposal is that delta power during non-rapid eye movement sleep reflects enhanced connectivity within cortical networks and preferentially benefits brain regions such as the prefrontal cortex. On the basis of these findings, one hypothesis which deserves further investigation is that improvements in sleep continuity and normalisation of sleep architecture, leads to enhanced functioning of the prefrontal cortex and, by extension, performance on tasks that recruit this brain region PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5XaWxja2VuczwvQXV0aG9yPjxZZWFyPjIwMTQ8L1llYXI+

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ADDIN EN.CITE.DATA (86). Of note, a more recent, uncontrolled study by Wilckens and colleagues ADDIN EN.CITE <EndNote><Cite><Author>Wilckens</Author><Year>2017</Year><RecNum>691</RecNum><DisplayText>(87)</DisplayText><record><rec-number>691</rec-number><foreign-keys><key app="EN" db-id="5prwe5sa1sz2speefwr5tx0oxdw9szzxpasr">691</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Wilckens, K. A.</author><author>Hall, M. H.</author><author>Erickson, K. I.</author><author>Germain, A.</author><author>Nimgaonkar, V. L.</author><author>Monk, T. H.</author><author>Buysse, D. J.</author></authors></contributors><auth-address>Department of Psychiatry, University of Pittsburgh School of Medicine, 3811 O&apos;Hara Street, Pittsburgh, PA 15213, USA. Electronic address: wilckenska@upmc.edu.&#xD;Department of Psychiatry, University of Pittsburgh School of Medicine, 3811 O&apos;Hara Street, Pittsburgh, PA 15213, USA.&#xD;Department of Psychology, University of Pittsburgh, 210 South Bouquet Street, Pittsburgh, PA 15260, USA.</auth-address><titles><title>Task switching in older adults with and without insomnia</title><secondary-title>Sleep Med</secondary-title><alt-title>Sleep medicine</alt-title></titles><periodical><full-title>Sleep Med</full-title><abbr-1>Sleep medicine</abbr-1></periodical><alt-periodical><full-title>Sleep Med</full-title><abbr-1>Sleep medicine</abbr-1></alt-periodical><pages>113-120</pages><volume>30</volume><edition>2017/02/22</edition><dates><year>2017</year><pub-dates><date>Feb</date></pub-dates></dates><isbn>1878-5506 (Electronic)&#xD;1389-9457 (Linking)</isbn><accession-num>28215233</accession-num><urls><related-urls><url>;(87) observed improvements in task-switching performance, pre-to-post CBT-I, in older adults with insomnia. These improvements were associated with reductions in WASO, however there was no association with whole night delta power. Controlled studies, employing both standard polysomnography and high-density EEG protocols PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5SaWVkbmVyPC9BdXRob3I+PFllYXI+MjAxNjwvWWVhcj48

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ADDIN EN.CITE.DATA (88) will help to define a) how CBT-I modifies sleep macro and micro-structure (including the temporospatial dynamics of delta power); and b) whether such changes mediate improvement in cognitive performance.Anxiety and low mood, which are often present in insomnia (particularly comorbid insomnia), have also been associated with cognitive impairment ADDIN EN.CITE <EndNote><Cite><Author>Lezak</Author><Year>2004</Year><RecNum>225</RecNum><DisplayText>(42)</DisplayText><record><rec-number>225</rec-number><foreign-keys><key app="EN" db-id="5prwe5sa1sz2speefwr5tx0oxdw9szzxpasr">225</key></foreign-keys><ref-type name="Book">6</ref-type><contributors><authors><author>Lezak, Muriel Deutsch</author><author>Howieson, Diane B.</author><author>Loring, David W.</author></authors></contributors><titles><title>Neuropsychological assessment</title></titles><edition>4th ed. / Muriel D. Lezak, Diane B. Howieson, David W. Loring with H. Julia Hannay and Jill S. Fischer.</edition><keywords><keyword>Neuropsychological tests.</keyword></keywords><dates><year>2004</year></dates><pub-location>Oxford</pub-location><publisher>Oxford University Press</publisher><isbn>0195111214 : ?59.50</isbn><call-num>616.80475 22&#xD;British Library HMNTS YC.2016.b.866&#xD;British Library DSC m04/29607</call-num><urls></urls></record></Cite></EndNote>(42). There is evidence that CBT-I leads to improvements in these variables PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5TYXZhcmQ8L0F1dGhvcj48WWVhcj4yMDA1PC9ZZWFyPjxS

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ADDIN EN.CITE.DATA (89-92) and therefore, in addition to investigating the potential mediating role of various sleep parameters, future studies should also examine the contribution of changes in secondary psychological variables. Measures of cognitive functioningDiscordance between self-report measures of cognitive functioning and performance on neuropsychological and cognitive tests has been demonstrated in individuals with primary insomnia ADDIN EN.CITE <EndNote><Cite><Author>Orff</Author><Year>2007</Year><RecNum>562</RecNum><DisplayText>(93)</DisplayText><record><rec-number>562</rec-number><foreign-keys><key app="EN" db-id="5prwe5sa1sz2speefwr5tx0oxdw9szzxpasr">562</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Orff, H. J.</author><author>Drummond, S. P.</author><author>Nowakowski, S.</author><author>Perils, M. L.</author></authors></contributors><auth-address>Joint Doctoral Program in Clinical Psychology, San Diego State University and University of California, San Diego, CA, USA.</auth-address><titles><title>Discrepancy between subjective symptomatology and objective neuropsychological performance in insomnia</title><secondary-title>Sleep</secondary-title><alt-title>Sleep</alt-title></titles><periodical><full-title>Sleep</full-title><abbr-1>Sleep</abbr-1></periodical><alt-periodical><full-title>Sleep</full-title><abbr-1>Sleep</abbr-1></alt-periodical><pages>1205-11</pages><volume>30</volume><number>9</number><keywords><keyword>Adult</keyword><keyword>Cognition</keyword><keyword>Cognition Disorders/diagnosis/*etiology</keyword><keyword>Female</keyword><keyword>Humans</keyword><keyword>Male</keyword><keyword>Memory</keyword><keyword>Middle Aged</keyword><keyword>*Neuropsychological Tests</keyword><keyword>Perception</keyword><keyword>Polysomnography</keyword><keyword>Psychomotor Performance</keyword><keyword>Reaction Time</keyword><keyword>Sleep Initiation and Maintenance Disorders/*complications</keyword><keyword>Task Performance and Analysis</keyword></keywords><dates><year>2007</year><pub-dates><date>Sep</date></pub-dates></dates><isbn>0161-8105 (Print)&#xD;0161-8105 (Linking)</isbn><accession-num>17910392</accession-num><urls><related-urls><url>;(93). Specifically, self-report measures tend to show higher levels of impairment than is found using objective assessment. This discordance is thought to be driven by selective attention to the daytime consequences of insomnia, a phenomenon which is proposed to contribute to the maintenance of the disorder ADDIN EN.CITE <EndNote><Cite><Author>Harvey</Author><Year>2002</Year><RecNum>570</RecNum><DisplayText>(94)</DisplayText><record><rec-number>570</rec-number><foreign-keys><key app="EN" db-id="5prwe5sa1sz2speefwr5tx0oxdw9szzxpasr">570</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Harvey, A. G.</author></authors></contributors><auth-address>Department of Experimental Psychology, University of Oxford, UK. allison.harvey@psy.ox.ac.uk</auth-address><titles><title>A cognitive model of insomnia</title><secondary-title>Behav Res Ther</secondary-title><alt-title>Behaviour research and therapy</alt-title></titles><periodical><full-title>Behav Res Ther</full-title><abbr-1>Behaviour research and therapy</abbr-1></periodical><alt-periodical><full-title>Behav Res Ther</full-title><abbr-1>Behaviour research and therapy</abbr-1></alt-periodical><pages>869-93</pages><volume>40</volume><number>8</number><keywords><keyword>Circadian Rhythm/physiology</keyword><keyword>Cognition Disorders/*etiology</keyword><keyword>Humans</keyword><keyword>Neuropsychological Tests</keyword><keyword>*Psychological Theory</keyword><keyword>Sleep Initiation and Maintenance Disorders/*complications</keyword></keywords><dates><year>2002</year><pub-dates><date>Aug</date></pub-dates></dates><isbn>0005-7967 (Print)&#xD;0005-7967 (Linking)</isbn><accession-num>12186352</accession-num><urls><related-urls><url>;(94). It is possible that CBT-I impacts on subjective and objective measures differentially, for example it may alter perceptions of impairment without impacting on objective performance. In addition, it is possible that there are different mechanisms through which CBT-I impacts on subjective and objective cognition. We were not able to examine this in the current review because there were no studies that investigated cognitive functioning using both subjective and objective measures. Moreover, it was not possible to compare the effects of CBT-I on subjective and objective measures across studies, due to heterogeneity. Future studies should consider the inclusion of both subjective and objective assessments of cognitive function to enable such a comparison.In spite of guidelines espousing the importance of investigating the daytime correlates of insomnia, there are no specific cognitive performance measures or self-report questionnaires that are recommended for routine use in insomnia samples ADDIN EN.CITE <EndNote><Cite><Author>Buysse</Author><Year>2006</Year><RecNum>480</RecNum><DisplayText>(95)</DisplayText><record><rec-number>480</rec-number><foreign-keys><key app="EN" db-id="5prwe5sa1sz2speefwr5tx0oxdw9szzxpasr">480</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Buysse, D. J.</author><author>Ancoli-Israel, S.</author><author>Edinger, J. D.</author><author>Lichstein, K. L.</author><author>Morin, C. M.</author></authors></contributors><auth-address>Department of Psychiatry, University of Pittsburgh School of Medicine, PA, USA. buyssedj@upmc.edu</auth-address><titles><title>Recommendations for a standard research assessment of insomnia</title><secondary-title>Sleep</secondary-title><alt-title>Sleep</alt-title></titles><periodical><full-title>Sleep</full-title><abbr-1>Sleep</abbr-1></periodical><alt-periodical><full-title>Sleep</full-title><abbr-1>Sleep</abbr-1></alt-periodical><pages>1155-73</pages><volume>29</volume><number>9</number><keywords><keyword>Anxiety/diagnosis/epidemiology</keyword><keyword>Depression/diagnosis/epidemiology</keyword><keyword>Disorders of Excessive Somnolence/epidemiology</keyword><keyword>Fatigue/epidemiology</keyword><keyword>*Guidelines as Topic</keyword><keyword>Health Status</keyword><keyword>Humans</keyword><keyword>Polysomnography</keyword><keyword>Psychomotor Disorders/diagnosis/epidemiology</keyword><keyword>Quality of Life/psychology</keyword><keyword>Sleep Initiation and Maintenance</keyword><keyword>Disorders/*diagnosis/epidemiology/physiopathology</keyword><keyword>Surveys and Questionnaires</keyword></keywords><dates><year>2006</year><pub-dates><date>Sep</date></pub-dates></dates><isbn>0161-8105 (Print)&#xD;0161-8105 (Linking)</isbn><accession-num>17040003</accession-num><urls><related-urls><url>;(95). A meta-analysis ADDIN EN.CITE <EndNote><Cite><Author>Fortier-Brochu</Author><Year>2012</Year><RecNum>172</RecNum><DisplayText>(13)</DisplayText><record><rec-number>172</rec-number><foreign-keys><key app="EN" db-id="5prwe5sa1sz2speefwr5tx0oxdw9szzxpasr">172</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Fortier-Brochu, E.</author><author>Beaulieu-Bonneau, S.</author><author>Ivers, H.</author><author>Morin, C. M.</author></authors></contributors><auth-address>Ecole de Psychologie, Universite Laval, Quebec, Canada. emilie.fortier-brochu.1@ulaval.ca</auth-address><titles><title>Insomnia and daytime cognitive performance: a meta-analysis</title><secondary-title>Sleep Med Rev</secondary-title><alt-title>Sleep medicine reviews</alt-title></titles><periodical><full-title>Sleep Med Rev</full-title><abbr-1>Sleep medicine reviews</abbr-1></periodical><alt-periodical><full-title>Sleep Med Rev</full-title><abbr-1>Sleep medicine reviews</abbr-1></alt-periodical><pages>83-94</pages><volume>16</volume><number>1</number><edition>2011/06/04</edition><keywords><keyword>Adult</keyword><keyword>*Cognition</keyword><keyword>Cognition Disorders/etiology</keyword><keyword>Humans</keyword><keyword>Neuropsychological Tests</keyword><keyword>Psychomotor Performance</keyword><keyword>Sleep Initiation and Maintenance Disorders/complications/*psychology</keyword></keywords><dates><year>2012</year><pub-dates><date>Feb</date></pub-dates></dates><isbn>1532-2955 (Electronic)&#xD;1087-0792 (Linking)</isbn><accession-num>21636297</accession-num><label>*</label><work-type>Meta-Analysis&#xD;Research Support, Non-U.S. Gov&apos;t</work-type><urls><related-urls><url>;(13) concluded that insomnia is associated with impairments on tasks assessing episodic memory, problem-solving and working memory. A caveat to these findings is that for some of the cognitive domains examined, there were few studies available and therefore low statistical power may explain lack of group differences. Accordingly, assessment of a broad range of cognitive domains is encouraged. In this review, we did not uncover any patterns across studies in terms of cognitive domains that appear to be more sensitive to the effects of CBT-I (see table S4). We recommend that where it is not feasible to assess a broad range of cognitive domains, researchers should focus on the assessment of those cognitive domains where impairments in insomnia samples has been demonstrated most robustly in cross-sectional studies (episodic memory, problem solving and working memory). On the basis of the findings from the highest methodological quality studies included in this review, future studies should also consider including the AFI (a self-report measure probing perceived effectiveness in activities requiring attention and working memory) and ANT-I (a computerised cognitive task probing attentional functioning). In addition, future studies should consider the impact of time of day on cognitive performance and seek to standardise this variable across participants and test sessions ADDIN EN.CITE <EndNote><Cite><Author>Schmidt</Author><Year>2007</Year><RecNum>489</RecNum><DisplayText>(76)</DisplayText><record><rec-number>489</rec-number><foreign-keys><key app="EN" db-id="5prwe5sa1sz2speefwr5tx0oxdw9szzxpasr">489</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Schmidt, C.</author><author>Collette, F.</author><author>Cajochen, C.</author><author>Peigneux, P.</author></authors></contributors><auth-address>Cyclotron Research Centre, University of Liege, Liege, Belgium.</auth-address><titles><title>A time to think: circadian rhythms in human cognition</title><secondary-title>Cogn Neuropsychol</secondary-title><alt-title>Cognitive neuropsychology</alt-title></titles><periodical><full-title>Cogn Neuropsychol</full-title><abbr-1>Cognitive neuropsychology</abbr-1></periodical><alt-periodical><full-title>Cogn Neuropsychol</full-title><abbr-1>Cognitive neuropsychology</abbr-1></alt-periodical><pages>755-89</pages><volume>24</volume><number>7</number><keywords><keyword>Adult</keyword><keyword>Aged</keyword><keyword>Aging/*psychology</keyword><keyword>Arousal</keyword><keyword>Attention</keyword><keyword>*Circadian Rhythm</keyword><keyword>*Cognition</keyword><keyword>Humans</keyword><keyword>Individuality</keyword><keyword>Inhibition (Psychology)</keyword><keyword>Memory</keyword><keyword>Middle Aged</keyword><keyword>Neuropsychological Tests</keyword><keyword>Problem Solving</keyword><keyword>Psychomotor Performance</keyword><keyword>Sleep</keyword><keyword>*Thinking</keyword><keyword>Wakefulness</keyword></keywords><dates><year>2007</year><pub-dates><date>Oct</date></pub-dates></dates><isbn>1464-0627 (Electronic)&#xD;0264-3294 (Linking)</isbn><accession-num>18066734</accession-num><urls><related-urls><url>;(76). There are a number of factors which require consideration with regards to the selection of tools for assessing change in cognitive performance, in individuals with insomnia. Possible explanations for null findings in the studies in this review which utilised objective assessment of cognitive performance, include that the cognitive tasks were not sensitive to sleep or were confounded by ceiling effects. Clearly the test needs to demonstrate sufficient sensitivity to enable the detection of potentially subtle changes over time. There appears to have been little consideration of this issue by the studies included within this review. Individuals with insomnia may compensate for deficits through increased cognitive effort and the recruitment of additional cerebral resources ADDIN EN.CITE <EndNote><Cite><Author>Orff</Author><Year>2007</Year><RecNum>562</RecNum><DisplayText>(93)</DisplayText><record><rec-number>562</rec-number><foreign-keys><key app="EN" db-id="5prwe5sa1sz2speefwr5tx0oxdw9szzxpasr">562</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Orff, H. J.</author><author>Drummond, S. P.</author><author>Nowakowski, S.</author><author>Perils, M. L.</author></authors></contributors><auth-address>Joint Doctoral Program in Clinical Psychology, San Diego State University and University of California, San Diego, CA, USA.</auth-address><titles><title>Discrepancy between subjective symptomatology and objective neuropsychological performance in insomnia</title><secondary-title>Sleep</secondary-title><alt-title>Sleep</alt-title></titles><periodical><full-title>Sleep</full-title><abbr-1>Sleep</abbr-1></periodical><alt-periodical><full-title>Sleep</full-title><abbr-1>Sleep</abbr-1></alt-periodical><pages>1205-11</pages><volume>30</volume><number>9</number><keywords><keyword>Adult</keyword><keyword>Cognition</keyword><keyword>Cognition Disorders/diagnosis/*etiology</keyword><keyword>Female</keyword><keyword>Humans</keyword><keyword>Male</keyword><keyword>Memory</keyword><keyword>Middle Aged</keyword><keyword>*Neuropsychological Tests</keyword><keyword>Perception</keyword><keyword>Polysomnography</keyword><keyword>Psychomotor Performance</keyword><keyword>Reaction Time</keyword><keyword>Sleep Initiation and Maintenance Disorders/*complications</keyword><keyword>Task Performance and Analysis</keyword></keywords><dates><year>2007</year><pub-dates><date>Sep</date></pub-dates></dates><isbn>0161-8105 (Print)&#xD;0161-8105 (Linking)</isbn><accession-num>17910392</accession-num><urls><related-urls><url>;(93). Such compensation may obscure both objective deficits and improvements over time. Accordingly, it seems important to include cognitive tests which are sufficiently difficult to overwhelm compensatory processes ADDIN EN.CITE <EndNote><Cite><Author>Espie</Author><Year>2008</Year><RecNum>662</RecNum><DisplayText>(96)</DisplayText><record><rec-number>662</rec-number><foreign-keys><key app="EN" db-id="5prwe5sa1sz2speefwr5tx0oxdw9szzxpasr">662</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Espie, C. A.</author><author>Kyle, S. D.</author></authors></contributors><auth-address>University of Glasgow Sleep Centre, Sackler Institute of Psychobiological Research, Faculty of Medicine, University of Glasgow, Scotland, UK. c.espie@clinmed.gla.ac.uk</auth-address><titles><title>Towards an improved neuropsychology of poor sleep?</title><secondary-title>Sleep</secondary-title></titles><periodical><full-title>Sleep</full-title><abbr-1>Sleep</abbr-1></periodical><pages>591-2</pages><volume>31</volume><number>5</number><keywords><keyword>*Attention</keyword><keyword>Cognition Disorders/*psychology</keyword><keyword>Humans</keyword><keyword>*Neuropsychological Tests</keyword><keyword>*Psychomotor Performance</keyword><keyword>Reaction Time</keyword><keyword>Reference Values</keyword><keyword>Sleep Initiation and Maintenance Disorders/*psychology</keyword></keywords><dates><year>2008</year><pub-dates><date>May</date></pub-dates></dates><isbn>0161-8105 (Print)&#xD;0161-8105 (Linking)</isbn><accession-num>18517027</accession-num><urls><related-urls><url>;(96). 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ADDIN EN.CITE.DATA (97) recommend the use of the Switching Attention Test (SAT). The SAT is a computerised cognitive test that presents a series of increasingly challenging psychomotor tasks that assess the participants ability to maintain concentration, switch attention, inhibit responses and make decisions rapidly. Alternatively, future studies could combine manipulations of task difficulty with neuroimaging, so that the role of compensatory mechanisms can be elucidated ADDIN EN.CITE <EndNote><Cite><Author>Drummond</Author><Year>2004</Year><RecNum>572</RecNum><DisplayText>(98)</DisplayText><record><rec-number>572</rec-number><foreign-keys><key app="EN" db-id="5prwe5sa1sz2speefwr5tx0oxdw9szzxpasr">572</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Drummond, S. P.</author><author>Brown, G. G.</author><author>Salamat, J. S.</author><author>Gillin, J. C.</author></authors></contributors><auth-address>Department of Psychiatry, University of California San Diego, 92161, USA. drummond@ucsd.edu</auth-address><titles><title>Increasing task difficulty facilitates the cerebral compensatory response to total sleep deprivation</title><secondary-title>Sleep</secondary-title><alt-title>Sleep</alt-title></titles><periodical><full-title>Sleep</full-title><abbr-1>Sleep</abbr-1></periodical><alt-periodical><full-title>Sleep</full-title><abbr-1>Sleep</abbr-1></alt-periodical><pages>445-51</pages><volume>27</volume><number>3</number><keywords><keyword>Adult</keyword><keyword>Brain/anatomy &amp; histology/blood supply/*physiopathology</keyword><keyword>Cognition/*physiology</keyword><keyword>Female</keyword><keyword>Hemodynamics/physiology</keyword><keyword>Humans</keyword><keyword>*Magnetic Resonance Imaging</keyword><keyword>Male</keyword><keyword>Sleep Deprivation/*physiopathology</keyword></keywords><dates><year>2004</year><pub-dates><date>May 1</date></pub-dates></dates><isbn>0161-8105 (Print)&#xD;0161-8105 (Linking)</isbn><accession-num>15164897</accession-num><urls><related-urls><url>;(98). The subjective outcome measures utilised in the included studies were developed for use in clinical samples, predominantly cancer patients. The validity of using these measures to assess cognitive functioning following an insomnia intervention is questionable. The experience of cognitive impairment related to insomnia may be qualitatively different to that associated with a physical health problem such as cancer. To the best of our knowledge, there are no subjective measures of cognitive functioning that have been specifically-developed for individuals with insomnia. This should be addressed in future research.HeterogeneityMeta-analyses have highlighted various factors which moderate sleep outcomes following CBT-I. These include rate of attrition, length of treatment, level of personal support, method of treatment delivery and duration of insomnia symptoms PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5aYWNoYXJpYWU8L0F1dGhvcj48WWVhcj4yMDE1PC9ZZWFy

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ADDIN EN.CITE.DATA (99, 100). Due to the preliminary nature of the literature and the large number of ways in which the included studies varied, it was not possible to identify specific moderators of improvements in cognitive performance. However, future reviews should consider whether there are any variables which enhance the impact of CBT-I on cognitive functioning. It is possible that particular characteristics of an individual with insomnia promote greater improvements in cognitive functioning following treatment. One characteristic that should be examined is cognitive reserve. There is evidence that older adults with less cognitive reserve (as indicated by lower levels of education) are more vulnerable to the negative effects of poor sleep on some aspects of cognitive functioning PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5aaW1tZXJtYW48L0F1dGhvcj48WWVhcj4yMDEyPC9ZZWFy

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ADDIN EN.CITE.DATA (101). This is thought to result from less capacity for compensation. Improvements in cognitive functioning may therefore be more easily identified in this group. The nature of the insomnia complaint may also moderate outcomes. Specifically, there is evidence that those with objective short sleep duration show greater deficits in cognitive performance PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5MbzwvQXV0aG9yPjxZZWFyPjIwMTY8L1llYXI+PFJlY051

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ADDIN EN.CITE.DATA (102, 103) and therefore we might expect to see greater improvements in cognitive functioning in this group, following an intervention. The majority of studies investigated the impact of CBT-I on cognitive functioning in comorbid samples. This contrasts with the literature on sleep outcomes following CBT-I, which has tended to focus on primary insomnia. It is possible that improvements in cognitive performance following CBT-I, are more likely to be observed in comorbid populations, particularly where cognitive dysfunction is a symptom of the comorbid condition. Limitations of the current reviewThis review has a number of limitations. First, a high proportion of the included studies were from cancer patients, which limits the generalisability of our synthesis. Second, the inclusion criteria used were broad, which resulted in studies that differed on a range of factors, including methodology, population studied, aspects of the intervention and outcomes measures. Such high levels of clinical and methodological diversity precluded the use of meta-analysis and also meant that we were not able to clearly identify factors that contributed to the heterogeneity in outcomes. Third, we included uncontrolled trials and studies with low methodological quality, but resisted drawing conclusions on the basis of their findings, due to high risk of bias. It could be argued that there was little benefit to including these studies however we reasoned that it was necessary to summarise all of the available evidence, given that this is an area of very limited research. Fourth, we combined studies that were very different in terms of content of intervention and method of delivery. For example, we included studies where the intervention combined just two components of CBT-I (relaxation and sleep hygiene), with studies that delivered all of the components. The validity of this is questionable. We did not conduct a meta-analysis and therefore the results from heterogeneous studies were not statistically combined. We suggest that high levels of variability in terms of the interventions delivered is reflective of the current state of the field, whereby there is a lack of clarity concerning the necessary and sufficient components of a CBT-I intervention.ConclusionsThere is preliminary evidence for small-to-moderate effects of CBT-I on self-report cognitive functioning. Included studies tended to have small sample sizes and many failed to find statistically significant results, therefore adequately powered RCTs are required before firm conclusions can be drawn. There is a distinct lack of research with regards to the effects of CBT-I on objective cognitive performance, which is surprising given the importance of cognition for everyday functioning. A consensus with regards to specific cognitive domains that should be assessed in insomnia samples should be a priority for researchers. There was substantial heterogeneity in the included studies, reflecting the broad inclusion criteria used and the preliminary nature of this research area. -476250-393382500Practice PointsImpairments in cognitive functioning are among the most commonly reported and troubling daytime symptoms of insomnia, however little is known about whether insomnia treatments lead to improvements in cognitive performance.There is preliminary evidence for small to moderate positive effects of CBT-I on self-report cognitive functioning however adequately powered RCTs are required before firm conclusions can be drawn.There is a lack of evidence with regards to the impact of CBT-I on objective cognitive performance.Research AgendaFurther research should aim to:Establish a battery of cognitive tests to be used in insomnia samples.Evaluate the effects of CBT-I on cognitive functioning, using a well powered and high quality study design which incorporates an active control condition, so that the specificity of the effects of CBT-I on cognitive performance can be established.Include both subjective and objective measures of cognitive performance and seek to compare the effects of CBT-I on subjective and objective measures. 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Sleep. 2010;33(4):459-65.067310Records identified through database searching (n = 2327)Additional records identified through other sources (n = 9)Total records screened (n = 2336)Duplicates excluded (n = 436)Records screened by title and abstract (n = 1900)Irrelevant papers (n = 1377)Full text articles assessed for eligibility (n = 523)Full text articles excluded (n = 505)No measure of cognition = 245Less than 2 components of CBT-I = 27Intervention included other treatment modality = 9Other = 224Studies included in the review (n = 18)IdentificationScreeningEligibilityIncluded00Records identified through database searching (n = 2327)Additional records identified through other sources (n = 9)Total records screened (n = 2336)Duplicates excluded (n = 436)Records screened by title and abstract (n = 1900)Irrelevant papers (n = 1377)Full text articles assessed for eligibility (n = 523)Full text articles excluded (n = 505)No measure of cognition = 245Less than 2 components of CBT-I = 27Intervention included other treatment modality = 9Other = 224Studies included in the review (n = 18)IdentificationScreeningEligibilityIncludedFigure 1: Search results00Arnedt et al. (2011)Arnedt et al. (2013)Casault et al. (2015)Matthews et al. (2014)Ritterband et al. (2012)Taylor et al. (2014)Favours controlFavours intervention00Arnedt et al. (2011)Arnedt et al. (2013)Casault et al. (2015)Matthews et al. (2014)Ritterband et al. (2012)Taylor et al. (2014)Favours controlFavours interventionFigure 2: Post-intervention standardised mean differences and 95% confidence intervals for subjective measures of cognitive functioning 00Miro et al. 2011: ANT-I ControlMiro et al. 2011: ANT-I OrientingMiro et al. 2011: ANT-I AlertingMiro et al. 2011: ANT-I mean RTOmvik et al. 2008: Vigil RTOmvik et al. 2008: Vigil No. correctWilckens et al. 2008: delayed recallWilckens et al. 2008: abstract reasoningWilckens et al. 2008: working memoryFavours controlFavours intervention00Miro et al. 2011: ANT-I ControlMiro et al. 2011: ANT-I OrientingMiro et al. 2011: ANT-I AlertingMiro et al. 2011: ANT-I mean RTOmvik et al. 2008: Vigil RTOmvik et al. 2008: Vigil No. correctWilckens et al. 2008: delayed recallWilckens et al. 2008: abstract reasoningWilckens et al. 2008: working memoryFavours controlFavours interventionFigure 3: Post-intervention standardised mean differences and 95% confidence intervals for objective measures of cognitive functioning 0-635Arnedt et al. (2013): MFI-20Casault et al. (2015): QLQ-C30Casault et al. (2015): QLQ-C30Matthews et al. (2014): AFIMatthews et al. (2014): AFISun et al. (2013): MMSESun et al. (2013): MMSESun et al. (2013): MMSESun et al. (2013): WMS number memorySun et al. (2013): WMS number memorySun et al. (2013): WMS number memorySun et al. (2013): WMS picture memorySun et al. (2013): WMS picture memorySun et al. (2013): WMS picture memorySun et al. (2013): WMS associative memorySun et al. (2013): WMS associative memorySun et al. (2013): WMS associative memorySun et al. (2013): WMS understanding memorySun et al. (2013): WMS understanding memoryOmvik et al. (2008): Vigil RTOmvik et al. (2008): No. correctJansson & Linton (2005): Concentration difficultiesSun et al.(2013): WMS understanding memory00Arnedt et al. (2013): MFI-20Casault et al. (2015): QLQ-C30Casault et al. (2015): QLQ-C30Matthews et al. (2014): AFIMatthews et al. (2014): AFISun et al. (2013): MMSESun et al. (2013): MMSESun et al. (2013): MMSESun et al. (2013): WMS number memorySun et al. (2013): WMS number memorySun et al. (2013): WMS number memorySun et al. (2013): WMS picture memorySun et al. (2013): WMS picture memorySun et al. (2013): WMS picture memorySun et al. (2013): WMS associative memorySun et al. (2013): WMS associative memorySun et al. (2013): WMS associative memorySun et al. (2013): WMS understanding memorySun et al. (2013): WMS understanding memoryOmvik et al. (2008): Vigil RTOmvik et al. (2008): No. correctJansson & Linton (2005): Concentration difficultiesSun et al.(2013): WMS understanding memory\sFigure 4: Follow-up SMD and 95% confidence intervals for cognitive outcomes. Diamonds represent 12 week follow-up, circles represent 24-32 week follow-up and squares represent 52-58 week follow-up. Subjective cognitive outcomes are displayed above the horizontal line and objective cognitive outcomes are displayed below the horizontal line.Table 1: Characteristics of studiesAuthor(year)DesignPopulationIntervention: components of CBT-I (No. of participants)Mode of deliveryNo of sessionsDurationComparator (No. of participants)Mode of deliveryNo of sessionsDurationMean age % femaleLength of follow upCognitive outcomeSummary of cognitive outcomes at follow upQR score out of 26Arnedt et al. (2007) PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5Bcm5lZHQ8L0F1dGhvcj48WWVhcj4yMDA3PC9ZZWFyPjxS

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ADDIN EN.CITE.DATA (45)RCTInsomnia comorbid with alcohol dependenceCBTI-AD: SR, SC, SH, CT (9)aIndividual4 face-to-face and 4 telephone8 weeksBPT (8)aIndividualised4 face-to-face 4 telephone8 weeksCBTI-AD: 46.2a33.3%aBPT:46.1a37.5%a8 weeks after baselineMFI-20 Mental FatigueScores were reduced at post-intervention for both groups. At post-intervention the BPT group reported greater levels of mental fatigue than the CBTI-AD group, however differences were non-significant. 19Arnedt et al. (2013) PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5Bcm5lZHQ8L0F1dGhvcj48WWVhcj4yMDEzPC9ZZWFyPjxS

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ADDIN EN.CITE.DATA (46)RCTChronic insomniaCBTI-Phone: SR, SC, SH, CT, RP (18)aIndividual4-8 telephone4- 8 weeksIPC (15)aParticipants instructed to read and follow recommendations in a CBT-I pamphlet1 telephone session with a study therapist to ensure material was reviewed.CBTI-Phone: 38.1b100%bIPC:40.0b80%b4-8 and 12 weeks after baselineMFI-20 Mental FatigueScores were reduced at post-intervention for both groups and this remained at the 12-week follow-up. No significant difference between the groups at post-intervention or follow-up.17Casault et al. (2015) PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5DYXNhdWx0PC9BdXRob3I+PFllYXI+MjAxNTwvWWVhcj48

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ADDIN EN.CITE.DATA (47)RCTInsomnia comorbid with cancermCBT-I: SC, SR, SH, CT, RP (17)aIndividualSelf-help + 3 telephone consultations6 weeksNo treatment control (18)amCBT-I: 56.9c95%cControl: 57.0c88.9%c6, 12 and 24 weeks after baselineQLQ-C30Cognitive FunctioningSignificantly greater improvement in the mCBT-I group from pre-to post-intervention compared to the control group. 20Davidson et al. (2001) ADDIN EN.CITE <EndNote><Cite><Author>Davidson</Author><Year>2001</Year><RecNum>258</RecNum><DisplayText>(56)</DisplayText><record><rec-number>258</rec-number><foreign-keys><key app="EN" db-id="5prwe5sa1sz2speefwr5tx0oxdw9szzxpasr" timestamp="1464904018">258</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Davidson, J. R.</author><author>Waisberg, J. L.</author><author>Brundage, M. D.</author><author>MacLean, A. W.</author></authors></contributors><auth-address>Department of Psychology, Queen&apos;s University, Kingston, Ontario, Canada. davidsnj@post.queensu.ca</auth-address><titles><title>Nonpharmacologic group treatment of insomnia: a preliminary study with cancer survivors</title><secondary-title>Psychooncology</secondary-title><alt-title>Psycho-oncology</alt-title></titles><pages>389-97</pages><volume>10</volume><number>5</number><edition>2001/09/06</edition><keywords><keyword>Attitude to Health</keyword><keyword>Cognitive Therapy/*methods</keyword><keyword>Female</keyword><keyword>Humans</keyword><keyword>Longitudinal Studies</keyword><keyword>Male</keyword><keyword>Middle Aged</keyword><keyword>Neoplasms/*complications/psychology/therapy</keyword><keyword>Patient Education as Topic/*methods</keyword><keyword>Program Evaluation</keyword><keyword>*Relaxation Therapy</keyword><keyword>Severity of Illness Index</keyword><keyword>Sleep Initiation and Maintenance Disorders/*etiology/psychology/*therapy</keyword><keyword>*Survivors/psychology</keyword><keyword>Time Factors</keyword><keyword>Treatment Outcome</keyword></keywords><dates><year>2001</year><pub-dates><date>Sep-Oct</date></pub-dates></dates><isbn>1057-9249 (Print)&#xD;1057-9249 (Linking)</isbn><accession-num>11536417</accession-num><work-type>Clinical Trial&#xD;Controlled Clinical Trial&#xD;Research Support, Non-U.S. Gov&apos;t</work-type><urls><related-urls><url>;(57)UTInsomnia comorbid with cancerSleep therapy: SC, SH, CT, RL, RP (12)aGroup6 sessions9 weeksNone54.7a91.7%a4 and 8 weeks after baselineQLQ-C30 Cognitive FunctioningTrend for an improvement in cognitive functioning.11Jansson & Linton(2005) PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5KYW5zc29uPC9BdXRob3I+PFllYXI+MjAwNTwvWWVhcj48

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ADDIN EN.CITE.DATA (48)RCTChronic insomniaCBT: SC, SR, SH, CT, RP (64)aGroup6 sessions + 1 booster session6 weeks + booster session 2 months after the 6th sessionSelf-help information containing modules on SC, SR and RL (72)a. Participants instructed to read and apply the materialCBT:50.0a,d84%a,dControl: 49.0a,d71%a,d158 weeks after baselineConcentration Difficulties (0-5)Significantly greater reduction in concentration difficulties in the CBT group compared to the control group.17Lami et al.(2016) ADDIN EN.CITE <EndNote><Cite><Author>Lami</Author><Year>2016</Year><RecNum>266</RecNum><DisplayText>(57)</DisplayText><record><rec-number>266</rec-number><foreign-keys><key app="EN" db-id="5prwe5sa1sz2speefwr5tx0oxdw9szzxpasr" timestamp="1464904102">266</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Lami, M. J.</author><author>Martinez, M. P.</author><author>Sanchez, A. I.</author><author>Miro, E.</author><author>Diener, F. N.</author><author>Prados, G.</author><author>Guzman, M. A.</author></authors></contributors><auth-address>Department of Personality, Assessment, and Psychological Treatment, Faculty of Psychology, University of Granada, Granada, Spain.&#xD;Mind, Brain and Behavior Research Center (CIMCYC), University of Granada, Granada, Spain.&#xD;Internal Medicine Service, Virgen de las Nieves University Hospital, and Rheumatology Service, Virgen de las Nieves University Hospital, Granada, Spain.</auth-address><titles><title>Gender Differences in Patients with Fibromyalgia Undergoing Cognitive-Behavioral Therapy for Insomnia: Preliminary Data</title><secondary-title>Pain Pract</secondary-title><alt-title>Pain practice : the official journal of World Institute of Pain</alt-title></titles><pages>E23-34</pages><volume>16</volume><number>2</number><edition>2016/02/04</edition><dates><year>2016</year><pub-dates><date>Feb</date></pub-dates></dates><isbn>1533-2500 (Electronic)&#xD;1530-7085 (Linking)</isbn><accession-num>26841198</accession-num><work-type>Research Support, Non-U.S. Gov&apos;t</work-type><urls><related-urls><url>;(58)UTInsomnia comorbid with fibromyalgiaCBT-I: SC, SR, SH, CT, RL, RP (27 at posttreatment and 24 at follow-up)aGroup9 sessions9 weeksNone46.29b53.6%b9 and 21 weeks after baselineMFI-20 Mental FatigueSignificant improvement in mental fatigue across the three time points. 11Matthews et al. (2014) PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5NYXR0aGV3czwvQXV0aG9yPjxZZWFyPjIwMTQ8L1llYXI+

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ADDIN EN.CITE.DATA (50)RCTInsomnia comorbid with fibromyalgiaCBT: SC, SR, SH, CT, RL, RP (16)aGroup6 sessions6 weeksSH (15)aGroup6 sessions6 weeksCBT:43.9a,d100%a,dSH:50.2a,d100%a,d7-8 weeks after baselineANT-I taskSignificantly greater improvement in attention-alerting and attention-control in the CBT group compared to the SH group. No significant difference between the groups in change in overall RT or attention-orienting. 17Omvik et al.(2008) PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5PbXZpazwvQXV0aG9yPjxZZWFyPjIwMDg8L1llYXI+PFJl

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ADDIN EN.CITE.DATA (51)RCTOlder adults with chronic insomniaCBT: SC, SR, SH, CT, RL (17 post-treatment; 7 follow-up)Individual6-8 sessions6-8 weeksZopliclone 7.5 mg (14 post-treatment; 10 follow-up)6 weeks1 meeting with a psychologist to check adherence to the treatmentCBT:59.7cNRZopiclone:62.0cNR8-10 and 32-34 weeks after baselineVigilance TestChange in performance on this test was not significantly different between the groups.15Quesnel et al. (2003) ADDIN EN.CITE <EndNote><Cite><Author>Quesnel</Author><Year>2003</Year><RecNum>276</RecNum><DisplayText>(61)</DisplayText><record><rec-number>276</rec-number><foreign-keys><key app="EN" db-id="5prwe5sa1sz2speefwr5tx0oxdw9szzxpasr" timestamp="1464904236">276</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Quesnel, C.</author><author>Savard, J.</author><author>Simard, S.</author><author>Ivers, H.</author><author>Morin, C. M.</author></authors></contributors><auth-address>School of Psychology and Cancer Research Centre, Universite Laval, Quebec, Quebec, Canada.</auth-address><titles><title>Efficacy of cognitive-behavioral therapy for insomnia in women treated for nonmetastatic breast cancer</title><secondary-title>J Consult Clin Psychol</secondary-title><alt-title>Journal of consulting and clinical psychology</alt-title></titles><pages>189-200</pages><volume>71</volume><number>1</number><edition>2003/02/27</edition><keywords><keyword>Adult</keyword><keyword>Aged</keyword><keyword>Breast Neoplasms/*psychology</keyword><keyword>Cognitive Therapy/*methods</keyword><keyword>Female</keyword><keyword>Humans</keyword><keyword>Middle Aged</keyword><keyword>Polysomnography</keyword><keyword>Quality of Life</keyword><keyword>Sleep Initiation and Maintenance Disorders/diagnosis/*etiology/*therapy</keyword><keyword>Surveys and Questionnaires</keyword></keywords><dates><year>2003</year><pub-dates><date>Feb</date></pub-dates></dates><isbn>0022-006X (Print)&#xD;0022-006X (Linking)</isbn><accession-num>12602439</accession-num><work-type>Clinical Trial&#xD;Research Support, Non-U.S. Gov&apos;t</work-type><urls><related-urls><url>;(62)Case seriesInsomnia secondary to metastatic breast cancerCBT: SC, SR, SH, CT, RP (8 at post-treatment; 7 at follow-up)aGroup8 sessions8 weeksNone54.3c100% c8-10, 20-22, and 32-34 weeks after baselineQLQ-C30Cognitive FunctioningSignificant improvement from pre to post intervention and no significant change from post-treatment to follow-up. 10Ritterband et al. (2012) PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5SaXR0ZXJiYW5kPC9BdXRob3I+PFllYXI+MjAxMjwvWWVh

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ADDIN EN.CITE.DATA (52)RCTInsomnia secondary to cancerCBT-I: SC, SR, SH, CT, RP (14)aInternet6 modules6-9 weeksWait list control (14)aCBT-I:53.7a,c100%a,cWLC:59.6a,c71.4%a,c9-11 weeks after baselineMFSI-SFMental FatigueGreater reduction in mental fatigue in the SHUTi group compared to WLC.17Simeit et al.(2004) ADDIN EN.CITE <EndNote><Cite><Author>Simeit</Author><Year>2004</Year><RecNum>279</RecNum><DisplayText>(60)</DisplayText><record><rec-number>279</rec-number><foreign-keys><key app="EN" db-id="5prwe5sa1sz2speefwr5tx0oxdw9szzxpasr" timestamp="1464904303">279</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Simeit, R.</author><author>Deck, R.</author><author>Conta-Marx, B.</author></authors></contributors><auth-address>Ropersbergklinik Ratzeburg, Ropersberg 47, 23909 Ratzeburg, Germany. info@rkrz.de</auth-address><titles><title>Sleep management training for cancer patients with insomnia</title><secondary-title>Support Care Cancer</secondary-title><alt-title>Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer</alt-title></titles><pages>176-83</pages><volume>12</volume><number>3</number><edition>2004/02/05</edition><keywords><keyword>Attitude to Health</keyword><keyword>Female</keyword><keyword>Health Care Surveys</keyword><keyword>Humans</keyword><keyword>Male</keyword><keyword>Middle Aged</keyword><keyword>Neoplasms/*complications/psychology</keyword><keyword>Patient Education as Topic/*methods</keyword><keyword>Program Evaluation</keyword><keyword>Quality of Life</keyword><keyword>Relaxation Therapy/*education</keyword><keyword>Sleep Initiation and Maintenance Disorders/prevention &amp; control/*rehabilitation</keyword><keyword>Surveys and Questionnaires</keyword></keywords><dates><year>2004</year><pub-dates><date>Mar</date></pub-dates></dates><isbn>0941-4355 (Print)&#xD;0941-4355 (Linking)</isbn><accession-num>14760542</accession-num><work-type>Clinical Trial&#xD;Controlled Clinical Trial&#xD;Research Support, Non-U.S. Gov&apos;t</work-type><urls><related-urls><url>;(61)NRTCancer patients with insomnia undergoing rehabilitationSleep management programme: SH, SC, CT, RL, RP.RL: PMR (80)a or AT (71)aGroup3 sessions 3-4 weeksStandard rehabilitation (78)aGroup3-4 weeks PMR:60.2a70%aAT:57.6a80.3aControl: 57.6a75.6%a3/4, 9/10 and 27/28 weeks after baselineQLQ-C30Cognitive FunctioningSignificant improvement between baseline and follow-up for all the groups. Change in scores was not significantly different between the groups. 12Sun et al.(2013) ADDIN EN.CITE <EndNote><Cite><Author>Sun</Author><Year>2013</Year><RecNum>280</RecNum><DisplayText>(52)</DisplayText><record><rec-number>280</rec-number><foreign-keys><key app="EN" db-id="5prwe5sa1sz2speefwr5tx0oxdw9szzxpasr" timestamp="1464904343">280</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Sun, J.</author><author>Kang, J.</author><author>Wang, P.</author><author>Zeng, H.</author></authors></contributors><auth-address>School of Nursing, Central South University, Changsha, Hunan Province, China.</auth-address><titles><title>Self-relaxation training can improve sleep quality and cognitive functions in the older: a one-year randomised controlled trial</title><secondary-title>J Clin Nurs</secondary-title><alt-title>Journal of clinical nursing</alt-title></titles><pages>1270-80</pages><volume>22</volume><number>9-10</number><edition>2013/04/12</edition><keywords><keyword>Adolescent</keyword><keyword>Adult</keyword><keyword>Aged</keyword><keyword>Aged, 80 and over</keyword><keyword>Analysis of Variance</keyword><keyword>Child</keyword><keyword>*Cognition</keyword><keyword>Female</keyword><keyword>Humans</keyword><keyword>Male</keyword><keyword>Middle Aged</keyword><keyword>Patient Education as Topic/*methods</keyword><keyword>*Relaxation Therapy</keyword><keyword>*Self Care</keyword><keyword>*Sleep</keyword><keyword>Surveys and Questionnaires</keyword><keyword>Young Adult</keyword></keywords><dates><year>2013</year><pub-dates><date>May</date></pub-dates></dates><isbn>1365-2702 (Electronic)&#xD;0962-1067 (Linking)</isbn><accession-num>23574290</accession-num><work-type>Randomized Controlled Trial&#xD;Research Support, Non-U.S. Gov&apos;t</work-type><urls><related-urls><url>;(53)RCTOlder adult poor sleepersSH, RL (37)aGroup4 sessions4 week intervention with assisted follow up for 1 yearSH (38)aBrochureExperimental: 68.6a,b70.3%a,bControl: 70.8a,b73.3%a,b12, 24 and 52 weeks after baselineMMSE,WMS-CRScores on the MMSE and four subtests from the WMS-CR significantly increased in the experimental group whereas they decreased in the control group.14Swanson et al. (2013) PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5Td2Fuc29uPC9BdXRob3I+PFllYXI+MjAxMzwvWWVhcj48

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ADDIN EN.CITE.DATA (54)RCTChronic insomnia in college studentsCBT-I: SC, SR, SH, RL, CT (16)aIndividual6 sessions6 weeksWait list control (13)aCBT-I:19.5c23.5%cWLC:19.9c58.8%c6 and 18 weeks after baselineMFI-20Mental FatigueNo significant difference between the groups in change in mental fatigue.19Tomfohr-Madsen et al. (2016) ADDIN EN.CITE <EndNote><Cite><Author>Tomfohr-Madsen</Author><Year>2016</Year><RecNum>287</RecNum><DisplayText>(59)</DisplayText><record><rec-number>287</rec-number><foreign-keys><key app="EN" db-id="5prwe5sa1sz2speefwr5tx0oxdw9szzxpasr" timestamp="1464904461">287</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Tomfohr-Madsen, L. M.</author><author>Clayborne, Z. M.</author><author>Rouleau, C. R.</author><author>Campbell, T. S.</author></authors></contributors><auth-address>a Department of Psychology , University of Calgary , Calgary , Alberta , Canada.&#xD;b Alberta Children&apos;s Hospital Research Institute for Child and Maternal Health , Calgary , Alberta , Canada.&#xD;c Department of Pediatrics , Alberta Children&apos;s Hospital , Calgary , Alberta , Canada.</auth-address><titles><title>Sleeping for Two: An Open-Pilot Study of Cognitive Behavioral Therapy for Insomnia in Pregnancy</title><secondary-title>Behav Sleep Med</secondary-title><alt-title>Behavioral sleep medicine</alt-title></titles><periodical><full-title>Behav Sleep Med</full-title><abbr-1>Behavioral sleep medicine</abbr-1></periodical><alt-periodical><full-title>Behav Sleep Med</full-title><abbr-1>Behavioral sleep medicine</abbr-1></alt-periodical><pages>1-17</pages><edition>2016/04/29</edition><dates><year>2016</year><pub-dates><date>Apr 28</date></pub-dates></dates><isbn>1540-2010 (Electronic)&#xD;1540-2002 (Linking)</isbn><accession-num>27124405</accession-num><urls><related-urls><url>;(60)UTInsomnia in pregnancyCBT-I: SC, SR, CT, RP (13)aGroup5 sessions5 weeksNone31.0a,b100%a,b7 weeks after baselineMFSI-SFMental FatigueSignificant improvement12Wilckens et al.(2016) ADDIN EN.CITE <EndNote><Cite><Author>Wilckens</Author><Year>2016</Year><RecNum>288</RecNum><DisplayText>(54)</DisplayText><record><rec-number>288</rec-number><foreign-keys><key app="EN" db-id="5prwe5sa1sz2speefwr5tx0oxdw9szzxpasr" timestamp="1464904500">288</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Wilckens, K. A.</author><author>Hall, M. H.</author><author>Nebes, R. D.</author><author>Monk, T. H.</author><author>Buysse, D. J.</author></authors></contributors><auth-address>a Department of Psychiatry , University of Pittsburgh School of Medicine , USA.</auth-address><titles><title>Changes in Cognitive Performance Are Associated with Changes in Sleep in Older Adults With Insomnia</title><secondary-title>Behav Sleep Med</secondary-title><alt-title>Behavioral sleep medicine</alt-title></titles><periodical><full-title>Behav Sleep Med</full-title><abbr-1>Behavioral sleep medicine</abbr-1></periodical><alt-periodical><full-title>Behav Sleep Med</full-title><abbr-1>Behavioral sleep medicine</abbr-1></alt-periodical><pages>295-310</pages><volume>14</volume><number>3</number><edition>2015/09/01</edition><dates><year>2016</year><pub-dates><date>May-Jun</date></pub-dates></dates><isbn>1540-2010 (Electronic)&#xD;1540-2002 (Linking)</isbn><accession-num>26322904</accession-num><urls><related-urls><url>;(55)RCTChronic comorbid insomnia in older adultsBBTI: SR, SC (NR)aIndividual2 face-to face sessions and 2 telephone3 weeksInformation-only Control (NR)aParticipants were instructed to read 3 publications containing information about behavioural treatment for insomnia and received a telephone call after two weeks.BBTI:72.665.8%IC:70.571.8%4 weeks after baselineLogical Memory Test, TONI,Letter-number sequencingNo significant difference between treatment groups in change in cognitive performance between baseline and follow-up.12Note. ANT-I task = attentional networks test – interactions task, AT = autogenic training, BBTI = brief behavioural treatment of insomnia, BPT = behavioural placebo treatment, CBT-I = cognitive behavioural therapy for insomnia, CBT-I AD = cognitive behavioural therapy for insomnia in recovering alcohol dependent patients, CBTI-Phone = telephone delivered cognitive behavioural therapy for insomnia, CT = cognitive therapy , IC = information control, IPC = information pamphlet control, mCBT-I = minimal CBT-I, MFI-20 = multidimensional fatigue inventory, MFSI-SF = multidimensional fatigue symptom inventory short form, MMSE = mini mental state exam, NR = not reported, NRT = non-randomised trial, PMR = progressive muscle relaxation, QR = quality rating, RCT = randomised controlled trial, RL = relaxation, RP = relapse prevention, RT = reaction time, SC = stimulus control, SH = sleep hygiene, SR = sleep restriction, TONI = test of nonverbal intelligence, UT = uncontrolled trial, WLC = wait list control, WMS-CR = Wechsler memory scale -Chinese revisiona = data are for participants included in the analysis.b = data are for participants who completed the intervention.c = data are for participants who were recruited/ randomised.d = data are for participants who completed the follow-up.Table S2: Post-intervention and follow-up data used to calculate standardised mean difference (SMD) for subjective measures of cognitive functioningAuthor InterventionCognitive outcomeAssessment point Intervention GroupControl GroupSMD(95% CI)NMeanSDNMeanSDArnedt et al. 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ADDIN EN.CITE.DATA (46)CBTI-PhoneMFI-20Mental Fatiguea8 weeks18-8.902.4015-10.62.80.66(-0.05, 1.36)Arnedt et al. (2013) PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5Bcm5lZHQ8L0F1dGhvcj48WWVhcj4yMDEzPC9ZZWFyPjxS

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ADDIN EN.CITE.DATA (46)CBTI-PhoneMFI-20Mental Fatiguea12 weeks18-8.62.415-10.53.60.63(-0.07, 1.34)Casault et al. (2015) PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5DYXNhdWx0PC9BdXRob3I+PFllYXI+MjAxNTwvWWVhcj48

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ADDIN EN.CITE.DATA (47)Minimal CBT-IQLQ-C30Cognitive Functioning24 weeks1783.8215.261882.4116.160.09(-0.57, 0.75)Jansson & Linton(2005) PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5KYW5zc29uPC9BdXRob3I+PFllYXI+MjAwNTwvWWVhcj48

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ADDIN EN.CITE.DATA (48)CBT-IConcentration Difficulties (0-5)a58 weeks64-2.51.172-2.71.00.19(-0.15, 0.53)Matthews et al. (2014) (49)CBT-IAttentional Function Index6 weeks326.871.76285.782.000.58(0.06, 1.10)Matthews et al. (2014) (49)CBT-IAttentional Function Index12 weeks326.911.98285.851.860.55(0.03, 1.07)Matthews et al. (2014) (49)CBT-IAttentional Function Index24 weeks326.931.84286.291.820.35(-0.16, 0.86)Ritterband et al. (2012) PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5SaXR0ZXJiYW5kPC9BdXRob3I+PFllYXI+MjAxMjwvWWVh

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ADDIN EN.CITE.DATA (52)SHUTiMFSI-SFMental Fatiguea9 weeks14-5.294.2014-5.643.930.09(-0.66, 0.83)Taylor et al.(2014) PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5UYXlsb3I8L0F1dGhvcj48WWVhcj4yMDE0PC9ZZWFyPjxS

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ADDIN EN.CITE.DATA (54)CBT-IMFI-20Mental Fatiguea6 weeks17-9.884.1014-11.383.110.41(-0.31, 1.12)Note. CBT-I = cognitive behavioural therapy for insomnia, CBT-I AD = cognitive behavioural therapy for insomnia in recovering alcohol dependent patients, CBTI-Phone = Telephone delivered cognitive behavioural therapy for insomnia, MFI-20 = multidimensional fatigue inventory, MFSI-SF = multidimensional fatigue symptom inventory short form, SHUTi = sleep healthy using the internet a = mean values were multiplied by -1 to adjust for differences in the direction of measurement.Table S3: Post-intervention and follow-up data used to calculate standardised mean difference (SMD) for objective measures of cognitive functioningAuthor InterventionCognitive outcomeAssessment point Intervention GroupControl GroupSMD(95% CI)NMeanSDNMeanSDMiro et al.(2011) PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5NaXJvPC9BdXRob3I+PFllYXI+MjAxMTwvWWVhcj48UmVj

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ADDIN EN.CITE.DATA (51)CBT-IVigilNo. correct30-32 weeks798.861.351099.401.78-0.33(-1.31, 0.64)Sun et al.(2013) ADDIN EN.CITE <EndNote><Cite><Author>Sun</Author><Year>2013</Year><RecNum>280</RecNum><DisplayText>(52)</DisplayText><record><rec-number>280</rec-number><foreign-keys><key app="EN" db-id="5prwe5sa1sz2speefwr5tx0oxdw9szzxpasr" timestamp="1464904343">280</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Sun, J.</author><author>Kang, J.</author><author>Wang, P.</author><author>Zeng, H.</author></authors></contributors><auth-address>School of Nursing, Central South University, Changsha, Hunan Province, China.</auth-address><titles><title>Self-relaxation training can improve sleep quality and cognitive functions in the older: a one-year randomised controlled trial</title><secondary-title>J Clin Nurs</secondary-title><alt-title>Journal of clinical nursing</alt-title></titles><pages>1270-80</pages><volume>22</volume><number>9-10</number><edition>2013/04/12</edition><keywords><keyword>Adolescent</keyword><keyword>Adult</keyword><keyword>Aged</keyword><keyword>Aged, 80 and over</keyword><keyword>Analysis of Variance</keyword><keyword>Child</keyword><keyword>*Cognition</keyword><keyword>Female</keyword><keyword>Humans</keyword><keyword>Male</keyword><keyword>Middle Aged</keyword><keyword>Patient Education as Topic/*methods</keyword><keyword>*Relaxation Therapy</keyword><keyword>*Self Care</keyword><keyword>*Sleep</keyword><keyword>Surveys and Questionnaires</keyword><keyword>Young Adult</keyword></keywords><dates><year>2013</year><pub-dates><date>May</date></pub-dates></dates><isbn>1365-2702 (Electronic)&#xD;0962-1067 (Linking)</isbn><accession-num>23574290</accession-num><work-type>Randomized Controlled Trial&#xD;Research Support, Non-U.S. Gov&apos;t</work-type><urls><related-urls><url>;(53)SH + RLMMSE12 weeks3826.302.713723.393.780.89(0.41, 1.36)Sun et al.(2013) ADDIN EN.CITE <EndNote><Cite><Author>Sun</Author><Year>2013</Year><RecNum>280</RecNum><DisplayText>(52)</DisplayText><record><rec-number>280</rec-number><foreign-keys><key app="EN" db-id="5prwe5sa1sz2speefwr5tx0oxdw9szzxpasr" timestamp="1464904343">280</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Sun, J.</author><author>Kang, J.</author><author>Wang, P.</author><author>Zeng, H.</author></authors></contributors><auth-address>School of Nursing, Central South University, Changsha, Hunan Province, China.</auth-address><titles><title>Self-relaxation training can improve sleep quality and cognitive functions in the older: a one-year randomised controlled trial</title><secondary-title>J Clin Nurs</secondary-title><alt-title>Journal of clinical nursing</alt-title></titles><pages>1270-80</pages><volume>22</volume><number>9-10</number><edition>2013/04/12</edition><keywords><keyword>Adolescent</keyword><keyword>Adult</keyword><keyword>Aged</keyword><keyword>Aged, 80 and over</keyword><keyword>Analysis of Variance</keyword><keyword>Child</keyword><keyword>*Cognition</keyword><keyword>Female</keyword><keyword>Humans</keyword><keyword>Male</keyword><keyword>Middle Aged</keyword><keyword>Patient Education as Topic/*methods</keyword><keyword>*Relaxation Therapy</keyword><keyword>*Self Care</keyword><keyword>*Sleep</keyword><keyword>Surveys and Questionnaires</keyword><keyword>Young Adult</keyword></keywords><dates><year>2013</year><pub-dates><date>May</date></pub-dates></dates><isbn>1365-2702 (Electronic)&#xD;0962-1067 (Linking)</isbn><accession-num>23574290</accession-num><work-type>Randomized Controlled Trial&#xD;Research Support, Non-U.S. Gov&apos;t</work-type><urls><related-urls><url>;(53)SH + RLNumber memory12 weeks3810.591.77378.971.620.95(0.48, 1.43)Sun et al.(2013) ADDIN EN.CITE <EndNote><Cite><Author>Sun</Author><Year>2013</Year><RecNum>280</RecNum><DisplayText>(52)</DisplayText><record><rec-number>280</rec-number><foreign-keys><key app="EN" db-id="5prwe5sa1sz2speefwr5tx0oxdw9szzxpasr" timestamp="1464904343">280</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Sun, J.</author><author>Kang, J.</author><author>Wang, P.</author><author>Zeng, H.</author></authors></contributors><auth-address>School of Nursing, Central South University, Changsha, Hunan Province, China.</auth-address><titles><title>Self-relaxation training can improve sleep quality and cognitive functions in the older: a one-year randomised controlled trial</title><secondary-title>J Clin Nurs</secondary-title><alt-title>Journal of clinical nursing</alt-title></titles><pages>1270-80</pages><volume>22</volume><number>9-10</number><edition>2013/04/12</edition><keywords><keyword>Adolescent</keyword><keyword>Adult</keyword><keyword>Aged</keyword><keyword>Aged, 80 and over</keyword><keyword>Analysis of Variance</keyword><keyword>Child</keyword><keyword>*Cognition</keyword><keyword>Female</keyword><keyword>Humans</keyword><keyword>Male</keyword><keyword>Middle Aged</keyword><keyword>Patient Education as Topic/*methods</keyword><keyword>*Relaxation Therapy</keyword><keyword>*Self Care</keyword><keyword>*Sleep</keyword><keyword>Surveys and Questionnaires</keyword><keyword>Young Adult</keyword></keywords><dates><year>2013</year><pub-dates><date>May</date></pub-dates></dates><isbn>1365-2702 (Electronic)&#xD;0962-1067 (Linking)</isbn><accession-num>23574290</accession-num><work-type>Randomized Controlled Trial&#xD;Research Support, Non-U.S. Gov&apos;t</work-type><urls><related-urls><url>;(53)SH + RLPicture memory12 weeks3810.952.3377.083.331.36(0.86, 1.87)Sun et al.(2013) ADDIN EN.CITE <EndNote><Cite><Author>Sun</Author><Year>2013</Year><RecNum>280</RecNum><DisplayText>(52)</DisplayText><record><rec-number>280</rec-number><foreign-keys><key app="EN" db-id="5prwe5sa1sz2speefwr5tx0oxdw9szzxpasr" timestamp="1464904343">280</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Sun, J.</author><author>Kang, J.</author><author>Wang, P.</author><author>Zeng, H.</author></authors></contributors><auth-address>School of Nursing, Central South University, Changsha, Hunan Province, China.</auth-address><titles><title>Self-relaxation training can improve sleep quality and cognitive functions in the older: a one-year randomised controlled trial</title><secondary-title>J Clin Nurs</secondary-title><alt-title>Journal of clinical nursing</alt-title></titles><pages>1270-80</pages><volume>22</volume><number>9-10</number><edition>2013/04/12</edition><keywords><keyword>Adolescent</keyword><keyword>Adult</keyword><keyword>Aged</keyword><keyword>Aged, 80 and over</keyword><keyword>Analysis of Variance</keyword><keyword>Child</keyword><keyword>*Cognition</keyword><keyword>Female</keyword><keyword>Humans</keyword><keyword>Male</keyword><keyword>Middle Aged</keyword><keyword>Patient Education as Topic/*methods</keyword><keyword>*Relaxation Therapy</keyword><keyword>*Self Care</keyword><keyword>*Sleep</keyword><keyword>Surveys and Questionnaires</keyword><keyword>Young Adult</keyword></keywords><dates><year>2013</year><pub-dates><date>May</date></pub-dates></dates><isbn>1365-2702 (Electronic)&#xD;0962-1067 (Linking)</isbn><accession-num>23574290</accession-num><work-type>Randomized Controlled Trial&#xD;Research Support, Non-U.S. Gov&apos;t</work-type><urls><related-urls><url>;(53)SH + RLAssociative memory12 weeks383.651.15371.991.401.30(0.80, 1.80)Sun et al.(2013) ADDIN EN.CITE <EndNote><Cite><Author>Sun</Author><Year>2013</Year><RecNum>280</RecNum><DisplayText>(52)</DisplayText><record><rec-number>280</rec-number><foreign-keys><key app="EN" db-id="5prwe5sa1sz2speefwr5tx0oxdw9szzxpasr" timestamp="1464904343">280</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Sun, J.</author><author>Kang, J.</author><author>Wang, P.</author><author>Zeng, H.</author></authors></contributors><auth-address>School of Nursing, Central South University, Changsha, Hunan Province, China.</auth-address><titles><title>Self-relaxation training can improve sleep quality and cognitive functions in the older: a one-year randomised controlled trial</title><secondary-title>J Clin Nurs</secondary-title><alt-title>Journal of clinical nursing</alt-title></titles><pages>1270-80</pages><volume>22</volume><number>9-10</number><edition>2013/04/12</edition><keywords><keyword>Adolescent</keyword><keyword>Adult</keyword><keyword>Aged</keyword><keyword>Aged, 80 and over</keyword><keyword>Analysis of Variance</keyword><keyword>Child</keyword><keyword>*Cognition</keyword><keyword>Female</keyword><keyword>Humans</keyword><keyword>Male</keyword><keyword>Middle Aged</keyword><keyword>Patient Education as Topic/*methods</keyword><keyword>*Relaxation Therapy</keyword><keyword>*Self Care</keyword><keyword>*Sleep</keyword><keyword>Surveys and Questionnaires</keyword><keyword>Young Adult</keyword></keywords><dates><year>2013</year><pub-dates><date>May</date></pub-dates></dates><isbn>1365-2702 (Electronic)&#xD;0962-1067 (Linking)</isbn><accession-num>23574290</accession-num><work-type>Randomized Controlled Trial&#xD;Research Support, Non-U.S. Gov&apos;t</work-type><urls><related-urls><url>;(53)SH + RLUnderstanding memory12 weeks389.863.43375.162.931.47(0.96, 1.98)Sun et al.(2013) ADDIN EN.CITE <EndNote><Cite><Author>Sun</Author><Year>2013</Year><RecNum>280</RecNum><DisplayText>(52)</DisplayText><record><rec-number>280</rec-number><foreign-keys><key app="EN" db-id="5prwe5sa1sz2speefwr5tx0oxdw9szzxpasr" timestamp="1464904343">280</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Sun, J.</author><author>Kang, J.</author><author>Wang, P.</author><author>Zeng, H.</author></authors></contributors><auth-address>School of Nursing, Central South University, Changsha, Hunan Province, China.</auth-address><titles><title>Self-relaxation training can improve sleep quality and cognitive functions in the older: a one-year randomised controlled trial</title><secondary-title>J Clin Nurs</secondary-title><alt-title>Journal of clinical nursing</alt-title></titles><pages>1270-80</pages><volume>22</volume><number>9-10</number><edition>2013/04/12</edition><keywords><keyword>Adolescent</keyword><keyword>Adult</keyword><keyword>Aged</keyword><keyword>Aged, 80 and over</keyword><keyword>Analysis of Variance</keyword><keyword>Child</keyword><keyword>*Cognition</keyword><keyword>Female</keyword><keyword>Humans</keyword><keyword>Male</keyword><keyword>Middle Aged</keyword><keyword>Patient Education as Topic/*methods</keyword><keyword>*Relaxation Therapy</keyword><keyword>*Self Care</keyword><keyword>*Sleep</keyword><keyword>Surveys and Questionnaires</keyword><keyword>Young Adult</keyword></keywords><dates><year>2013</year><pub-dates><date>May</date></pub-dates></dates><isbn>1365-2702 (Electronic)&#xD;0962-1067 (Linking)</isbn><accession-num>23574290</accession-num><work-type>Randomized Controlled Trial&#xD;Research Support, Non-U.S. Gov&apos;t</work-type><urls><related-urls><url>;(53)SH + RLMMSE24 weeks3826.465.073722.893.930.79(0.32, 1.26)Sun et al.(2013) ADDIN EN.CITE <EndNote><Cite><Author>Sun</Author><Year>2013</Year><RecNum>280</RecNum><DisplayText>(52)</DisplayText><record><rec-number>280</rec-number><foreign-keys><key app="EN" db-id="5prwe5sa1sz2speefwr5tx0oxdw9szzxpasr" timestamp="1464904343">280</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Sun, J.</author><author>Kang, J.</author><author>Wang, P.</author><author>Zeng, H.</author></authors></contributors><auth-address>School of Nursing, Central South University, Changsha, Hunan Province, China.</auth-address><titles><title>Self-relaxation training can improve sleep quality and cognitive functions in the older: a one-year randomised controlled trial</title><secondary-title>J Clin Nurs</secondary-title><alt-title>Journal of clinical nursing</alt-title></titles><pages>1270-80</pages><volume>22</volume><number>9-10</number><edition>2013/04/12</edition><keywords><keyword>Adolescent</keyword><keyword>Adult</keyword><keyword>Aged</keyword><keyword>Aged, 80 and over</keyword><keyword>Analysis of Variance</keyword><keyword>Child</keyword><keyword>*Cognition</keyword><keyword>Female</keyword><keyword>Humans</keyword><keyword>Male</keyword><keyword>Middle Aged</keyword><keyword>Patient Education as Topic/*methods</keyword><keyword>*Relaxation Therapy</keyword><keyword>*Self Care</keyword><keyword>*Sleep</keyword><keyword>Surveys and Questionnaires</keyword><keyword>Young Adult</keyword></keywords><dates><year>2013</year><pub-dates><date>May</date></pub-dates></dates><isbn>1365-2702 (Electronic)&#xD;0962-1067 (Linking)</isbn><accession-num>23574290</accession-num><work-type>Randomized Controlled Trial&#xD;Research Support, Non-U.S. Gov&apos;t</work-type><urls><related-urls><url>;(53)SH + RLNumber memory24 weeks3811.412.65377.841.651.61(1.09, 2.13)Sun et al.(2013) ADDIN EN.CITE <EndNote><Cite><Author>Sun</Author><Year>2013</Year><RecNum>280</RecNum><DisplayText>(52)</DisplayText><record><rec-number>280</rec-number><foreign-keys><key app="EN" db-id="5prwe5sa1sz2speefwr5tx0oxdw9szzxpasr" timestamp="1464904343">280</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Sun, J.</author><author>Kang, J.</author><author>Wang, P.</author><author>Zeng, H.</author></authors></contributors><auth-address>School of Nursing, Central South University, Changsha, Hunan Province, China.</auth-address><titles><title>Self-relaxation training can improve sleep quality and cognitive functions in the older: a one-year randomised controlled trial</title><secondary-title>J Clin Nurs</secondary-title><alt-title>Journal of clinical nursing</alt-title></titles><pages>1270-80</pages><volume>22</volume><number>9-10</number><edition>2013/04/12</edition><keywords><keyword>Adolescent</keyword><keyword>Adult</keyword><keyword>Aged</keyword><keyword>Aged, 80 and over</keyword><keyword>Analysis of Variance</keyword><keyword>Child</keyword><keyword>*Cognition</keyword><keyword>Female</keyword><keyword>Humans</keyword><keyword>Male</keyword><keyword>Middle Aged</keyword><keyword>Patient Education as Topic/*methods</keyword><keyword>*Relaxation Therapy</keyword><keyword>*Self Care</keyword><keyword>*Sleep</keyword><keyword>Surveys and Questionnaires</keyword><keyword>Young Adult</keyword></keywords><dates><year>2013</year><pub-dates><date>May</date></pub-dates></dates><isbn>1365-2702 (Electronic)&#xD;0962-1067 (Linking)</isbn><accession-num>23574290</accession-num><work-type>Randomized Controlled Trial&#xD;Research Support, Non-U.S. Gov&apos;t</work-type><urls><related-urls><url>;(53)SH + RLPicture memory24 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nursing</alt-title></titles><pages>1270-80</pages><volume>22</volume><number>9-10</number><edition>2013/04/12</edition><keywords><keyword>Adolescent</keyword><keyword>Adult</keyword><keyword>Aged</keyword><keyword>Aged, 80 and over</keyword><keyword>Analysis of Variance</keyword><keyword>Child</keyword><keyword>*Cognition</keyword><keyword>Female</keyword><keyword>Humans</keyword><keyword>Male</keyword><keyword>Middle Aged</keyword><keyword>Patient Education as Topic/*methods</keyword><keyword>*Relaxation Therapy</keyword><keyword>*Self Care</keyword><keyword>*Sleep</keyword><keyword>Surveys and Questionnaires</keyword><keyword>Young Adult</keyword></keywords><dates><year>2013</year><pub-dates><date>May</date></pub-dates></dates><isbn>1365-2702 (Electronic)&#xD;0962-1067 (Linking)</isbn><accession-num>23574290</accession-num><work-type>Randomized Controlled Trial&#xD;Research Support, Non-U.S. Gov&apos;t</work-type><urls><related-urls><url>;(53)SH + RLAssociative memory24 weeks384.381.45371.831.151.95(1.40, 2.50)Sun et al.(2013) ADDIN EN.CITE <EndNote><Cite><Author>Sun</Author><Year>2013</Year><RecNum>280</RecNum><DisplayText>(52)</DisplayText><record><rec-number>280</rec-number><foreign-keys><key app="EN" db-id="5prwe5sa1sz2speefwr5tx0oxdw9szzxpasr" timestamp="1464904343">280</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Sun, J.</author><author>Kang, J.</author><author>Wang, P.</author><author>Zeng, H.</author></authors></contributors><auth-address>School of Nursing, Central South University, Changsha, Hunan Province, China.</auth-address><titles><title>Self-relaxation training can improve sleep quality and cognitive functions in the older: a one-year randomised controlled trial</title><secondary-title>J Clin Nurs</secondary-title><alt-title>Journal of clinical nursing</alt-title></titles><pages>1270-80</pages><volume>22</volume><number>9-10</number><edition>2013/04/12</edition><keywords><keyword>Adolescent</keyword><keyword>Adult</keyword><keyword>Aged</keyword><keyword>Aged, 80 and over</keyword><keyword>Analysis of Variance</keyword><keyword>Child</keyword><keyword>*Cognition</keyword><keyword>Female</keyword><keyword>Humans</keyword><keyword>Male</keyword><keyword>Middle Aged</keyword><keyword>Patient Education as Topic/*methods</keyword><keyword>*Relaxation Therapy</keyword><keyword>*Self Care</keyword><keyword>*Sleep</keyword><keyword>Surveys and Questionnaires</keyword><keyword>Young Adult</keyword></keywords><dates><year>2013</year><pub-dates><date>May</date></pub-dates></dates><isbn>1365-2702 (Electronic)&#xD;0962-1067 (Linking)</isbn><accession-num>23574290</accession-num><work-type>Randomized Controlled Trial&#xD;Research Support, Non-U.S. Gov&apos;t</work-type><urls><related-urls><url>;(53)SH + RLUnderstanding memory24 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nursing</alt-title></titles><pages>1270-80</pages><volume>22</volume><number>9-10</number><edition>2013/04/12</edition><keywords><keyword>Adolescent</keyword><keyword>Adult</keyword><keyword>Aged</keyword><keyword>Aged, 80 and over</keyword><keyword>Analysis of Variance</keyword><keyword>Child</keyword><keyword>*Cognition</keyword><keyword>Female</keyword><keyword>Humans</keyword><keyword>Male</keyword><keyword>Middle Aged</keyword><keyword>Patient Education as Topic/*methods</keyword><keyword>*Relaxation Therapy</keyword><keyword>*Self Care</keyword><keyword>*Sleep</keyword><keyword>Surveys and Questionnaires</keyword><keyword>Young Adult</keyword></keywords><dates><year>2013</year><pub-dates><date>May</date></pub-dates></dates><isbn>1365-2702 (Electronic)&#xD;0962-1067 (Linking)</isbn><accession-num>23574290</accession-num><work-type>Randomized Controlled Trial&#xD;Research Support, Non-U.S. Gov&apos;t</work-type><urls><related-urls><url>;(53)SH + RLMMSE52 weeks3827.572.263722.713.671.60(1.08, 2.12)Sun et al.(2013) ADDIN EN.CITE <EndNote><Cite><Author>Sun</Author><Year>2013</Year><RecNum>280</RecNum><DisplayText>(52)</DisplayText><record><rec-number>280</rec-number><foreign-keys><key app="EN" db-id="5prwe5sa1sz2speefwr5tx0oxdw9szzxpasr" timestamp="1464904343">280</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Sun, J.</author><author>Kang, J.</author><author>Wang, P.</author><author>Zeng, H.</author></authors></contributors><auth-address>School of Nursing, Central South University, Changsha, Hunan Province, China.</auth-address><titles><title>Self-relaxation training can improve sleep quality and cognitive functions in the older: a one-year randomised controlled trial</title><secondary-title>J Clin Nurs</secondary-title><alt-title>Journal of clinical nursing</alt-title></titles><pages>1270-80</pages><volume>22</volume><number>9-10</number><edition>2013/04/12</edition><keywords><keyword>Adolescent</keyword><keyword>Adult</keyword><keyword>Aged</keyword><keyword>Aged, 80 and over</keyword><keyword>Analysis of Variance</keyword><keyword>Child</keyword><keyword>*Cognition</keyword><keyword>Female</keyword><keyword>Humans</keyword><keyword>Male</keyword><keyword>Middle Aged</keyword><keyword>Patient Education as Topic/*methods</keyword><keyword>*Relaxation Therapy</keyword><keyword>*Self Care</keyword><keyword>*Sleep</keyword><keyword>Surveys and Questionnaires</keyword><keyword>Young Adult</keyword></keywords><dates><year>2013</year><pub-dates><date>May</date></pub-dates></dates><isbn>1365-2702 (Electronic)&#xD;0962-1067 (Linking)</isbn><accession-num>23574290</accession-num><work-type>Randomized Controlled Trial&#xD;Research Support, Non-U.S. Gov&apos;t</work-type><urls><related-urls><url>;(53)SH + RLNumber memory52 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nursing</alt-title></titles><pages>1270-80</pages><volume>22</volume><number>9-10</number><edition>2013/04/12</edition><keywords><keyword>Adolescent</keyword><keyword>Adult</keyword><keyword>Aged</keyword><keyword>Aged, 80 and over</keyword><keyword>Analysis of Variance</keyword><keyword>Child</keyword><keyword>*Cognition</keyword><keyword>Female</keyword><keyword>Humans</keyword><keyword>Male</keyword><keyword>Middle Aged</keyword><keyword>Patient Education as Topic/*methods</keyword><keyword>*Relaxation Therapy</keyword><keyword>*Self Care</keyword><keyword>*Sleep</keyword><keyword>Surveys and Questionnaires</keyword><keyword>Young Adult</keyword></keywords><dates><year>2013</year><pub-dates><date>May</date></pub-dates></dates><isbn>1365-2702 (Electronic)&#xD;0962-1067 (Linking)</isbn><accession-num>23574290</accession-num><work-type>Randomized Controlled Trial&#xD;Research Support, Non-U.S. Gov&apos;t</work-type><urls><related-urls><url>;(53)SH + RLPicture memory52 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nursing</alt-title></titles><pages>1270-80</pages><volume>22</volume><number>9-10</number><edition>2013/04/12</edition><keywords><keyword>Adolescent</keyword><keyword>Adult</keyword><keyword>Aged</keyword><keyword>Aged, 80 and over</keyword><keyword>Analysis of Variance</keyword><keyword>Child</keyword><keyword>*Cognition</keyword><keyword>Female</keyword><keyword>Humans</keyword><keyword>Male</keyword><keyword>Middle Aged</keyword><keyword>Patient Education as Topic/*methods</keyword><keyword>*Relaxation Therapy</keyword><keyword>*Self Care</keyword><keyword>*Sleep</keyword><keyword>Surveys and Questionnaires</keyword><keyword>Young Adult</keyword></keywords><dates><year>2013</year><pub-dates><date>May</date></pub-dates></dates><isbn>1365-2702 (Electronic)&#xD;0962-1067 (Linking)</isbn><accession-num>23574290</accession-num><work-type>Randomized Controlled Trial&#xD;Research Support, Non-U.S. Gov&apos;t</work-type><urls><related-urls><url>;(53)SH + RLAssociative memory52 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nursing</alt-title></titles><pages>1270-80</pages><volume>22</volume><number>9-10</number><edition>2013/04/12</edition><keywords><keyword>Adolescent</keyword><keyword>Adult</keyword><keyword>Aged</keyword><keyword>Aged, 80 and over</keyword><keyword>Analysis of Variance</keyword><keyword>Child</keyword><keyword>*Cognition</keyword><keyword>Female</keyword><keyword>Humans</keyword><keyword>Male</keyword><keyword>Middle Aged</keyword><keyword>Patient Education as Topic/*methods</keyword><keyword>*Relaxation Therapy</keyword><keyword>*Self Care</keyword><keyword>*Sleep</keyword><keyword>Surveys and Questionnaires</keyword><keyword>Young Adult</keyword></keywords><dates><year>2013</year><pub-dates><date>May</date></pub-dates></dates><isbn>1365-2702 (Electronic)&#xD;0962-1067 (Linking)</isbn><accession-num>23574290</accession-num><work-type>Randomized Controlled Trial&#xD;Research Support, Non-U.S. Gov&apos;t</work-type><urls><related-urls><url>;(53)SH + RLUnderstanding memory52 weeks3811.413.26376.502.651.65(1.12, 2.18)Wilckens et al.(2016) ADDIN EN.CITE <EndNote><Cite><Author>Wilckens</Author><Year>2016</Year><RecNum>288</RecNum><DisplayText>(54)</DisplayText><record><rec-number>288</rec-number><foreign-keys><key app="EN" db-id="5prwe5sa1sz2speefwr5tx0oxdw9szzxpasr" timestamp="1464904500">288</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Wilckens, K. 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J.</author></authors></contributors><auth-address>a Department of Psychiatry , University of Pittsburgh School of Medicine , USA.</auth-address><titles><title>Changes in Cognitive Performance Are Associated with Changes in Sleep in Older Adults With Insomnia</title><secondary-title>Behav Sleep Med</secondary-title><alt-title>Behavioral sleep medicine</alt-title></titles><periodical><full-title>Behav Sleep Med</full-title><abbr-1>Behavioral sleep medicine</abbr-1></periodical><alt-periodical><full-title>Behav Sleep Med</full-title><abbr-1>Behavioral sleep medicine</abbr-1></alt-periodical><pages>295-310</pages><volume>14</volume><number>3</number><edition>2015/09/01</edition><dates><year>2016</year><pub-dates><date>May-Jun</date></pub-dates></dates><isbn>1540-2010 (Electronic)&#xD;1540-2002 (Linking)</isbn><accession-num>26322904</accession-num><urls><related-urls><url>;(55)BBTIDelayed recall4 weeks3820.46.83919.07.70.19(-0.26, 0.64)Wilckens et al.(2016) ADDIN EN.CITE <EndNote><Cite><Author>Wilckens</Author><Year>2016</Year><RecNum>288</RecNum><DisplayText>(54)</DisplayText><record><rec-number>288</rec-number><foreign-keys><key app="EN" db-id="5prwe5sa1sz2speefwr5tx0oxdw9szzxpasr" timestamp="1464904500">288</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Wilckens, K. 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J.</author></authors></contributors><auth-address>a Department of Psychiatry , University of Pittsburgh School of Medicine , USA.</auth-address><titles><title>Changes in Cognitive Performance Are Associated with Changes in Sleep in Older Adults With Insomnia</title><secondary-title>Behav Sleep Med</secondary-title><alt-title>Behavioral sleep medicine</alt-title></titles><periodical><full-title>Behav Sleep Med</full-title><abbr-1>Behavioral sleep medicine</abbr-1></periodical><alt-periodical><full-title>Behav Sleep Med</full-title><abbr-1>Behavioral sleep medicine</abbr-1></alt-periodical><pages>295-310</pages><volume>14</volume><number>3</number><edition>2015/09/01</edition><dates><year>2016</year><pub-dates><date>May-Jun</date></pub-dates></dates><isbn>1540-2010 (Electronic)&#xD;1540-2002 (Linking)</isbn><accession-num>26322904</accession-num><urls><related-urls><url>;(55)BBTIAbstract reasoning4 weeks3825.86.33927.46.0-0.26(-0.72, 0.19)Wilckens et al.(2016) ADDIN EN.CITE <EndNote><Cite><Author>Wilckens</Author><Year>2016</Year><RecNum>288</RecNum><DisplayText>(54)</DisplayText><record><rec-number>288</rec-number><foreign-keys><key app="EN" db-id="5prwe5sa1sz2speefwr5tx0oxdw9szzxpasr" timestamp="1464904500">288</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Wilckens, K. A.</author><author>Hall, M. H.</author><author>Nebes, R. D.</author><author>Monk, T. H.</author><author>Buysse, D. J.</author></authors></contributors><auth-address>a Department of Psychiatry , University of Pittsburgh School of Medicine , USA.</auth-address><titles><title>Changes in Cognitive Performance Are Associated with Changes in Sleep in Older Adults With Insomnia</title><secondary-title>Behav Sleep Med</secondary-title><alt-title>Behavioral sleep medicine</alt-title></titles><periodical><full-title>Behav Sleep Med</full-title><abbr-1>Behavioral sleep medicine</abbr-1></periodical><alt-periodical><full-title>Behav Sleep Med</full-title><abbr-1>Behavioral sleep medicine</abbr-1></alt-periodical><pages>295-310</pages><volume>14</volume><number>3</number><edition>2015/09/01</edition><dates><year>2016</year><pub-dates><date>May-Jun</date></pub-dates></dates><isbn>1540-2010 (Electronic)&#xD;1540-2002 (Linking)</isbn><accession-num>26322904</accession-num><urls><related-urls><url>;(55)BBTIWorking memory4 weeks3811.12.63910.42.50.27(-0.17, 0.72)Note. ANT-I = attentional networks test – interactions task, BBTI = brief behavioural treatment of insomnia, CBT-I = cognitive behavioural therapy for insomnia, MMSE = mini mental state exam, RL = relaxation, RT = reaction time, SH = sleep hygiene, TONI = test of nonverbal intelligence, UT = uncontrolled trial, WLC = wait list control, WMS-CR = Wechsler memory scale -Chinese revision a = mean values were multiplied by -1 to adjust for differences in the direction of measurement.Table S4: Treatment effect across cognitive domainsArnedt et al., 2007Arnedt et al., 2011Arnedt et al., 2013Casault et al., 2015Davidson et al., 2001Jansson & Linton, 2005Lami et al., 2016Matthews et al., 2014Miro et al., 2011Omvik et al., 2008Quesnel et al., 2003Ritterband et al., 2002Simeit et al., 2004Sun et al., 2013Swanson et al., 2013Taylor et al., 2014Tomfohr-Madsen et al., 2016Wilckens et al., 2016Self-Report cognitive performanceConcentrationxxxxConcentration and memory Trend xAttention, concentration and memory Attention, memory and executive functioningTrend Objectively assessed cognitive performanceSustained attentionxExecutive functioningxMemoryxGeneral cognitive performanceNote. = significant effect of treatment, x = no effect of treatment, Trend = trend for an effect of the treatment ................
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