The effect of non-pharmacological sleep interventions on glycaemic measures in adults with sleep disturbances and behaviours: A systematic review and meta-analysis.

Summary

This systematic review and meta-analysis of 24 studies found that CBT-I and/or sleep hygiene produced significant and clinically meaningful reductions in HbA1c, particularly in type 2 diabetes, while sleep extension studies were fewer and heterogeneous. Findings support integrating sleep assessment and treatment into routine diabetes care.

Key Findings

• Across 24 studies (15 CBT-I/sleep hygiene; 9 sleep extension), CBT-I/sleep hygiene significantly reduced HbA1c, with clinically meaningful effects in T2DM.
• Comprehensive searches (MEDLINE, EMBASE, CINAHL, Cochrane) and PROSPERO registration (CRD42022376606) support methodological transparency.
• Evidence for sleep extension was limited and heterogeneous, suggesting benefit may depend on intervention fidelity and baseline sleep debt.

Clinical Implications

Screen for insomnia and sleep insufficiency in diabetes care and offer CBT-I/sleep hygiene as adjuncts to standard therapy to improve HbA1c. Multidisciplinary collaboration (sleep medicine, behavioral therapy) is recommended.

Limitations

• Heterogeneity across interventions and populations; incomplete reporting of study quality in abstract
• Potential publication bias and short follow-up in several included studies

Future Directions

Large, well-controlled trials comparing CBT-I versus active controls with standardized glycaemic outcomes and actigraphy-verified sleep improvements; implementation studies integrating sleep care into diabetes pathways.