Amir Qaseem, MD, PhD, MHA; Devan Kansagara, MD, MCR; Mary Ann Forciea, MD; Molly Cooke, MD; Thomas D. Denberg, MD, PhD; for the Clinical Guidelines Committee of the American College of Physicians *
Note: Clinical practice guidelines are “guides” only and may not apply to all patients and all clinical situations. Thus, they are not intended to override clinicians' judgment. All ACP clinical practice guidelines are considered automatically withdrawn or invalid 5 years after publication or once an update has been issued.
Disclaimer: The authors of this article are responsible for its contents, including any clinical or treatment recommendations.
Financial Support: Financial support for the development of this guideline comes exclusively from the ACP operating budget.
Disclosures: Dr. Barry reports grants, personal fees, and nonfinancial support from the Informed Medical Decisions Foundation and Healthwise outside the submitted work. Dr. Manaker reports personal fees from work as a grand rounds speaker, lecturer, consultant, and expert witness on documentation, coding, billing, and reimbursement to hospitals, physicians, departments, practice groups, professional societies, insurers, and attorneys; personal fees from work as an expert witness in workers' compensation and medical negligence matters; dividend income from stock held by his spouse in Pfizer and Johnson & Johnson; and meal and travel expenses for serving on the Centers for Medicare & Medicaid Services Hospital Outpatient Panel, the American Medical Association/Specialty Society Relative Value Unit Update Committee, the Board of Regents of the American College of Chest Physicians (ACCP), and the Board of Directors of ACCP Enterprises. Authors not named here have disclosed no conflicts of interest. Disclosures can also be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M15-2175. All financial and intellectual disclosures of interest were declared, and potential conflicts were discussed and managed. Drs. Boyd and Wilt participated in the discussion for this guideline but were each recused from voting on the recommendations because of an active indirect conflict. A record of disclosures and management of conflicts of interest is kept for each Clinical Guidelines Committee meeting and conference call and can be viewed at www.acponline.org/about-acp/who-we-are/leadership/committees-boards-councils/clinical-guidelines-committee/disclosure-of-interests-for-clinical-guidelines-committee.
Editors' Disclosures: Christine Laine, MD, MPH, Editor in Chief, reports that she has no financial relationships or interests to disclose. Darren B. Taichman, MD, PhD, Executive Deputy Editor, reports that he has no financial relationships or interests to disclose. Cynthia D. Mulrow, MD, MSc, Senior Deputy Editor, reports that she has no relationships or interests to disclose. Deborah Cotton, MD, MPH, Deputy Editor, reports that she has no financial relationships or interest to disclose. Jaya K. Rao, MD, MHS, Deputy Editor, reports that she has stock holdings/options in Eli Lilly and Pfizer. Sankey V. Williams, MD, Deputy Editor, reports that he has no financial relationships or interests to disclose. Catharine B. Stack, PhD, MS, Deputy Editor for Statistics, reports that she has stock holdings in Pfizer and Johnson & Johnson.
Requests for Single Reprints: Amir Qaseem, MD, PhD, MHA, American College of Physicians, 190 N. Independence Mall West, Philadelphia, PA 19106; e-mail, email@example.com.
Current Author Addresses: Dr. Qaseem: American College of Physicians, 190 N. Independence Mall West, Philadelphia, PA 19106.
Dr. Kansagara: Portland VA Medical Center, 3805 NE 34th Avenue, Portland, OR 97212.
Dr. Forciea: Penn Health System, 3615 Chestnut Street, Philadelphia, PA 19104.
Dr. Cooke: University of California, San Francisco, 550 16th Street, San Francisco, CA 94158.
Dr. Denberg: Carilion Clinic, PO Box 13727, Roanoke, VA 24036.
Author Contributions: Conception and design: A. Qaseem, D. Kansagara, M. Cooke, R. McLean.
Analysis and interpretation of the data: A. Qaseem, D. Kansagara, M.A. Forciea, M. Cooke, M.J. Barry, R.P. Harris, S. Manaker, R. McLean, S. Vijan.
Drafting of the article: A. Qaseem, D. Kansagara, M. Cooke, T. Denberg, R.D. Chow.
Critical revision of the article for important intellectual content: A. Qaseem, D. Kansagara, M.A. Forciea, M. Cooke, T. Denberg, M.J. Barry, R.D. Chow, R.P. Harris, S. Manaker, R. McLean, S. Vijan.
Final approval of the article: A. Qaseem, D. Kansagara, M.A. Forciea, M. Cooke, T. Denberg, M.J. Barry, R.D. Chow, N. Fitterman, R.P. Harris, L.L. Humphrey, S. Manaker, R. McLean, S. Vijan.
Statistical expertise: A. Qaseem.
Obtaining of funding: A. Qaseem.
Administrative, technical, or logistic support: A. Qaseem.
Collection and assembly of data: A. Qaseem, M. Cooke.
The American College of Physicians (ACP) developed this guideline to present the evidence and provide clinical recommendations on the management of chronic insomnia disorder in adults.
This guideline is based on a systematic review of randomized, controlled trials published in English from 2004 through September 2015. Evaluated outcomes included global outcomes assessed by questionnaires, patient-reported sleep outcomes, and harms. The target audience for this guideline includes all clinicians, and the target patient population includes adults with chronic insomnia disorder. This guideline grades the evidence and recommendations by using the ACP grading system, which is based on the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach.
ACP recommends that all adult patients receive cognitive behavioral therapy for insomnia (CBT-I) as the initial treatment for chronic insomnia disorder. (Grade: strong recommendation, moderate-quality evidence)
ACP recommends that clinicians use a shared decision-making approach, including a discussion of the benefits, harms, and costs of short-term use of medications, to decide whether to add pharmacological therapy in adults with chronic insomnia disorder in whom cognitive behavioral therapy for insomnia (CBT-I) alone was unsuccessful. (Grade: weak recommendation, low-quality evidence)
Qaseem A, Kansagara D, Forciea MA, Cooke M, Denberg TD, for the Clinical Guidelines Committee of the American College of Physicians. Management of Chronic Insomnia Disorder in Adults: A Clinical Practice Guideline From the American College of Physicians. Ann Intern Med. 2016;165:125–133. doi: 10.7326/M15-2175
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Published: Ann Intern Med. 2016;165(2):125-133.
Published at www.annals.org on 3 May 2016
Guidelines, High Value Care, Pulmonary/Critical Care, Sleep Disorders.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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