Sleep-related Attentional and Interpretive Bias In Insomnia: A Systematic Review and Meta-analysis.

DOI: https://doi.org/10.21203/rs.3.rs-1467002/v1

Abstract

Prominent cognitive models of insomnia have emphasized the notion that the disorder is in part maintained by cognitive biases of attention and interpretation for sleep-related “threat” cues which may be internal or external in nature. We present the first systematic review of the sleep-related attention and interpretive bias literature that includes meta-analytic calculations for each respective construct. Literature search identified N=21 attentional bias and N=8 interpretive bias studies that met pre-defined inclusion/exclusion criteria. Seventeen of the twenty-one reviewed attention bias studies compared normal sleeping controls and poor sleepers/insomnia patients. Based on a random effects model, meta-analytic data based on the standardized mean differences of attentional bias studies determined the weighted pooled effect size (17 studies, N=922) to be moderate at .60 (95% CI: 0.26 to 0.93). Furthermore, seven of eight sleep-related interpretive bias studies examined normal sleeping controls and poor sleepers/insomnia patients in sleep-related interpretive bias. Meta-analytic data determined the weighted pooled effect size (7 studies, N=577) to be moderate at .44 (95% CI: 0.19 to 0.69). Based on the outcomes, disorder congruent attentional and interpretive biases appear to be a tentative feature of insomnia. However, despite statistical support for this notion, the absence of longitudinal data limits causal inference concerning the relative role of these biases in the development and maintenance of insomnia. Methodological factors pertaining to the task design, sample population and stimuli are discussed in relation to variation in study outcomes. Finally, we discuss the next steps moving forward to advance the understanding of sleep-related attentional and interpretive bias in insomnia.  

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Declarations

Competing interests: The authors declare no competing interests.