Cognitive behavioral therapy for insomnia in chronic disease—reply

In Reply: We thank Türkmen et al for their thoughtful and constructive response to our meta-analysis1 and for the opportunity to further discuss the clinical implications of this work.

As Türkmen et al highlighted, our original protocol included plans to examine whether cognitive behavioral therapy for insomnia (CBT-I) was associated with changes in disease-specific outcomes (eg, pain severity, inflammatory markers).1 However, we included a large number of trials and observed substantial heterogeneity in disease-related measures and reporting. As such, any synthesis of disease-related outcomes would necessarily have been qualitative in nature and was beyond the scope of a single article. We agree that understanding the secondary effects of insomnia treatment on disease-specific symptoms is of high clinical relevance, and view this as an important direction for future research and potential secondary analyses.