Pharmacotherapy for sleep disturbances in post-traumatic stress disorder (PTSD): A network meta-analysis.
Sleep Med
; 119: 467-479, 2024 Jul.
Article
in En
| MEDLINE
| ID: mdl-38795401
ABSTRACT
BACKGROUND:
Sleep disturbances are an important symptom dimension of post-traumatic-stress-disorder (PTSD). There is no meta-analytic evidence examining the effects of all types of pharmacotherapy on sleep outcomes among patients with PTSD.METHODS:
Medline/Embase/PsychInfo/CENTRAL/clinicaltrials.gov/ICTRP, reference lists of published reviews and all included studies were searched for Randomised Controlled Trials (RCTs) examining any pharmacotherapy vs. placebo or any other drug among patients with PTSD. PRIMARYOUTCOMES:
total sleep time, nightmares, sleep quality. SECONDARYOUTCOMES:
sleep onset latency, number of nocturnal awakenings, time spent awake following sleep onset, dropouts due to sleep-related adverse-effects, insomnia/somnolence/vivid-dreams as adverse-effects. Pairwise and network meta-analyses were performed.RESULTS:
99 RCTs with 10,481 participants were included. Prazosin may be the most effective treatment for insomnia (SMD = -0.88, 95%CI = [-1.22;-0.54], nightmares (SMD = -0.44, 95%CI = [-0.84;-0.04]) and poor sleep quality (SMD = -0.55, 95%CI = [-1.01;-0.10]). Evidence is scarce and indicates lack of efficacy for SSRIs, Mirtazapine, z-drugs and benzodiazepines, which are widely used in daily practice. Risperidone and Quetiapine carry a high risk of causing somnolence without having a clear therapeutic benefit. Hydroxyzine, Trazodone, Nabilone, Paroxetine and MDMA-assisted psychotherapy may be promising options, but more research is needed.CONCLUSIONS:
Underpowered individual comparisons and very-low to moderate confidence in effect estimates hinder the generalisability of the results. More RCTs, specifically reporting on sleep-related outcomes, are urgently needed.Key words
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Sleep Wake Disorders
/
Stress Disorders, Post-Traumatic
/
Network Meta-Analysis
Limits:
Humans
Language:
En
Journal:
Sleep Med
Journal subject:
NEUROLOGIA
/
PSICOFISIOLOGIA
Year:
2024
Document type:
Article