1
|
Imamura K, Akagi KI, Miyanoiri Y, Tsujimoto H, Hirokawa T, Ashida H, Murakami K, Inoue A, Suno R, Ikegami T, Sekiyama N, Iwata S, Kobayashi T, Tochio H. Interaction modes of human orexin 2 receptor with selective and nonselective antagonists studied by NMR spectroscopy. Structure 2024; 32:352-361.e5. [PMID: 38194963 DOI: 10.1016/j.str.2023.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 08/17/2023] [Accepted: 12/13/2023] [Indexed: 01/11/2024]
Abstract
Orexin neuropeptides have many physiological roles in the sleep-wake cycle, feeding behavior, reward demands, and stress responses by activating cognitive receptors, the orexin receptors (OX1R and OX2R), distributed in the brain. There are only subtle differences between OX1R and OX2R in the orthosteric site, which has hindered the rational development of subtype-selective antagonists. In this study, we utilized solution-state NMR to capture the structural plasticity of OX2R labeled with 13CH3-ε-methionine in complex with antagonists. Mutations in the orthosteric site allosterically affected the intracellular tip of TM6. Ligand exchange experiments with the subtype-selective EMPA and the nonselective suvorexant identified three methionine residues that were substantially perturbed. The NMR spectra suggested that the suvorexant-bound state exhibited more structural plasticity than the EMPA-bound state, which has not been foreseen from the close similarity of their crystal structures, providing insights into dynamic features to be considered in understanding the ligand recognition mode.
Collapse
Affiliation(s)
- Kayo Imamura
- Department of Biophysics, Graduate School of Science, Kyoto University, Sakyo-ku, Kyoto 606-8502, Japan
| | - Ken-Ichi Akagi
- Section of Laboratory Equipment, National Institute of Biomedical Innovation, Health, and Nutrition, Osaka 567-0085, Japan
| | - Yohei Miyanoiri
- Institute for Protein Research, Osaka University, 3-2 Yamadaoka, Suita, Osaka 565-0871, Japan
| | - Hirokazu Tsujimoto
- Department of Cell Biology and Medical Chemistry, Graduate School of Medicine, Kyoto University, Kyoto 606-8501, Japan
| | - Takatsugu Hirokawa
- Division of Biomedical Science, Faculty of Medicine, University of Tsukuba, Tsukuba 305-8575, Japan; Transborder Medical Research Center, University of Tsukuba, Tsukuba 305-8575, Japan
| | - Hideo Ashida
- Department of Biophysics, Graduate School of Science, Kyoto University, Sakyo-ku, Kyoto 606-8502, Japan
| | - Kaori Murakami
- Department of Biophysics, Graduate School of Science, Kyoto University, Sakyo-ku, Kyoto 606-8502, Japan
| | - Asuka Inoue
- Graduate School of Pharmaceutical Sciences, Tohoku University, Sendai, Miyagi 980-8578, Japan
| | - Ryoji Suno
- Department of Medical Chemistry, Kansai Medical University, Hirakata 573-1010, Japan
| | - Takahisa Ikegami
- Graduate School of Medical Life Science, Yokohama City University, 1-7-29 Suehiro, Yokohama, Kanagawa 230-0045, Japan
| | - Naotaka Sekiyama
- Department of Biophysics, Graduate School of Science, Kyoto University, Sakyo-ku, Kyoto 606-8502, Japan
| | - So Iwata
- Department of Cell Biology and Medical Chemistry, Graduate School of Medicine, Kyoto University, Kyoto 606-8501, Japan
| | - Takuya Kobayashi
- Department of Medical Chemistry, Kansai Medical University, Hirakata 573-1010, Japan
| | - Hidehito Tochio
- Department of Biophysics, Graduate School of Science, Kyoto University, Sakyo-ku, Kyoto 606-8502, Japan.
| |
Collapse
|
2
|
Zhang X, Zhao S, Wang T, Shu C, Ding L. Development and validation of an LC-MS/MS method for simultaneous determination of EVT201 and its five metabolites in human plasma: Application to a clinical study in Chinese healthy subjects. J Pharm Biomed Anal 2023; 235:115601. [PMID: 37523867 DOI: 10.1016/j.jpba.2023.115601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 07/16/2023] [Accepted: 07/22/2023] [Indexed: 08/02/2023]
Abstract
EVT201 is a partial GABAA receptor agonist, which inhibits nervous system to treat insomnia. EVT201 can form a variety of metabolites in vivo including Ro46-1927, Ro18-5528, Ro40-9970, Ro66-9196 and Ro66-5448. This study developed a simple method to realize the simultaneous determination of EVT201 and its five metabolites by HPLC-MS/MS with an electrospray ion source (ESI). The deuterium substitute of EVT201 was chosen as the internal standard and the multiple reaction monitoring (MRM) was used for the quantification. The separation of the six compounds was accomplished with an ACE Excel 3 AQ column (50 × 2.1 mm, 3 µm, ACE). The process of protein precipitating-transferring-nitrogen blowing-reconstituting was adopted for the sample pretreatment. This method was successfully validated according to the FDA guidance. Calibration curves were linear over the concentration range of 0.100-100 ng/mL for EVT201, 0.0300-30.0 ng/mL for Ro46-1927, 0.0600-6.00 ng/mL for Ro18-5528, 0.0200-4.00 ng/mL for Ro40-9970, 0.100-20.0 ng/mL for Ro66-9196 and 0.100-20.0 ng/mL for Ro66-5448. The intra-run and inter-run precisions and accuracies were all within 14.5%. This fully validated method was successfully applied to a clinical pharmacokinetic study of EVT201 and its five metabolites in Chinese healthy subjects after the single (2.5 mg and 5 mg, N = 12) and multiple dose (2.5 mg, N = 13) administration of EVT201 capsules. The test results of 2.5 mg dose group showed that for EVT201, Ro46-1927, Ro18-5528, Ro40-9970, Ro66-9196 and Ro66-5448, the Cmax values (ng/mL) were 39.2 ± 9.2, 10.3 ± 1.4, 0.218 ± 0.044, 0.128 ± 0.051, 7.01 ± 1.51, 8.73 ± 3.69, respectively; the AUC0-t values (h·ng/mL) were 231 ± 79, 143 ± 72, 10.9 ± 2.1, 1.84 ± 0.78, 55.9 ± 18.7, 135 ± 40 respectively. For EVT201, Ro46-1927, Ro66-5528, Ro66-9196 and Ro40-5448, the results of Cmax and AUC0-t proved that the five compounds showed linear pharmacokinetic profile over the dose ranges of 2.5 mg to 5 mg. Meanwhile, it is the first report to evaluate the pharmacokinetic characteristics of Ro40-9970, Ro66-9196 and Ro66-5448 in human plasma. It provided meaningful parameters for the safety and tolerability evaluation of EVT201 capsules in human.
Collapse
Affiliation(s)
- Xinrui Zhang
- Department of Pharmaceutical Analysis, China Pharmaceutical University, Nanjing, China; Nanjing Clinical Tech. Laboratories Inc., Nanjing, China
| | - Shunbo Zhao
- Nanjing Clinical Tech. Laboratories Inc., Nanjing, China
| | - Tao Wang
- Nanjing Clinical Tech. Laboratories Inc., Nanjing, China
| | - Chang Shu
- Department of Pharmaceutical Analysis, China Pharmaceutical University, Nanjing, China.
| | - Li Ding
- Department of Pharmaceutical Analysis, China Pharmaceutical University, Nanjing, China; Nanjing Clinical Tech. Laboratories Inc., Nanjing, China.
| |
Collapse
|
3
|
Zhao B, Bi Y, Chen Y, Zhang J, Zhang S, Zhang D, Rong P. Altered functional connectivity of the thalamus in patients with insomnia disorder after transcutaneous auricular vagus nerve stimulation therapy. Front Neurol 2023; 14:1164869. [PMID: 37483453 PMCID: PMC10357469 DOI: 10.3389/fneur.2023.1164869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 06/14/2023] [Indexed: 07/25/2023] Open
Abstract
The pathogenesis of insomnia is related to the dysfunction of the thalamus. Transcutaneous auricular vagus nerve stimulation (taVNS) has proved to be effective in treating insomnia. However, whether taVNS alleviates insomnia through modulating thalamus-related functional connectivity remains unclear. To elucidate the instant modulating effects of taVNS on the resting state functional connectivity (RSFC) of the thalamus, 20 patients with insomnia disorder were recruited to receive taVNS treatment and their resting state functional magnetic resonance imaging (fMRI) data were collected immediately before and after stimulation. The fMRI data were compared with 20 age- and gender-matched healthy subjects who received no stimulation and had RSFC fMRI data collected once. RSFC analyses of the thalamus were performed in both groups. In addition to assessing the group differences between ID patients and healthy controls regarding the RSFC of the thalamus, we examined the taVNS-induced changes of RSFC of the thalamus in ID patients. Before taVNS treatment, the ID patients showed increased RSFC of the thalamus with the right insula and inferior frontal gyrus than healthy controls. After taVNS treatment, the RSFC between the thalamus and the right angular gyrus, left anterior cingulate gyrus, and precuneus were significantly decreased in patients. This study provides insights into the instant brain effects involving the thalamus-related functional connectivity of taVNS performed on insomnia disorder patients.
Collapse
Affiliation(s)
- Bin Zhao
- Department of Acupuncture, College of Traditional Chinese Medicine, Southern Medical University, Guangzhou, Guangdong, China
| | - Yanzhi Bi
- Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Yong Chen
- Department of Rheumatology and Immunology, Shenzhen People’s Hospital, The Second Clinical Medical College of Jinan University, Shenzhen, Guangdong, China
| | - Jinling Zhang
- Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing, China
| | - Shuai Zhang
- Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing, China
| | - Dongshu Zhang
- Department of Acupuncture, College of Traditional Chinese Medicine, Southern Medical University, Guangzhou, Guangdong, China
| | - Peijing Rong
- Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing, China
| |
Collapse
|
4
|
Nowakowska-Domagała K, Podlecka M, Stecz P, Lewandowska A, Sipowicz K, Kosmalski M, Pietras T, Mokros Ł. The Relationship between Selected Factors (Temperament, Bipolar Traits, Sleep Quality, Severity of Addiction) and Depressive Symptoms in Alcohol-Dependent Men. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4072. [PMID: 36901082 PMCID: PMC10001749 DOI: 10.3390/ijerph20054072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 02/11/2023] [Accepted: 02/22/2023] [Indexed: 06/18/2023]
Abstract
Clinical and epidemiological studies have demonstrated a relationship between alcohol addiction and mood disorders. Alcohol-dependent patients with depression tend to demonstrate clinically more severe manic symptoms, which complicates the process of diagnosis and therapy. However, the predictors indicating the risk of mood disorders in addicted patients remain unclear. The aim of the study was to examine the relationship between personal dispositions, bipolar traits, depth of addiction, quality of sleep, and depressive symptoms in alcohol-dependent men. The study group comprised 70 men (age M = 46.06, SD = 11.29) diagnosed with alcohol addiction. The participants completed a battery of questionnaires: BDI, HCL-32, PSQI, EPQ-R and MAST. The results were tested using Pearson's correlation quotient and general linear model. The findings indicate that some of the studied patients are likely to have mood disorders of clinically significant severity. High neuroticism and poor sleep quality are independent predictors of depressive symptoms in alcohol-dependent patients. Among the components of sleep quality, problems with falling asleep and waking up at night appear to be most strongly associated with depressive symptoms. The intensity of depressive symptoms may relate to the intensity of certain bipolar features, such as risk-taking activity and irritability. High neuroticism and poor sleep quality are independent predictors of depressive symptoms in the studied group.
Collapse
Affiliation(s)
- Katarzyna Nowakowska-Domagała
- Institute of Psychology, Faculty of Educational Sciences, University of Lodz, Al. Rodzeństwa Scheiblerów 2, 90-128 Lodz, Poland
| | - Marlena Podlecka
- Institute of Psychiatry and Neurology, Department of Neurosis, Personality and Eating Disorders, Sobieskiego Street 9, 02-957 Warsaw, Poland
| | - Patryk Stecz
- Institute of Psychology, Faculty of Educational Sciences, University of Lodz, Al. Rodzeństwa Scheiblerów 2, 90-128 Lodz, Poland
| | - Aleksandra Lewandowska
- J. Babiński Specialist Psychiatric Health Care Team, Psychiatric Ward for Children, Aleksandrowska 159, 02-229 Lodz, Poland
| | - Kasper Sipowicz
- Department of Interdisciplinary Disability Studies, The Maria Grzegorzewska University in Warsaw, Szczęśliwicka 40, 02-353 Warsaw, Poland
| | - Marcin Kosmalski
- Department of Clinical Pharmacology, Medical University of Lodz, Kopcinskiego Street 22, 90-153 Lodz, Poland
| | - Tadeusz Pietras
- Institute of Psychiatry and Neurology, Second Department of Psychiatry, Sobieskiego Street 9, 02-957 Warsaw, Poland
| | - Łukasz Mokros
- Department of Clinical Pharmacology, Medical University of Lodz, Kopcinskiego Street 22, 90-153 Lodz, Poland
| |
Collapse
|
5
|
Abstract
INTRODUCTION Designer benzodiazepines (DBs) are a subclass of novel psychoactive substances (NPS). DBs mimic the properties of approved and prescribed benzodiazepines. AREA COVERED A systematic search of literature on DB classification, structure-activity relationships, pharmacologic properties, and adverse effects. EXPERT OPINION The prevalence of DB use has increased substantially over the last decade. All DBs are full-agonist ligands at the gamma-aminobutyric acid type A-benzodiazepine (GABAA-BZ) receptor system. This is not surprising, since DBs largely represent either minor structural modifications, or well-recognized active metabolites, of existing approved benzodiazepines. As such, the pharmacologic profile and associated risks and hazards of DBs are similar or identical to clinically approved and legitimately prescribed benzodiazepines, most of which have been in use for decades. Concurrent use of DBs along with other abusable or recreational drugs (alcohol, opioids, cocaine, stimulants, hallucinogens, other sedative-hypnotics) represents the principal public health risk. The increasing illicit availability and use of DBs is of concern and requires regulatory attention, but DBs do not rank highly among designer psychotropic agents in terms of health risk to humans.
Collapse
Affiliation(s)
- Xiao Yu
- Program in Pharmacology and Drug Development, Tufts University School of Medicine and Graduate School of Biomedical Sciences, Boston, MA, USA
| | - H Karl Greenblatt
- Program in Pharmacology and Drug Development, Tufts University School of Medicine and Graduate School of Biomedical Sciences, Boston, MA, USA
| | - David J Greenblatt
- Program in Pharmacology and Drug Development, Tufts University School of Medicine and Graduate School of Biomedical Sciences, Boston, MA, USA
| |
Collapse
|
6
|
Mu K, Zhang J, Feng X, Zhang D, Li K, Li R, Yang P, Mao S. Sedative-hypnotic effects of Boropinol-B on mice via activation of GABAA receptors. J Pharm Pharmacol 2023; 75:57-65. [PMID: 36385301 DOI: 10.1093/jpp/rgac077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 09/14/2022] [Indexed: 11/18/2022]
Abstract
OBJECTIVES Boropinol-B is a phenylpropanoid compound originally isolated from Boronia pinnata Sm. (Rutaceae). This study aimed to evaluate the sedative-hypnotic effects of Boropinol-B and explore the underlying mechanisms. METHODS Pentobarbital sodium-induced sleep mouse model and caffeine-induced insomnia mouse model were used to investigate the sedative effects of Boropinol-B. Pharmacokinetics profiles of Boropinol-B in rats were evaluated by high-performance liquid chromatography. The effects of Boropinol-B on the γ-aminobutyric acid (GABA)ergic system were investigated using ELISA assay and patch-clamp technique. Immunohistochemistry and immunofluorescence were carried out to assess the effects of Boropinol-B on sleep-related brain nucleus. KEY FINDINGS Boropinol-B showed significant sedative effects, including reduced sleep latency, increased sleep duration in pentobarbital sodium-treated mice and decreased locomotor activity in insomnia mice. Pharmacokinetics studies demonstrated that Boropinol-B had a rapid onset of action, a short half-life and no accumulation. It increased the GABA level in mice's brain, and promoted chloride ions influx mediated by the γ-aminobutyric acid type A (GABAA) receptors in neurons. Also, it increased the c-Fos positive ratio of GABAergic neurons in ventrolateral preoptic nucleus and decreased c-Fos expression in tuberomammillary nucleus. CONCLUSION Boropinol-B showed significant sedative-hypnotic effects in mice by activating the GABAA receptors and stimulating the sleep-related brain nucleus.
Collapse
Affiliation(s)
- Keman Mu
- Key Laboratory of Drug-Targeting and Drug Delivery System of the Education Ministry and Sichuan Province, Sichuan Engineering Laboratory for Plant-Sourced Drug and Sichuan Research Center for Drug Precision Industrial Technology, West China School of Pharmacy, Sichuan University, Chengdu 610041, China
| | - Jian Zhang
- Key Laboratory of Drug-Targeting and Drug Delivery System of the Education Ministry and Sichuan Province, Sichuan Engineering Laboratory for Plant-Sourced Drug and Sichuan Research Center for Drug Precision Industrial Technology, West China School of Pharmacy, Sichuan University, Chengdu 610041, China
| | - Xinqian Feng
- Key Laboratory of Drug-Targeting and Drug Delivery System of the Education Ministry and Sichuan Province, Sichuan Engineering Laboratory for Plant-Sourced Drug and Sichuan Research Center for Drug Precision Industrial Technology, West China School of Pharmacy, Sichuan University, Chengdu 610041, China
| | - Di Zhang
- Key Laboratory of Drug-Targeting and Drug Delivery System of the Education Ministry and Sichuan Province, Sichuan Engineering Laboratory for Plant-Sourced Drug and Sichuan Research Center for Drug Precision Industrial Technology, West China School of Pharmacy, Sichuan University, Chengdu 610041, China
| | - Kangning Li
- Key Laboratory of Drug-Targeting and Drug Delivery System of the Education Ministry and Sichuan Province, Sichuan Engineering Laboratory for Plant-Sourced Drug and Sichuan Research Center for Drug Precision Industrial Technology, West China School of Pharmacy, Sichuan University, Chengdu 610041, China
| | - Rui Li
- Key Laboratory of Drug-Targeting and Drug Delivery System of the Education Ministry and Sichuan Province, Sichuan Engineering Laboratory for Plant-Sourced Drug and Sichuan Research Center for Drug Precision Industrial Technology, West China School of Pharmacy, Sichuan University, Chengdu 610041, China
| | - Peng Yang
- Key Laboratory of Drug-Targeting and Drug Delivery System of the Education Ministry and Sichuan Province, Sichuan Engineering Laboratory for Plant-Sourced Drug and Sichuan Research Center for Drug Precision Industrial Technology, West China School of Pharmacy, Sichuan University, Chengdu 610041, China
| | - Shengjun Mao
- Key Laboratory of Drug-Targeting and Drug Delivery System of the Education Ministry and Sichuan Province, Sichuan Engineering Laboratory for Plant-Sourced Drug and Sichuan Research Center for Drug Precision Industrial Technology, West China School of Pharmacy, Sichuan University, Chengdu 610041, China
| |
Collapse
|
7
|
Uemura SI, Imanishi A, Terui Y, Park I, Satake M, Han G, Shioya T, Kanbayashi T, Nishino S. Residual effects of low dose of suvorexant, zolpidem, and ramelteon in healthy elderly subjects: A randomized double‐blind study. Neuropsychopharmacol Rep 2022; 42:288-298. [PMID: 35748642 PMCID: PMC9515713 DOI: 10.1002/npr2.12262] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 04/27/2022] [Accepted: 05/01/2022] [Indexed: 11/08/2022] Open
Abstract
Introduction Methods Result Conclusion
Collapse
Affiliation(s)
- Sachiko Ito Uemura
- Department of Physical Therapy Akita University Graduate School of Health Sciences Akita Japan
| | - Aya Imanishi
- Department of Psychiatry Akita University Graduate School of Medicine Akita Japan
| | - Yoshino Terui
- Department of Physical Therapy Akita University Graduate School of Health Sciences Akita Japan
| | - Insung Park
- International Institute for Integrative Sleep Medicine (WPI‐IIIS) University of Tsukuba Tsukuba Japan
| | - Masahiro Satake
- Department of Physical Therapy Akita University Graduate School of Health Sciences Akita Japan
| | - GoEun Han
- International Institute for Integrative Sleep Medicine (WPI‐IIIS) University of Tsukuba Tsukuba Japan
| | | | - Takashi Kanbayashi
- International Institute for Integrative Sleep Medicine (WPI‐IIIS) University of Tsukuba Tsukuba Japan
- Ibaraki Prefectural Medical Center of Psychiatry Kasama Japan
| | - Seiji Nishino
- Sleep & Circadian Neurobiology Laboratory, Stanford Sleep Research Center Stanford University School of Medicine Palo Alto California USA
| |
Collapse
|
8
|
Inoue E, Suzuki T, Nakayama T, Yoshimura T, Sudo K, Shimizu Y, Iwaki Y, Kawasaki H, Ishida N. Novel hypnotics of Japanese traditional herbal medicines to caffeine-induced insomnia in Drosophila by using Newly-developed automated sleep and rhythm analysis system (AutoCircaS). Gene 2022; 846:146852. [PMID: 36058496 DOI: 10.1016/j.gene.2022.146852] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 08/16/2022] [Accepted: 08/26/2022] [Indexed: 11/16/2022]
Abstract
Sleep in Drosophila was defined in the year 2000 by using Drosophila Activity Monitor (DAM) system. But DAM is very small tube space and one fly per tube is very limited to analyze for fly social behavior. To overcome such demerits of DAM system, we developed a novel automated sleep and rhythm analysis system (AutoCircaS) which monitors and records any behaviors like social mating, sleep, and circadian rhythm in flies (Drosophila) and small fishes medaka (Oryzias latipes) in free space using the time-lapse (one frame per 10 sec) imaging. AutoCircaS can detect the caffeine-induced insomnia in flies in light-dark (LD) and constant dark (DD) conditions. Thus, using the AutoCircaS, we discovered that Japanese traditional herbal medicines, KyushinKannouGan-ki (KKG), NouKassei (NK) as well as, and Sansoninto, significantly improved caffeine-induced insomnia in flies. The data suggest that AutoCircaS is useful for sleep analysis of small animals and screening of new sedative-hypnotics from many origins.
Collapse
Affiliation(s)
- Eiji Inoue
- Tokyo Research Center, Kyushin Pharmaceutical Co, Ltd., Suginami, Tokyo, Japan; Institute for Chronobiology, Foundation for Advancement of International Science (FAIS), Tsukuba, Ibaraki, Japan.
| | - Takahiro Suzuki
- Institute for Chronobiology, Foundation for Advancement of International Science (FAIS), Tsukuba, Ibaraki, Japan; SHIGRAY Inc, Tsuchiura, Ibaraki, Japan.
| | - Tomoya Nakayama
- Laboratory of Animal Integrative Physiology, Graduate School of Bioagricultural Sciences, Nagoya University, Nagoya, Aichi, Japan; Institute of Transformative Bio-Molecules (WPI-ITbM), Nagoya University, Nagoya, Aichi, Japan.
| | - Takashi Yoshimura
- Laboratory of Animal Integrative Physiology, Graduate School of Bioagricultural Sciences, Nagoya University, Nagoya, Aichi, Japan; Institute of Transformative Bio-Molecules (WPI-ITbM), Nagoya University, Nagoya, Aichi, Japan.
| | - Keiichi Sudo
- Tokyo Research Center, Kyushin Pharmaceutical Co, Ltd., Suginami, Tokyo, Japan.
| | - Yasuharu Shimizu
- Tokyo Research Center, Kyushin Pharmaceutical Co, Ltd., Suginami, Tokyo, Japan.
| | | | - Haruhisa Kawasaki
- Institute for Chronobiology, Foundation for Advancement of International Science (FAIS), Tsukuba, Ibaraki, Japan.
| | - Norio Ishida
- Institute for Chronobiology, Foundation for Advancement of International Science (FAIS), Tsukuba, Ibaraki, Japan.
| |
Collapse
|
9
|
Riemann D, Benz F, Dressle RJ, Espie CA, Johann AF, Blanken TF, Leerssen J, Wassing R, Henry AL, Kyle SD, Spiegelhalder K, Van Someren EJW. Insomnia disorder: State of the science and challenges for the future. J Sleep Res 2022; 31:e13604. [PMID: 35460140 DOI: 10.1111/jsr.13604] [Citation(s) in RCA: 71] [Impact Index Per Article: 35.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Revised: 03/23/2022] [Accepted: 03/23/2022] [Indexed: 12/25/2022]
Abstract
Insomnia disorder comprises symptoms during night and day that strongly affect quality of life and wellbeing. Prolonged sleep latency, difficulties to maintain sleep and early morning wakening characterize sleep complaints, whereas fatigue, reduced attention, impaired cognitive functioning, irritability, anxiety and low mood are key daytime impairments. Insomnia disorder is well acknowledged in all relevant diagnostic systems: Diagnostic and Statistical Manual of the American Psychiatric Association, 5th revision, International Classification of Sleep Disorders, 3rd version, and International Classification of Diseases, 11th revision. Insomnia disorder as a chronic condition is frequent (up to 10% of the adult population, with a preponderance of females), and signifies an important and independent risk factor for physical and, especially, mental health. Insomnia disorder diagnosis primarily rests on self-report. Objective measures like actigraphy or polysomnography are not (yet) part of the routine diagnostic canon, but play an important role in research. Disease concepts of insomnia range from cognitive-behavioural models to (epi-) genetics and psychoneurobiological approaches. The latter is derived from knowledge about basic sleep-wake regulation and encompass theories like rapid eye movement sleep instability/restless rapid eye movement sleep. Cognitive-behavioural models of insomnia led to the conceptualization of cognitive-behavioural therapy for insomnia, which is now considered as first-line treatment for insomnia worldwide. Future research strategies will include the combination of experimental paradigms with neuroimaging and may benefit from more attention to dysfunctional overnight alleviation of distress in insomnia. With respect to therapy, cognitive-behavioural therapy for insomnia merits widespread implementation, and digital cognitive-behavioural therapy may assist delivery along treatment guidelines. However, given the still considerable proportion of patients responding insufficiently to cognitive-behavioural therapy for insomnia, fundamental studies are highly necessary to better understand the brain and behavioural mechanisms underlying insomnia. Mediators and moderators of treatment response/non-response and the associated development of tailored and novel interventions also require investigation. Recent studies suggest that treatment of insomnia may prove to add significantly as a preventive strategy to combat the global burden of mental disorders.
Collapse
Affiliation(s)
- Dieter Riemann
- Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, Freiburg, Germany.,Center for Basics in NeuroModulation (NeuroModulBasics), Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Fee Benz
- Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, Freiburg, Germany
| | - Raphael J Dressle
- Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, Freiburg, Germany
| | - Colin A Espie
- Sir Jules Thorn Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK.,Big Health Ltd, London, UK.,Big Health Ltd, San Francisco, California, USA
| | - Anna F Johann
- Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, Freiburg, Germany.,Institute of Medical Psychology and Medical Sociology, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Tessa F Blanken
- Department of Psychological Methods, University of Amsterdam, Amsterdam, The Netherlands
| | - Jeanne Leerssen
- Department of Sleep and Cognition, Netherlands Institute for Neuroscience, Royal Netherlands Academy of Arts and Sciences, Amsterdam, The Netherlands
| | - Rick Wassing
- Centre for Integrated Research and Understanding of Sleep (CIRUS), Woolcock Institute of Medical Research, The Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Alasdair L Henry
- Sir Jules Thorn Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK.,Big Health Ltd, London, UK.,Big Health Ltd, San Francisco, California, USA
| | - Simon D Kyle
- Sir Jules Thorn Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Kai Spiegelhalder
- Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, Freiburg, Germany
| | - Eus J W Van Someren
- Department of Sleep and Cognition, Netherlands Institute for Neuroscience, Royal Netherlands Academy of Arts and Sciences, Amsterdam, The Netherlands
| |
Collapse
|
10
|
Dasdelen MF, Er S, Kaplan B, Celik S, Beker MC, Orhan C, Tuzcu M, Sahin N, Mamedova H, Sylla S, Komorowski J, Ojalvo SP, Sahin K, Kilic E. A Novel Theanine Complex, Mg-L-Theanine Improves Sleep Quality via Regulating Brain Electrochemical Activity. Front Nutr 2022; 9:874254. [PMID: 35449538 PMCID: PMC9017334 DOI: 10.3389/fnut.2022.874254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 03/07/2022] [Indexed: 11/26/2022] Open
Abstract
L-Theanine is commonly used to improve sleep quality through inhibitory neurotransmitters. On the other hand, Mg2+, a natural NMDA antagonist and GABA agonist, has a critical role in sleep regulation. Using the caffeine-induced brain electrical activity model, here we investigated the potency of L-theanine and two novel Mg-L-theanine compounds with different magnesium concentrations on electrocorticography (ECoG) patterns, GABAergic and serotonergic receptor expressions, dopamine, serotonin, and melatonin levels. Furthermore, we evaluated the sleep latency and duration in the pentobarbital induced sleep model. We herein showed that L-theanine, particularly its various complexes with magnesium increases the expression of GABAergic, serotonergic, and glutamatergic receptors, which were associated with decreased ECoG frequency, increased amplitude, and enhanced delta wave powers. Besides increased dopamine, serotonin, and melatonin; decreased MDA and increased antioxidant enzyme levels were also observed particularly with Mg-complexes. Protein expression analyses also showed that Mg-L-theanine complexes decrease inducible nitric oxide synthase (iNOS) and endothelial nitric oxide synthase (eNOS) levels significantly. In accordance with these results, Mg complexes improved the sleep latency and duration even after caffeine administration. As a result, our data indicate that Mg-L-theanine compounds potentiate the effect of L-theanine on sleep by boosting slow-brain waves, regulating brain electrical activity, and increasing neurotransmitter and GABA receptor levels.
Collapse
Affiliation(s)
| | - Sezgin Er
- International School of Medicine, Istanbul Medipol University, Istanbul, Turkey
| | - Berkan Kaplan
- Department of Neurology, Istanbul Medipol University, Istanbul, Turkey
| | - Suleyman Celik
- International School of Medicine, Istanbul Medipol University, Istanbul, Turkey
| | - Mustafa Caglar Beker
- Department of Physiology, School of Medicine, Istanbul Medipol University, Istanbul, Turkey
| | - Cemal Orhan
- Department of Animal Nutrition, Faculty of Veterinary Medicine, Firat University, Elazig, Turkey
| | - Mehmet Tuzcu
- Department of Animal Nutrition, Faculty of Veterinary Medicine, Firat University, Elazig, Turkey
| | - Nurhan Sahin
- Department of Animal Nutrition, Faculty of Veterinary Medicine, Firat University, Elazig, Turkey
| | - Havakhanum Mamedova
- Department of Physiology, School of Medicine, Istanbul Medipol University, Istanbul, Turkey
| | - Sarah Sylla
- Scientific and Regulatory Affairs, Nutrition21, LLC, Purchase, NY, United States
| | - James Komorowski
- Scientific and Regulatory Affairs, Nutrition21, LLC, Purchase, NY, United States
| | - Sara Perez Ojalvo
- Scientific and Regulatory Affairs, Nutrition21, LLC, Purchase, NY, United States
| | - Kazim Sahin
- Department of Animal Nutrition, Faculty of Veterinary Medicine, Firat University, Elazig, Turkey
| | - Ertugrul Kilic
- Department of Physiology, School of Medicine, Istanbul Medipol University, Istanbul, Turkey,*Correspondence: Ertugrul Kilic, ;
| |
Collapse
|
11
|
Berger AA, Sottosanti ER, Winnick A, Keefe J, Gilbert E, Hasoon J, Thase ME, Kaye AD, Viswanath O, Urits I. Suvorexant in the Treatment of Difficulty Falling and Staying Asleep (Insomnia). PSYCHOPHARMACOLOGY BULLETIN 2022; 52:68-90. [PMID: 35342199 PMCID: PMC8896749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 02/27/2023]
Abstract
Purpose of Review Insomnia affects more than 10% of the population and causes significant discomfort and disability. Suvorexant is an orexin receptor antagonist that specifically targets the wake-sleep cycle. This review summarizes recent and seminal evidence in the biological and physiological evidence of insomnia, the mechanism of action of suvorexant in treating insomnia, and clinical evidence regarding its use. Recent Findings There is no single clear diagnosis for insomnia, and thus prevalence is not entirely clear, but it is estimated to affect 10%-30% of the adult population. Comorbidities include obesity, diabetes, and various psychiatric conditions, and insomnia likely has a contributing role in these conditions. Insomnia, by definition, impacts sleep quality and also wakefulness, including academic success and work efficiency. Insomnia is likely related to genetic susceptibility and a triggering event, leading to hyper-arousal states and functional brain disturbances. This leads to hyperactivity of the hypothalamic-pituitary-adrenal axis, over-secretion of corticotropin-releasing factor, and aberrancy in neurotransmitter release. Though several pharmacological options exist for the treatment of insomnia, there is equivocal data regarding their efficacy or limits to their use due to side effects and contraindications. Suvorexant is a novel dual orexin receptor antagonist, which is shown to improve sleep by reducing arousals. Unlike classical therapeutics, suvorexant does not alter the sleep profile; it prolongs the time spent in each sleep state. Though it may cause some somnolence, it is milder than reported with other drugs. Summary Multiple clinical studies support the use of suvorexant in insomnia. In primary insomnia, suvorexant is effective (over placebo), as measured by polysomnography and reported by patients, in both attaining and maintaining sleep. Similar, albeit to a smaller degree, results were found in secondary insomnia. Suvorexant carries two significant advantages over existing therapies; it has a much better safety profile in approved doses, and it preserves natural sleep architecture, thus promoting more restful sleep and recovery. Unfortunately, data exists mostly for suvorexant versus placebo, and head-to-head trials with common hypnotics are needed to assess the true efficacy of suvorexant over the alternatives. And while tolerance is less likely to develop, close monitoring of post-marketing data is required to evaluate for long term adverse events and efficacy.
Collapse
|
12
|
Sharma R, Parikh M, Mishra V, Zuniga A, Sahota P, Thakkar M. Sleep, sleep homeostasis and arousal disturbances in alcoholism. Brain Res Bull 2022; 182:30-43. [PMID: 35122900 DOI: 10.1016/j.brainresbull.2022.01.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 01/12/2022] [Accepted: 01/29/2022] [Indexed: 12/11/2022]
Abstract
The effects of alcohol on human sleep were first described almost 70 years ago. Since then, accumulating evidences suggest that alcohol intake at bed time immediately induces sleep [reduces the time to fall asleep (sleep onset latency), and consolidates and enhances the quality (delta power) and the quantity of sleep]. Such potent sleep promoting activity makes alcohol as one of the most commonly used "over the counter" sleep aid. However, the somnogenic effects, after alcohol intake, slowly wane off and often followed by sleep disruptions during the rest of the night. Repeated use of alcohol leads to the development of rapid tolerance resulting into an alcohol abuse. Moreover, chronic and excessive alcohol intake leads to the development of alcohol use disorder (AUD). Alcoholics, both during drinking periods and during abstinences, suffer from a multitude of sleep disruptions manifested by profound insomnia, excessive daytime sleepiness, and altered sleep architecture. Furthermore, subjective and objective indicators of sleep disturbances are predictors of relapse. Finally, within the USA, it is estimated that societal costs of alcohol-related sleep disorders exceed $18 billion. Thus, although alcohol associated sleep problems have significant economic and clinical consequences, very little is known about how and where alcohol acts to affect sleep. In this review, a conceptual framework and clinical research focused on understanding the relationship between alcohol and sleep is first described. In the next section, our new and exciting preclinical studies, to understand the cellular and molecular mechanism of how acute and chronic alcohol affects sleep, are described. In the end, based on observations from our recent findings and related literature, opportunities for the development of innovative strategies to prevent and treat AUD are proposed.
Collapse
Affiliation(s)
- Rishi Sharma
- Harry S. Truman Memorial Veterans Hospital and Department of Neurology, University of Missouri, Columbia MO 65201
| | - Meet Parikh
- Harry S. Truman Memorial Veterans Hospital and Department of Neurology, University of Missouri, Columbia MO 65201
| | - Vaibhav Mishra
- Harry S. Truman Memorial Veterans Hospital and Department of Neurology, University of Missouri, Columbia MO 65201
| | - Abigail Zuniga
- Harry S. Truman Memorial Veterans Hospital and Department of Neurology, University of Missouri, Columbia MO 65201
| | - Pradeep Sahota
- Harry S. Truman Memorial Veterans Hospital and Department of Neurology, University of Missouri, Columbia MO 65201
| | - Mahesh Thakkar
- Harry S. Truman Memorial Veterans Hospital and Department of Neurology, University of Missouri, Columbia MO 65201.
| |
Collapse
|
13
|
At the intersection of sleep deficiency and opioid use: mechanisms and therapeutic opportunities. Transl Res 2021; 234:58-73. [PMID: 33711513 PMCID: PMC8217216 DOI: 10.1016/j.trsl.2021.03.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 02/17/2021] [Accepted: 03/06/2021] [Indexed: 12/18/2022]
Abstract
Due to the ongoing opioid epidemic, innovative scientific perspectives and approaches are urgently needed to reduce the unprecedented personal and societal burdens of nonmedical and recreational opioid use. One promising opportunity is to focus on the relationship between sleep deficiency and opioid use. In this review, we examine empirical evidence: (1) at the interface of sleep deficiency and opioid use, including hypothesized bidirectional associations between sleep efficiency and opioid abstinence; (2) as to whether normalization of sleep deficiency might directly or indirectly improve opioid abstinence (and vice versa); and (3) regarding mechanisms that could link improvements in sleep to opioid abstinence. Based on available data, we identify candidate sleep-restorative therapeutic approaches that should be examined in rigorous clinical trials.
Collapse
|
14
|
Effects of Bedtime Dosing With Suvorexant and Zolpidem on Balance and Psychomotor Performance in Healthy Elderly Participants During the Night and in the Morning. J Clin Psychopharmacol 2021; 41:414-420. [PMID: 34181362 DOI: 10.1097/jcp.0000000000001439] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE/BACKGROUND This study was designed as an early assessment of the safety of the orexin receptor antagonist suvorexant, but also included exploratory assessments of balance and psychomotor performance that are the focus of this report. METHODS/PROCEDURES This was a double-blind, randomized, 3-period, crossover, phase 1 study. Balance and psychomotor performance were evaluated during the night in 12 healthy elderly participants after bedtime administration of suvorexant 30 mg (a supratherapeutic dose), the GABAergic agonist zolpidem 5 mg (the recommended dose in the elderly), or placebo. Balance (body sway measured by platform stability) and psychomotor performance (measured by choice reaction time) were assessed predose and at 1.5, 4, and 8 hours postdose in each period. Memory (measured by word recall) was assessed predose and at 4 hours postdose. FINDINGS/RESULTS At 1.5 hours after nighttime administration of each drug (the approximate time of their anticipated maximal plasma concentrations), both zolpidem and suvorexant increased body sway versus placebo, with a greater increase for zolpidem than suvorexant. Suvorexant increased choice reaction time compared with placebo or zolpidem at 1.5 hours. There were no treatment differences on body sway or choice reaction time at 4 or 8 hours, or on word recall at 4 hours. IMPLICATIONS/CONCLUSIONS These exploratory data suggest that a 30-mg dose of suvorexant (supratherapeutic) and a 5-mg dose of zolpidem (recommended dose in the elderly) impaired balance at 1.5 hours in healthy elderly people, with potentially less impairment for suvorexant relative to zolpidem, but no treatment differences on body sway or psychomotor performance at 4 and 8 hours. Because of their exploratory nature, these findings and their clinical relevance, if any, require confirmation in a prospective study.
Collapse
|
15
|
Matsumoto T. Suvorexant improves intractable nocturnal enuresis by altering sleep architecture. BMJ Case Rep 2021; 14:14/3/e239621. [PMID: 33727289 PMCID: PMC7970267 DOI: 10.1136/bcr-2020-239621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Little is known about sleep-based approaches to the treatment of nocturnal enuresis (NE). This report is the first to describe the successful use of suvorexant, an orexin receptor antagonist, in a 12-year-old boy with intractable NE. With suvorexant, the frequency of NE gradually decreased from 14 of 14 days (100%) to 5 of 14 days (35.7%). Sleep polysomnography indicated that rapid eye movement (REM) sleep increased from 101.5 min (19.9%) before suvorexant to 122.1 min (24.9%) with suvorexant. Furthermore, N2 increased from 233 min (45.6%) to 287.5 min (58.7%) during non-REM sleep. In contrast, N3 decreased from 160 min (31.3%) to 65 min (13.3%) during non-REM sleep. Suvorexant appeared to lighten the depth of sleep and alter sleep architecture. Although the application of an insomnia medication for treating NE seems paradoxical, suvorexant reduced the frequency of NE in patients with severe intractable NE. Thus, this treatment strategy warrants further examination.
Collapse
|
16
|
Celikkayalar E, Airaksinen M, Kivelä SL, Nieminen J, Kleme J, Puustinen J. Are Older People Aware of Potential Risks Related to Benzodiazepines They are Taking and Has Anything Changed in Risk Awareness Over Ten Years? Patient Prefer Adherence 2021; 15:141-147. [PMID: 33536750 PMCID: PMC7850572 DOI: 10.2147/ppa.s280503] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 12/09/2020] [Indexed: 01/10/2023] Open
Abstract
PURPOSE The use of benzodiazepines and related drugs (BZD) is common among older adults although there is growing evidence of their harmful effects. This study investigated how well older people are aware of the potential risks related to the BZD they are taking and whether the risk awareness has changed in the years between 2004 and 2015. PATIENTS AND METHODS The data were collected by interviewing BZD using home-dwelling patients aged ≥65 years with normal cognitive function (MMSE ≥20) who were admitted to the hospital within a 1 month study period in the years 2004 and 2015. Patients were asked whether they were aware of the ten main potential risks related to BZD use. A risk awareness score (range 0-10) was assessed for each patient, each known potential risk yielding one point. RESULTS The study included 37 patients in 2004 and 31 patients in 2015. In 2004, 6/37 patients (16%), while 16/31 patients (52%) in 2015 had risk awareness scores between 6 and 10. Awareness of dependence (p=0.047), interaction with alcohol (p=0.001), dizziness (p=0.002) and developing tolerance (p=0.002) had improved, while awareness of the other potential risks remained unchanged, muscle weakness being the least known (3/37 in 2004 and 4/31 in 2015 were aware of it as a potential risk). Regular BZD use had declined (p=0.043) but pro re nata (PRN; when required) BZD use had increased (p=0.003) between the years 2004 and 2015. CONCLUSION Older BZD users' awareness of some potential risks related to BZD use (dependence, interaction with alcohol, dizziness and developing tolerance) had improved between 2004 and 2015, while awareness of other potential risks remained unchanged.
Collapse
Affiliation(s)
- Ercan Celikkayalar
- Clinical Pharmacy Group, Division of Pharmacology and Pharmacotherapy, Faculty of Pharmacy, University of Helsinki, Helsinki, Finland
- Correspondence: Ercan Celikkayalar Email
| | - Marja Airaksinen
- Clinical Pharmacy Group, Division of Pharmacology and Pharmacotherapy, Faculty of Pharmacy, University of Helsinki, Helsinki, Finland
| | - Sirkka-Liisa Kivelä
- Clinical Pharmacy Group, Division of Pharmacology and Pharmacotherapy, Faculty of Pharmacy, University of Helsinki, Helsinki, Finland
- Unit of Family Medicine, Department of Clinical Medicine, Faculty of Medicine, University of Turku, Turku, Finland
| | - Jenni Nieminen
- Clinical Pharmacy Group, Division of Pharmacology and Pharmacotherapy, Faculty of Pharmacy, University of Helsinki, Helsinki, Finland
| | - Jenni Kleme
- Clinical Pharmacy Group, Division of Pharmacology and Pharmacotherapy, Faculty of Pharmacy, University of Helsinki, Helsinki, Finland
| | - Juha Puustinen
- Clinical Pharmacy Group, Division of Pharmacology and Pharmacotherapy, Faculty of Pharmacy, University of Helsinki, Helsinki, Finland
- Social Security Center of Pori, Pori, Finland
- Unit of Neurology, Satasairaala Central Hospital, Pori, Finland
| |
Collapse
|
17
|
Ivgy-May N, Hajak G, van Osta G, Braat S, Chang Q, Roth T. Efficacy and safety of esmirtazapine in adult outpatients with chronic primary insomnia: a randomized, double-blind placebo-controlled study and open-label extension. J Clin Sleep Med 2020; 16:1455-1467. [PMID: 32351205 DOI: 10.5664/jcsm.8526] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES Esmirtazapine (1.5-4.5 mg) has demonstrated short-term sleep-promoting effects in nonelderly outpatients with chronic insomnia. This phase 3, randomized, double-blind study (NCT00631657) and its open-label extension (NCT00750919) investigated efficacy and safety of long-term esmirtazapine treatment in adult outpatients with chronic insomnia. METHODS Participants were randomized to receive esmirtazapine 4.5 mg or placebo for 6 months; those receiving esmirtazapine were then rerandomized to esmirtazapine or placebo for an additional 7 days. Participants could enter the 6-month open-label extension with esmirtazapine 4.5 mg. The primary objective of the double-blind study was to assess long-term efficacy of esmirtazapine vs placebo on self-reported total sleep time. Assessing long-term safety and tolerability were secondary and primary objectives of the double-blind and extension studies, respectively. RESULTS Overall, 457 participants received treatment in the double-blind study (esmirtazapine, n = 342; placebo, n = 115) and 184 participants (prior esmirtazapine, n = 136; prior placebo, n = 48) received esmirtazapine in the extension. In the double-blind study, a 48.7-minute increase in average nightly total sleep time was observed for esmirtazapine vs placebo (95% confidence interval, 35.0-62.5; P < .0001) at months 4-6. There was no evidence of residual effects on next-day alertness or daytime functioning and no evidence of rebound insomnia or withdrawal symptoms upon treatment discontinuation. Esmirtazapine was generally well tolerated; somnolence and weight gain were the most common adverse events. CONCLUSIONS Esmirtazapine improved sleep duration vs placebo over at least 6 months. There was no evidence of next-day residual effects or of withdrawal symptoms or rebound insomnia following abrupt treatment discontinuation. CLINICAL TRIAL REGISTRATION Registry: ClinicalTrials.gov; Name: A 6-Month Efficacy and Safety Study of Org 50081 in Adult Patients With Chronic Primary Insomnia (21106/P05701/MK-8265-002); URL: https://clinicaltrials.gov/ct2/show/NCT00631657; Identifier: NCT00631657; and Registry: ClinicalTrials.gov; Name: Twenty-Six Week Extension Trial of Org 50081 (Esmirtazapine) in Outpatients With Chronic Primary Insomnia (176003/P05721/MK-8265-007); URL: https://clinicaltrials.gov/ct2/show/NCT00750919); Identifier: NCT00750919.
Collapse
Affiliation(s)
| | - Goeran Hajak
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, Social Foundation Bamberg, Bamberg, Germany
| | | | | | - Qing Chang
- Merck & Co., Inc., Kenilworth, New Jersey
| | | |
Collapse
|
18
|
Kishi T, Nomura I, Matsuda Y, Sakuma K, Okuya M, Ikuta T, Iwata N. Lemborexant vs suvorexant for insomnia: A systematic review and network meta-analysis. J Psychiatr Res 2020; 128:68-74. [PMID: 32531478 DOI: 10.1016/j.jpsychires.2020.05.025] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 05/14/2020] [Accepted: 05/25/2020] [Indexed: 10/24/2022]
Abstract
We conducted a random-effects model network meta-analysis to examine differences between lemborexant and suvorexant in efficacy and safety outcomes for treating patients with insomnia. We searched Embase, MEDLINE, and CENTRAL from their inception until April/28/2020. Primary outcomes were subjective time to sleep onset (sTSO), subjective total sleep time (sTST), and subjective wake-after-sleep onset (sWASO) at week 1. Four double-blind, randomized controlled trials were identified (n = 3237; 72.4% female; mean age 58.0 years). The treatment arm consisted of lemborexant 10 mg/d (LEM10, n = 592), lemborexant 5 mg/d (LEM5, n = 589), suvorexant 20/15 mg/d (SUV20/15, n = 493), zolpidem tartrate extended release 6.25 mg/d (ZOL6.25, n = 263), and placebo (n = 1300). All active treatments outperformed placebo regarding sTSO at week 1; standardized mean differences (95% credible interval): LEM10 = -0.51 (-0.63, -0.39), LEM5 = -0.48 (-0.60, -0.36), SUV20/15 = -0.21 (-0.33, -0.10), and ZOL6.25 = -0.30 (-0.46, -0.14); sTST at week 1: LEM10 = -0.58 (-0.70, -0.45), LEM5 = -0.33 (-0.46, -0.21), SUV20/15 = -0.34 (-0.46, -0.23), and ZOL6.25 = -0.42 (-0.59, -0.25); and sWASO at week 1: LEM10 = -0.42 (-0.57, -0.28), LEM5 = -0.26 (-0.40, -0.11), SUV20/15 = -0.18 (-0.32, -0.05), and ZOL6.25 = -0.37 (-0.56, -0.18). Although no significant differences were found in discontinuation due to adverse events between each active drug and placebo, LEM10 and SUV20/15 were associated with greater somnolence compared with placebo. LEM10 had the largest effect size compared with placebo for all primary outcomes, although with a risk of somnolence.
Collapse
Affiliation(s)
- Taro Kishi
- Department of Psychiatry, Fujita Health University School of Medicine, Toyoake, Aichi, 470-1192, Japan.
| | - Ikuo Nomura
- Department of Psychiatry, The Moriyama General Mental Hospital, Nagoya, Aichi, 463-8570, Japan
| | - Yuki Matsuda
- Department of Psychiatry, Jikei University School of Medicine, Minato-ku, Tokyo, 105-8461, Japan
| | - Kenji Sakuma
- Department of Psychiatry, Fujita Health University School of Medicine, Toyoake, Aichi, 470-1192, Japan
| | - Makoto Okuya
- Department of Psychiatry, Fujita Health University School of Medicine, Toyoake, Aichi, 470-1192, Japan
| | - Toshikazu Ikuta
- Department of Communication Sciences and Disorders, School of Applied Sciences, University of Mississippi, University, MS, 38677, USA
| | - Nakao Iwata
- Department of Psychiatry, Fujita Health University School of Medicine, Toyoake, Aichi, 470-1192, Japan
| |
Collapse
|
19
|
Abstract
After participating in this activity, learners should be better able to:• Assess the misuse potential of clonazepam• Characterize the nonmedical use of clonazepam• Identify the health problems associated with long-term use of clonazepam ABSTRACT: Clonazepam, a benzodiazepine, is commonly used in treating various conditions, including anxiety disorders and epileptic seizures. Due to its low price and easy availability, however, it has become a commonly misused medication, both in medical and recreational contexts. In this review, we aim to highlight the behavioral and pharmacological aspects of clonazepam and its history following its approval for human use. We examine the circumstances commonly associated with the nonmedical use of clonazepam and raise points of particular concern. Clonazepam, alone or in combination with other psychoactive substances, can lead to unwanted effects on health, such as motor and cognitive impairment, sleep disorders, and aggravation of mood and anxiety disorders. Prolonged use of clonazepam may lead to physical dependence and tolerance. There is therefore a need to find safer therapeutic alternatives for treating seizures and anxiety disorders. Greater awareness of its frequent nonmedical use is also needed to achieve safer overall use of this medication.
Collapse
|
20
|
Kalmbach DA, Cheng P, O'Brien LM, Swanson LM, Sangha R, Sen S, Guille C, Cuamatzi-Castelan A, Henry AL, Roth T, Drake CL. A randomized controlled trial of digital cognitive behavioral therapy for insomnia in pregnant women. Sleep Med 2020; 72:82-92. [PMID: 32559716 DOI: 10.1016/j.sleep.2020.03.016] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 02/18/2020] [Accepted: 03/12/2020] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Despite high rates of prenatal insomnia, efficacious treatment options for this population are quite limited. Early evidence from randomized controlled trials (RCTs) support the efficacy of face-to-face cognitive-behavioral therapy for insomnia (CBTI) for prenatal insomnia. Yet, as many patients are unable to access this specialist-driven care, a critical need exists to increase its accessibility. This RCT examined the efficacy internet-based digital CBTI in pregnant women with insomnia. METHODS Single-site RCT. A total of 91 pregnant women (29.03 ± 4.16 years) nearing/entering the third trimester who screened positive for clinical insomnia on the Insomnia Severity Index (ISI) were randomized to digital CBTI or digital sleep education control. The ISI, Pittsburgh Sleep Quality Index (PSQI), Edinburgh Postnatal Depression Scale (EPDS), and Pre-Sleep Arousal Scale's Cognitive factor (PSAS-C) served as study outcomes, which were collected before treatment and after treatment during pregnancy, then six weeks after childbirth. RESULTS From pre to posttreatment, CBTI patients reported reductions in ISI (-4.91 points, p < 0.001) and PSQI (-2.98 points, p < 0.001) and increases in nightly sleep duration by 32 min (p = 0.008). Sleep symptoms did not change during pregnancy in the control group. After childbirth, CBTI patients, relative to controls, slept longer by 40 min per night (p = 0.01) and reported better sleep maintenance. No pre or postnatal treatment effects on depression or cognitive arousal were observed. CONCLUSIONS Digital CBTI improves sleep quality and sleep duration during pregnancy and after childbirth. To better optimize outcomes, CBTI should be tailored to meet the changing needs of women as the progress through pregnancy and early parenting. NAME: Insomnia and Rumination in Late Pregnancy and the Risk for Postpartum Depression. URL: clinicaltrials.gov. Registration: NCT03596879.
Collapse
Affiliation(s)
- David A Kalmbach
- Thomas Roth Sleep Disorders & Research Center, Henry Ford Health System, Detroit, MI, USA.
| | - Philip Cheng
- Thomas Roth Sleep Disorders & Research Center, Henry Ford Health System, Detroit, MI, USA
| | - Louise M O'Brien
- Departments of Obstetrics & Gynecology and Neurology, University of Michigan, Ann Arbor, MI, USA
| | - Leslie M Swanson
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Roopina Sangha
- Department of Obstetrics & Gynecology, Henry Ford Health System, Detroit, MI, USA
| | - Srijan Sen
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Constance Guille
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | | | - Alasdair L Henry
- Big Health Inc, San Francisco, CA, USA; Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Thomas Roth
- Thomas Roth Sleep Disorders & Research Center, Henry Ford Health System, Detroit, MI, USA
| | - Christopher L Drake
- Thomas Roth Sleep Disorders & Research Center, Henry Ford Health System, Detroit, MI, USA
| |
Collapse
|
21
|
Zhao B, Bi Y, Li L, Zhang J, Hong Y, Zhang L, He J, Fang J, Rong P. The Instant Spontaneous Neuronal Activity Modulation of Transcutaneous Auricular Vagus Nerve Stimulation on Patients With Primary Insomnia. Front Neurosci 2020; 14:205. [PMID: 32231517 PMCID: PMC7082749 DOI: 10.3389/fnins.2020.00205] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Accepted: 02/24/2020] [Indexed: 01/19/2023] Open
Abstract
Primary insomnia (PI) is associated with increased spontaneous neuronal activity. Transcutaneous auricular vagus nerve stimulation (taVNS) modulates brain function, and it is an effective treatment for primary insomnia. However, whether taVNS alleviates insomnia through modulating spontaneous neuronal activity is not fully clarified. This study aims to investigate the instant effect of taVNS in modulating spontaneous neuronal activity in PI patients using resting-state functional magnetic resonance imaging (rs-fMRI). Twenty-two PI subjects underwent rs-fMRI scanning prior and immediately after 30 min treatment of taVNS controlled by twenty healthy adults. Amplitude of low frequency fluctuations (ALFF) analysis was employed to assess the difference in spontaneous neuronal activity between PI patients and healthy adults, as well as between pre-treatment and post-treatment of taVNS. The taVNS-induced altered ALFF brain areas were then selected as regions of interest to perform the resting state functional connectivity (RSFC) analysis in PI patients. The right precuneus showed significantly increased ALFF in PI patients. After immediate taVNS treatment, the ALFF was significantly decreased in the right precuneus and increased in the left middle occipital gyrus. The RSFC in right precuneus with right angular, right superior frontal gyrus, and right middle frontal gyrus was significantly decreased. This study provides insights into the instant brain effects of taVNS on PI patients.
Collapse
Affiliation(s)
- Bin Zhao
- Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing, China
| | - Yanzhi Bi
- CAS Key Laboratory of Mental Health, Institute of Psychology, Beijing, China.,Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Liang Li
- Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing, China
| | - Jinling Zhang
- Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing, China
| | - Yang Hong
- Department of Radiology, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Lei Zhang
- Department of Radiology, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Jiakai He
- Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing, China
| | - Jiliang Fang
- Department of Radiology, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Peijing Rong
- Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing, China
| |
Collapse
|
22
|
Abstract
Sleep management is essential to effective treatment of pain symptoms. Identification of the precise nature of sleep complaint, awareness of patient's age and co-morbid conditions and choice of the hypnotic medication class can help guide treatment approach. In addition to benzodiazepine and non-benzodiazepine medications acting at the GABA receptor, novel approaches, including orexin receptor agonists, may be safer and more promising pharmacologic approaches. Pharmacologic interventions, when used cautiously for a limited period of time and in complement with behavioral and cognitive approaches, can serve to improve sleep quality and significantly help in management of pain.
Collapse
Affiliation(s)
- Lina Fine
- Swedish Sleep Medicine, 550 17 Avenue, Seattle, WA 98122, USA.
| |
Collapse
|
23
|
Geoffroy PA, Lejoyeux M, Rolland B. Management of insomnia in alcohol use disorder. Expert Opin Pharmacother 2020; 21:297-306. [DOI: 10.1080/14656566.2019.1705279] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Pierre A. Geoffroy
- Département de psychiatrie et d’addictologie, AP-HP, Hopital Bichat - Claude Bernard, Paris, France
- NeuroDiderot, Inserm, Université de Paris, Paris, France
| | - Michel Lejoyeux
- Département de psychiatrie et d’addictologie, AP-HP, Hopital Bichat - Claude Bernard, Paris, France
- Department of Epidemiology, Paris Hospital Group - Psychiatry & Neurosciences, Paris, France
| | - Benjamin Rolland
- Pôle MOPHA, CH Le Vinatier, Service Universitaire d’Addictologie de Lyon (SUAL), Bron, France
| |
Collapse
|
24
|
Abrahao KP, Pava MJ, Lovinger DM. Dose-dependent alcohol effects on electroencephalogram: Sedation/anesthesia is qualitatively distinct from sleep. Neuropharmacology 2019; 164:107913. [PMID: 31843396 DOI: 10.1016/j.neuropharm.2019.107913] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Revised: 11/27/2019] [Accepted: 12/13/2019] [Indexed: 02/07/2023]
Abstract
Alcohol is commonly used as a sleep inducer/aid by humans. However, individuals diagnosed with alcohol use disorders have sleep problems. Few studies have examined the effect of ethanol on physiological features of sedation and anesthesia, particularly at high doses. This study used polysomnography and a rapid, unbiased scoring of vigilance states with an automated algorithm to provide a thorough characterization of dose-dependent acute ethanol effects on sleep and electroencephalogram (EEG) power spectra in C57BL/6J male mice. Ethanol had a narrow dose-response effect on sleep. Only a high dose (4.0 g/kg) produced a unique, transient state that could not be characterized in terms of canonical sleep-wake states, so we dubbed this novel state Drug-Induced State with a Characteristic Oscillation in the Theta Band (DISCO-T). After this anesthetic effect, the high dose of alcohol promoted NREM sleep by increasing the duration of NREM bouts while reducing wake. REM sleep was differentially responsive to the circadian timing of ethanol administration. EEG power spectra proved more sensitive to ethanol than sleep measures as there were clear effects of ethanol at 2.0 and 4.0 g/kg doses. Ethanol promoted delta oscillations and suppressed faster frequencies, but there were clear, differential effects on wake and REM EEG power based on the timing of the ethanol injection. Understanding the neural basis of the extreme soporific effects of high dose ethanol may aid in treating acute toxicity brought about by patterns of excessive binge consumption commonly observed in young people.
Collapse
Affiliation(s)
- Karina P Abrahao
- Laboratory for Integrative Neuroscience, Division of Intramural Clinical and Biological Research, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, MD, USA.
| | - Matthew J Pava
- Laboratory for Integrative Neuroscience, Division of Intramural Clinical and Biological Research, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, MD, USA.
| | - David M Lovinger
- Laboratory for Integrative Neuroscience, Division of Intramural Clinical and Biological Research, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, MD, USA.
| |
Collapse
|
25
|
Gamble MC, Katsuki F, McCoy JG, Strecker RE, McKenna JT. The dual orexinergic receptor antagonist DORA-22 improves the sleep disruption and memory impairment produced by a rodent insomnia model. Sleep 2019; 43:5583907. [PMID: 31595304 DOI: 10.1093/sleep/zsz241] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 09/06/2019] [Indexed: 12/16/2022] Open
Abstract
AbstractInsomnia-related sleep disruption can contribute to impaired learning and memory. Treatment of insomnia should ideally improve the sleep profile while minimally affecting mnemonic function, yet many hypnotic drugs (e.g. benzodiazepines) are known to impair memory. Here, we used a rat model of insomnia to determine whether the novel hypnotic drug DORA-22, a dual orexin receptor antagonist, improves mild stress-induced insomnia with minimal effect on memory. Animals were first trained to remember the location of a hidden platform (acquisition) in the Morris Water Maze and then administered DORA-22 (10, 30, or 100 mg/kg doses) or vehicle control. Animals were then subjected to a rodent insomnia model involving two exposures to dirty cages over a 6-hr time period (at time points 0 and 3 hr), followed immediately by a probe trial in which memory of the water maze platform location was evaluated. DORA-22 treatment improved the insomnia-related sleep disruption—wake was attenuated and NREM sleep was normalized. REM sleep amounts were enhanced compared with vehicle treatment for one dose (30 mg/kg). In the first hour of insomnia model exposure, DORA-22 promoted the number and average duration of NREM sleep spindles, which have been previously proposed to play a role in memory consolidation (all doses). Water maze measures revealed probe trial performance improvement for select doses of DORA-22, including increased time spent in the platform quadrant (10 and 30 mg/kg) and time spent in platform location and number of platform crossings (10 mg/kg only). In conclusion, DORA-22 treatment improved insomnia-related sleep disruption and memory consolidation deficits.
Collapse
Affiliation(s)
- Mackenzie C Gamble
- Boston VA Research Institute, Inc., Jamaica Plain, MA
- VA Boston Healthcare System, West Roxbury, MA
| | - Fumi Katsuki
- Boston VA Research Institute, Inc., Jamaica Plain, MA
- VA Boston Healthcare System, West Roxbury, MA
- Department of Psychiatry, Harvard Medical School, West Roxbury, MA
| | - John G McCoy
- Boston VA Research Institute, Inc., Jamaica Plain, MA
- VA Boston Healthcare System, West Roxbury, MA
- Neuroscience Program, Stonehill College, Easton, MA
| | - Robert E Strecker
- Boston VA Research Institute, Inc., Jamaica Plain, MA
- VA Boston Healthcare System, West Roxbury, MA
- Department of Psychiatry, Harvard Medical School, West Roxbury, MA
| | - James Timothy McKenna
- Boston VA Research Institute, Inc., Jamaica Plain, MA
- VA Boston Healthcare System, West Roxbury, MA
- Department of Psychiatry, Harvard Medical School, West Roxbury, MA
| |
Collapse
|
26
|
Abstract
BACKGROUND In 2013 the Food and Drug Administration (FDA) claimed the existence of new data showing women to be at risk for excessive daytime sedation and impaired driving proficiency following bedtime doses of zolpidem. The putative explanation was the reduced metabolic clearance of zolpidem and higher morning blood concentrations in women compared to men. The FDA acted to reduce the recommended dosage for women down to 50% of the dose for men. No other regulatory agency worldwide has taken similar action. METHODS Gender effects on zolpidem pharmacokinetics, pharmacodynamics, adverse effects, clinical efficacy, and driving performance were evaluated through a further analysis of data from a previous study, together with a literature review. RESULTS Women had on average 35% lower apparent clearance of zolpidem than men (236 vs 364 mL/min, P < 0.001). This difference was not explained by body weight. In some laboratory studies, women had greater functional impairment than men taking the same dose, but in all studies active drug was not distinguishable from placebo at 8 hours after oral dosage. On-the-road driving studies likewise showed no evidence of driving impairment in men or women at 8 hours after 10 mg of oral immediate-release zolpidem. No clinical trial demonstrated a gender-related difference in clinical efficacy or adverse reactions, and there was no evidence of a particular risk to women. CONCLUSIONS Dosage reduction in women is not supported by available scientific evidence, and may in fact lead to underdosing and the consequent hazard of inadequately treated insomnia.
Collapse
|
27
|
Liu J, Cai W, Zhao M, Cai W, Sui F, Hou W, Wang H, Yu D, Yuan K. Reduced resting-state functional connectivity and sleep impairment in abstinent male alcohol-dependent patients. Hum Brain Mapp 2019; 40:4941-4951. [PMID: 31379038 PMCID: PMC6865575 DOI: 10.1002/hbm.24749] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 07/21/2019] [Accepted: 07/24/2019] [Indexed: 01/17/2023] Open
Abstract
Alcohol dependence is associated with poor sleep quality, which has both been implicated with thalamocortical circuits function. To identify the possible roles of these circuits in the alcohol-sleep association, we investigated the volume of both left and right thalamus and corresponding resting-state functional connectivity (RSFC) differences between 15 alcohol-dependent patients (AD) and 15 healthy controls (HC) male participants. The neuroimaging findings were then correlated with clinical variables, that is, Alcohol Use Disorders Identification Test (AUDIT) and Pittsburgh Sleep Quality Index (PSQI). Additionally, mediation analysis was carried out to test whether the thalamocortical RSFC mediates the relationship between drinking behavior and sleep impairments in AD when applicable. We observed a significant positive correlation between AUDIT score and PSQI score in AD. Compared with HC, AD showed reduced RSFC between the left thalamus and medial prefrontal cortex (mPFC), orbitofrontal cortex, anterior cingulate cortex (ACC), and right caudate. We also observed a negative correlation between RSFC of the left thalamus-mPFC and PSQI score in AD. More importantly, the left thalamus-mPFC RSFC strength mediated the relationship between AUDIT score and PSQI score in AD. No significant difference was detected in the normalized volume of both left and right thalamus, and volumes were not significantly correlated with clinical variables. Our results demonstrate that AD show abnormal interactions within thalamocortical circuits in association with drinking behaviors and sleep impairments. It is hoped that our study focusing on thalamocortical circuits could provide new information on potential novel therapeutic targets for treatment of sleep impairment in alcohol-dependent patients.
Collapse
Affiliation(s)
- Jingjing Liu
- School of Life Science and Technology, Xidian University, Xi'an, Shaanxi, People's Republic of China.,Engineering Research Center of Molecular and Neuro Imaging Ministry of Education, Xi'an, People's Republic of China
| | - Wanye Cai
- School of Life Science and Technology, Xidian University, Xi'an, Shaanxi, People's Republic of China.,Engineering Research Center of Molecular and Neuro Imaging Ministry of Education, Xi'an, People's Republic of China
| | - Meng Zhao
- School of Life Science and Technology, Xidian University, Xi'an, Shaanxi, People's Republic of China.,Engineering Research Center of Molecular and Neuro Imaging Ministry of Education, Xi'an, People's Republic of China
| | - Wenlong Cai
- Xilinguole Meng Mongolian General Hospital, Xilinhaote, Inner Mongolian, People's Republic of China
| | - Feng Sui
- Xilinguole Meng Mongolian General Hospital, Xilinhaote, Inner Mongolian, People's Republic of China
| | - Wenbao Hou
- Xilinguole Meng Mongolian General Hospital, Xilinhaote, Inner Mongolian, People's Republic of China
| | - Hongde Wang
- Xilinguole Meng Mongolian General Hospital, Xilinhaote, Inner Mongolian, People's Republic of China
| | - Dahua Yu
- Inner Mongolia Key Laboratory of Pattern Recognition and Intelligent Image Processing, School of Information Engineering, Inner Mongolia University of Science and Technology, Baotou, Inner Mongolia, People's Republic of China
| | - Kai Yuan
- School of Life Science and Technology, Xidian University, Xi'an, Shaanxi, People's Republic of China.,Engineering Research Center of Molecular and Neuro Imaging Ministry of Education, Xi'an, People's Republic of China.,Inner Mongolia Key Laboratory of Pattern Recognition and Intelligent Image Processing, School of Information Engineering, Inner Mongolia University of Science and Technology, Baotou, Inner Mongolia, People's Republic of China.,Guangxi Key Laboratory of Multi-Source Information Mining and Security, Guangxi Normal University, Guilin, People's Republic of China
| |
Collapse
|
28
|
Uchimura N, Nakatome K, Miyata K, Uchiyama M. Effect of ramelteon coadministered with antidepressant in patients with insomnia and major depressive disorder: an exploratory study. Sleep Biol Rhythms 2019. [DOI: 10.1007/s41105-019-00230-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
29
|
Kishi T, Sakuma K, Okuya M, Ninomiya K, Oya K, Kubo M, Matsui Y, Nomura I, Okuyama Y, Matsunaga S, Iwata N. Suvorexant for insomnia in patients with psychiatric disorder: A 1-week, open-label study. Neuropsychopharmacol Rep 2019; 39:252-255. [PMID: 31283862 PMCID: PMC7292311 DOI: 10.1002/npr2.12069] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Revised: 06/24/2019] [Accepted: 06/24/2019] [Indexed: 11/26/2022] Open
Abstract
Aim There have been no previous reports on the efficacy and safety of suvorexant for insomnia in people with psychiatric disorders. Methods This one‐week, prospective, single‐arm, clinical trial of fixed dose of suvorexant (20 mg if ages 18–64 or 15 mg if age ≥ 65 years) for insomnia included 57 patients with psychiatric disorders who had experienced any of the following insomnia symptoms for four or more nights during the week prior to the start of the study: total sleep time (TST) <6 hours, time to sleep onset (TSO) ≥30 minutes, or two or more episodes of wake after sleep onset. Results The mean age of the patients was 49.4 ± 17.3 years; 54.4% were women, 49.1% had a major depressive disorder, and 77.2% completed the trial. Compared with the baseline scores (the mean scores for the two days before the start of the study), taking suvorexant was associated with significant improvements in TST, TSO, wake time after sleep onset, and the patients' sleep satisfaction level at week 1. Adverse events included at least one adverse event (43.9%), sleepiness (28.8%), fatigue (11.5%), nightmares (5.8%), headache (3.8%), dizziness (3.8%), and vomiting (1.9%). Conclusion Suvorexant was beneficial for the treatment of insomnia in people with psychiatric disorders. However, this study was of short duration and included only a relatively small number of patients. A larger, long‐term study is needed to investigate the efficacy and safety of suvorexant for insomnia in people with psychiatric disorders. This is one‐week, prospective, single‐arm, clinical trial of fixed dose of suvorexant for insomnia included 57 patients with psychiatric disorders. Compared with the baseline scores, taking suvorexant was associated with significant improvements in total sleep time, time to sleep onset, wake time after sleep onset, and the patients' sleep satisfaction level at week 1.![]()
Collapse
Affiliation(s)
- Taro Kishi
- Department of Psychiatry, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
| | - Kenji Sakuma
- Department of Psychiatry, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
| | - Makoto Okuya
- Department of Psychiatry, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
| | - Kohei Ninomiya
- Department of Psychiatry, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
| | - Kazuto Oya
- Department of Psychiatry, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
| | - Momoko Kubo
- Department of Psychiatry, Fujita Health University School of Medicine, Toyoake, Aichi, Japan.,Department of Psychiatry, The Okehazama Hospital, Toyoake, Aichi, Japan
| | - Yuki Matsui
- Department of Psychiatry, Fujita Health University School of Medicine, Toyoake, Aichi, Japan.,Department of Psychiatry, The Jindai Hospital, Toyota, Aichi, Japan
| | - Ikuo Nomura
- Department of Psychiatry, Fujita Health University School of Medicine, Toyoake, Aichi, Japan.,Department of Psychiatry, The Moriyama General Mental Hospital, Nagoya, Aichi, Japan
| | - Yuji Okuyama
- Department of Psychiatry, Fujita Health University School of Medicine, Toyoake, Aichi, Japan.,Department of Psychiatry, The Moriyama General Mental Hospital, Nagoya, Aichi, Japan
| | - Shinji Matsunaga
- Department of Psychiatry, Fujita Health University School of Medicine, Toyoake, Aichi, Japan.,Department of Geriatrics and Cognitive Disorders, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
| | - Nakao Iwata
- Department of Psychiatry, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
| |
Collapse
|
30
|
Robertson I, Cheung A, Fan X. Insomnia in patients with schizophrenia: current understanding and treatment options. Prog Neuropsychopharmacol Biol Psychiatry 2019; 92:235-242. [PMID: 30707986 DOI: 10.1016/j.pnpbp.2019.01.016] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2018] [Revised: 01/11/2019] [Accepted: 01/28/2019] [Indexed: 12/21/2022]
Abstract
In patients with schizophrenia, insomnia is a common yet often overlooked comorbidity. With sleep disturbances inextricably linked to increased severity of schizophrenia and worsening clinical outcomes, insomnia is an important therapeutic target within this patient population. Thus, through a review of the current literature, this paper reiterates the important etiological link between these two conditions, while evaluating the safety, efficacy, and limitations of current therapeutic options for the treatment of comorbid insomnia in schizophrenia. Despite the continued use of benzodiazepine receptor agonists (BZRAs) for insomnia, the use of other therapies such as Cognitive Behavioral Therapy for Insomnia (CBT-I) and suvorexant warrants increased consideration. More large-scale clinical trials are needed to assess the efficacy of such therapeutic options in the schizophrenia patient population.
Collapse
Affiliation(s)
- Ian Robertson
- Uniformed Services, University of the Health Sciences, School of Medicine, Bethesda, MD, USA
| | - Amy Cheung
- University of Massachusetts, Medical School/UMass Memorial Medical Center, Worcester, MA, USA
| | - Xiaoduo Fan
- University of Massachusetts, Medical School/UMass Memorial Medical Center, Worcester, MA, USA.
| |
Collapse
|
31
|
Sake F, Wong K, Bartlett DJ, Saini B. Benzodiazepine usage and patient preference for alternative therapies: A descriptive study. Health Sci Rep 2019; 2:e116. [PMID: 31139756 PMCID: PMC6529930 DOI: 10.1002/hsr2.116] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 01/26/2019] [Accepted: 01/28/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND AND AIMS The prevalence of chronic benzodiazepine use in primary care settings remains high despite clear evidence of adverse health outcomes resulting from long-term use and the availability of effective alternative behavioural therapies. Eliciting factors influencing past or current usage experience of benzodiazepine users and their future behavioural intention regarding discontinuation or alternative behavioural therapy adoption could be useful in developing informed strategies facilitating successful benzodiazepine withdrawal in long-term users. The aim of this study was to identify patient factors influencing their current long-term benzodiazepine use, past withdrawal attempt, and future intention to trial safer alternative behavioural therapies. Additionally, the study also aimed to explore patients' preference for information sources on behavioural therapies. METHODS Point of purchase surveys were conducted with patients obtaining benzodiazepines from selected pharmacies across New South Wales (NSW), Australia. Survey items included the Beliefs about Medicines Questionnaire (BMQ-specific), questions about patient's sociodemographic characteristics, as well as their views about long-term benzodiazepine use and behavioural therapies. RESULTS Seventy-five patients were recruited from 12 pharmacies across New South Wales (NSW). The surveys were conducted from November 2016 to July 2017. The mean (±SD) age of the participants was 54.3 (±16.7) with a range of 23 to 86 years, and 67% of the participants had been using the benzodiazepine for at least 1 year. Lower-education levels, stronger beliefs about the necessity of use, and lower concerns about ongoing benzodiazepine use were significantly associated with prolonged use. Sixty-four percent of the participants were not interested in behavioural therapies, and there was a significant relationship between the participants' future preference for behavioural therapies and their concerns about the potential adverse effects of benzodiazepines. A majority of the participants rated general practitioners (GPs) as their first choice and pharmacists as the second choice for discussing behavioural therapies. CONCLUSIONS Specific individual sociodemographic characteristics of benzodiazepine users and their medication-related beliefs influence their current benzodiazepine usage and future intention to trial behavioural therapies as an alternative to their benzodiazepines. Based on the reported preferences of benzodiazepine users in this study, developing and evaluating GP-pharmacist collaborative services to improve the uptake of behavioural therapies as an alternative to benzodiazepines can be recommended.
Collapse
Affiliation(s)
- Fatema‐Tun‐Naher Sake
- The School of Pharmacy, Faculty of Medicine and HealthUniversity of SydneySydneyAustralia
| | - Keith Wong
- Faculty of Medicine and HealthThe University of SydneySydneyAustralia
- Woolcock Institute of Medical ResearchThe University of SydneySydneyAustralia
- Department of Respiratory and Sleep MedicineRoyal Prince Alfred HospitalCamperdownAustralia
| | - Delwyn J. Bartlett
- Faculty of Medicine and HealthThe University of SydneySydneyAustralia
- Woolcock Institute of Medical ResearchThe University of SydneySydneyAustralia
| | - Bandana Saini
- The School of Pharmacy, Faculty of Medicine and HealthUniversity of SydneySydneyAustralia
- Woolcock Institute of Medical ResearchThe University of SydneySydneyAustralia
| |
Collapse
|
32
|
Effects of suvorexant on the Insomnia Severity Index in patients with insomnia: analysis of pooled phase 3 data. Sleep Med 2019; 56:219-223. [DOI: 10.1016/j.sleep.2018.09.010] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Revised: 07/24/2018] [Accepted: 09/05/2018] [Indexed: 11/20/2022]
|
33
|
Rong P, Luo M, Li L, Zhang J, Guo X, Zhao B, Li S, Yang Y, Liu S, Wang Y, Li S, Jiao Y, Zhao Y. Sleep electroencephalography power spectral response to transcutaneous auricular vagus nerve stimulation on insomnia rats. HEART AND MIND 2019. [DOI: 10.4103/hm.hm_51_19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
|
34
|
Sake FTN, Wong K, Bartlett DJ, Saini B. Benzodiazepine use risk: Understanding patient specific risk perceptions and medication beliefs. Res Social Adm Pharm 2018; 15:1317-1325. [PMID: 30639048 DOI: 10.1016/j.sapharm.2018.12.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Revised: 12/11/2018] [Accepted: 12/19/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND Benzodiazepines are widely prescribed psychotropic medications. These medications have the potential to cause alertness impairing effects and their prolonged use is associated with serious adverse effects. Despite the listed adverse health outcomes and provision of warnings, many benzodiazepine users tend to ignore the safety information and use them inappropriately. OBJECTIVE To elicit the risk perceptions of benzodiazepine users and explore the association of risk perceptions with their socio-demographic factors or medication use profiles (e.g. past withdrawal attempt, length of use and future willingness to try behavioural alternatives). METHODS Point of purchase surveys were conducted with patients who were supplied benzodiazepines from selected pharmacies across New South Wales (NSW), Australia. Survey items included questions about patient's demographic characteristics, their past attempt for withdrawing benzodiazepines and their future intention to consider alternative behavioural therapies. The validated Beliefs about Medications Questionnaire (BMQ-specific) and a customised scale assessing risk perception were included in the survey. Data obtained from the surveys were entered into the IBM SPSS package (Version 22.0) and subjected to descriptive, correlational and regression analyses. RESULTS Seventy-five patients (67% female, a mean age of 54.3) obtaining benzodiazepines from 12 pharmacies were recruited for the survey. Participant's beliefs regarding potential side effects of benzodiazepines and their level of education were significantly associated with their risk perception scores. While the overall risk perception scores did not influence patient's previous attempts to withdraw benzodiazepines, the risk perception score about immediate effects of benzodiazepines (within 3-4 h of consumption) was a predictor of preference for behavioural therapies. Eighty-three percent (n = 62) of the participants believed that pharmacists can play a key role in improving risk perceptions of consumers around benzodiazepine use. CONCLUSIONS Individual patient characteristics and their beliefs about medications significantly influence their perception of risk about benzodiazepine use. The findings of this study suggest that pharmacist support can be utilized in effective risk communication, promoting the safe use of benzodiazepines and in facilitating the uptake of relevant behavioural interventions as alternatives to benzodiazepines.
Collapse
Affiliation(s)
| | - Keith Wong
- Faculty of Medicine and Health, The University of Sydney, NSW, Australia; Woolcock Institute of Medical Research, The University of Sydney, NSW, Australia; Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, NSW, Australia
| | - Delwyn J Bartlett
- Faculty of Medicine and Health, The University of Sydney, NSW, Australia; Woolcock Institute of Medical Research, The University of Sydney, NSW, Australia
| | - Bandana Saini
- Faculty of Medicine and Health, The University of Sydney, NSW, Australia; Woolcock Institute of Medical Research, The University of Sydney, NSW, Australia
| |
Collapse
|
35
|
Chen B, Zhang G, Liu C, Chen Q, Zhang M, Li J, Zhou P, Fu W, Zhu M. Effectiveness and safety of warm needle acupuncture on insomnia: Protocol for a systematic review and meta-analysis. Medicine (Baltimore) 2018; 97:e13598. [PMID: 30572465 PMCID: PMC6319996 DOI: 10.1097/md.0000000000013598] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Accepted: 11/17/2018] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Warm needle acupuncture (WNA) combines acupuncture and moxibustion, which is an integral part of the acupuncture therapy. Insomnia is a common sleep disorder, which affects sub-healthy people and patients with chronic disease. The clinical practice indicates that WNA has a therapeutic effect on insomnia. Here we will provide a protocol to explore the effectiveness and safety of WNA for insomnia. METHODS We will search the randomized controlled trails (RCT) literatures of WNA for insomnia in 9 electronic databases, including 5 English databases [PubMed, Web of Science, EMBASE, the Cochrane Central Register of Controlled Trials (Cochrane Library), and WHO International Clinical Trials Registry Platform (TCTRP)] and 4 Chinese databases [Chinese National Knowledge Infrastructure (CNKI), Chinese VIP Information, Wanfang Database, and Chinese Biomedical Literature Database (CBM)]. Sleep quality value of the patient will be considered as the primary outcome and the secondary outcome will include biochemical, indicators total scores on the insomnia severity index, quality of life, adverse events caused by WNA, and changes of symptom in Traditional Chinese Medicine. The selection of the studies will be performed by EndnoteX7 software. All analyses will be conducted by using RevMan software V5.3. RESULT This study will provide a rational synthesis of current evidences for warm needle acupuncture on insomnia. CONCLUSION The conclusion of this study will provide evidence to judge the effectiveness and safety of WNA on insomnia. REGISTRATION PROS-PERO CRD42018112645.
Collapse
Affiliation(s)
- Baishu Chen
- Baoan Hospital of Traditional Chinese Medicine in Shenzhen, Shenzhen
| | - GangYu Zhang
- Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Cuiling Liu
- Baoan Hospital of Traditional Chinese Medicine in Shenzhen, Shenzhen
| | - QianYing Chen
- Guangzhou University of Chinese Medicine, Guangzhou, China
| | - MingJia Zhang
- Guangzhou University of Chinese Medicine, Guangzhou, China
| | - JianHao Li
- Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Peng Zhou
- Baoan Hospital of Traditional Chinese Medicine in Shenzhen, Shenzhen
| | - Wei Fu
- Baoan Hospital of Traditional Chinese Medicine in Shenzhen, Shenzhen
| | - Meiling Zhu
- Baoan Hospital of Traditional Chinese Medicine in Shenzhen, Shenzhen
| |
Collapse
|
36
|
Kalmbach DA, Anderson JR, Drake CL. The impact of stress on sleep: Pathogenic sleep reactivity as a vulnerability to insomnia and circadian disorders. J Sleep Res 2018; 27:e12710. [PMID: 29797753 PMCID: PMC7045300 DOI: 10.1111/jsr.12710] [Citation(s) in RCA: 235] [Impact Index Per Article: 39.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Revised: 04/12/2018] [Accepted: 04/13/2018] [Indexed: 12/19/2022]
Abstract
Sleep reactivity is the trait-like degree to which stress exposure disrupts sleep, resulting in difficulty falling and staying asleep. Individuals with highly reactive sleep systems experience drastic deterioration of sleep when stressed, whereas those with low sleep reactivity proceed largely unperturbed during stress. Research shows that genetics, familial history of insomnia, female gender and environmental stress influence how the sleep system responds to stress. Further work has identified neurobiological underpinnings for sleep reactivity involving disrupted cortical networks and dysregulation in the autonomic nervous system and hypothalamic-pituitary-adrenal axis. Sleep reactivity is most pathologically and clinically pertinent when in excess, such that high sleep reactivity predicts risk for future insomnia disorder, with early evidence suggesting high sleep reactivity corresponds to severe insomnia phenotypes (sleep onset insomnia and short sleep insomnia). High sleep reactivity is also linked to risk of shift-work disorder, depression and anxiety. Importantly, stress-related worry and rumination may exploit sensitive sleep systems, thereby augmenting the pathogenicity of sleep reactivity. With the development of cost-effective assessment of sleep reactivity, we can now identify individuals at risk of future insomnia, shift-work disorder and mental illness, thus identifying a target population for preventive intervention. Given that insomniacs with high sleep reactivity tend to present with severe insomnia phenotypes, patient sleep reactivity may inform triaging to different levels of treatment. Future research on sleep reactivity is needed to clarify its neurobiology, characterize its long-term prospective associations with insomnia and shift-work disorder phenotypes, and establish its prognostic value for mental illness and other non-sleep disorders.
Collapse
Affiliation(s)
- David A. Kalmbach
- Sleep Disorders and Research Center, Henry Ford Hospital, Detroit, Michigan
| | - Jason R. Anderson
- Department of Psychological Sciences, Kent State University, Kent, Ohio
| | | |
Collapse
|
37
|
Herring WJ, Roth T, Krystal AD, Michelson D. Orexin receptor antagonists for the treatment of insomnia and potential treatment of other neuropsychiatric indications. J Sleep Res 2018; 28:e12782. [DOI: 10.1111/jsr.12782] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Revised: 09/06/2018] [Accepted: 09/22/2018] [Indexed: 01/06/2023]
Affiliation(s)
| | - Thomas Roth
- Sleep Disorders and Research Center Henry Ford Hospital Detroit MI USA
| | - Andrew D. Krystal
- Department of Psychiatry University of California San Francisco California USA
| | - David Michelson
- Clinical ResearchMerck & Co., Inc. Kenilworth New Jersey USA
| |
Collapse
|
38
|
Insomnia in Adolescence. Med Sci (Basel) 2018; 6:medsci6030072. [PMID: 30200388 PMCID: PMC6164454 DOI: 10.3390/medsci6030072] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Revised: 08/28/2018] [Accepted: 08/29/2018] [Indexed: 11/16/2022] Open
Abstract
Adolescent insomnia is a common condition that negatively impacts a developing young adult's mental and physical health. While the treatment of adult insomnia has been standardized, the treatment of pediatric insomnia is very practitioner-dependent and few large-scale studies are available to determine a standard recommended practice. There is great hope that as the adolescent medicine and sleep medicine fields flourish, larger cohort analyses will be performed to determine the prevalence and precipitating factors of adolescent insomnia, allowing for standardized treatment recommendations and systematic efforts to make these recommendations available to all adolescents.
Collapse
|
39
|
Sharma R, Sahota P, Thakkar MM. Melatonin promotes sleep in mice by inhibiting orexin neurons in the perifornical lateral hypothalamus. J Pineal Res 2018; 65:e12498. [PMID: 29654707 DOI: 10.1111/jpi.12498] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Accepted: 03/27/2018] [Indexed: 12/14/2022]
Abstract
Melatonin promotes sleep. However, the underlying mechanisms are unknown. Orexin neurons in the perifornical lateral hypothalamus (PFH) are pivotal for wake promotion. Does melatonin promote sleep by inhibiting orexin neurons? We used C57BL/6J mice and designed 4 experiments to address this question. Experiment 1 used double-labeled immunofluorescence and examined the presence of melatonin receptors on orexin neurons. Second, mice, implanted with bilateral guides targeted toward PFH and sleep-recording electrodes, were infused with melatonin (500 pmole/50 nL/side) at dark onset (onset of active period), and spontaneous bouts of sleep-wakefulness were examined. Third, mice, implanted with bilateral guides into the PFH, were infused with melatonin (500 pmole/50 nL/side) at dark onset and euthanized 2 hours later, to examine the activation of orexin neurons using c-Fos expression in orexin neurons. Fourth, mice, implanted with PFH bilateral guides and sleep-recording electrodes, were infused with melatonin receptor antagonist, luzindole (10 pmol/50 nL/side), at light onset (onset of sleep period), and spontaneous bouts of sleep-wakefulness were examined. Our results suggest that orexin neurons express MT1, but not MT2 receptors. Melatonin infusion into the PFH, at dark onset, site-specifically and significantly increased NREM sleep (43.7%, P = .003) and reduced wakefulness (12.3%, P = .013). Local melatonin infusion at dark onset inhibited orexin neurons as evident by a significant reduction (66%, P = .0004) in the number of orexin neurons expressing c-Fos. Finally, luzindole infusion-induced blockade of melatonin receptors in PFH at sleep onset significantly increased wakefulness (44.1%, P = .015). Based on these results, we suggest that melatonin may act via the MT1 receptors to inhibit orexin neurons and promote sleep.
Collapse
Affiliation(s)
- Rishi Sharma
- Harry S. Truman Memorial Veterans Hospital and Department of Neurology, University of Missouri-School of Medicine, Columbia, MO, USA
| | - Pradeep Sahota
- Harry S. Truman Memorial Veterans Hospital and Department of Neurology, University of Missouri-School of Medicine, Columbia, MO, USA
| | - Mahesh M Thakkar
- Harry S. Truman Memorial Veterans Hospital and Department of Neurology, University of Missouri-School of Medicine, Columbia, MO, USA
| |
Collapse
|
40
|
Baradaran Rahimi V, Askari VR, Tajani AS, Hosseini A, Rakhshandeh H. Evaluation of the Sleep-Prolonging Effect of Lagenaria vulgaris and Cucurbita pepo Extracts on Pentobarbital-Induced Sleep and Possible Mechanisms of Action. MEDICINA (KAUNAS, LITHUANIA) 2018; 54:E55. [PMID: 30344286 PMCID: PMC6174352 DOI: 10.3390/medicina54040055] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Revised: 07/22/2018] [Accepted: 07/26/2018] [Indexed: 02/01/2023]
Abstract
Introduction: Sleeplessness is the most common sleep disorder. In this study, the hypnotic effect of macerated (HAME) and soxhlet (HASE) extract of Lagenaria vulgaris (fruit and seed) and Cucurbita pepo (fruit) were studied in mice. Methods: Extracts and fractions were administered intra-peritoneally (i.p.) in mice 30 min before the sodium pentobarbital (30 mg/kg, i.p.). Moreover, the influence of flumazenil or naloxone on the hypnotic effects of the extract and its toxic effects were evaluated. Results: The HAME and HASE of C. pepo prolonged the pentobarbital-induced sleep duration at dose of 200 mg/kg. The HAME of L. vulgaris (fruit) at dose of 200 mg/kg increased the sleeping time. The HAME and HASE of L. vulgaris (seed) increased sleep duration at doses of 50 and 100 mg/kg. Besides, flumazenil (2 mg/kg) reversed the effects of both diazepam (P < 0.001 vs. diazepam group), 200 mg/kg of HAME of C. pepo and 50 mg/kg of HAME and HASE of L. vulgaris (seed). All fractions especially ethyl-acetate fraction (EAF) of L. vulgaris (seed) increased the sleep duration. Naloxone reversed the hypnotic effect of HAME and HASE of L. vulgaris (seed). The extracts showed no neurotoxic effects on PC12 and L929 cell lines. Conclusion: The results showed that L. vulgaris (seed and fruit) and C. pepo potentiated pentobarbital hypnosis without toxic influence. The hypnotic effects of L. vulgaris seed was greater than its fruit and C. pepo. The GABA and opioid receptors may play role in the sleep-induction of L. vulgaris seed.
Collapse
Affiliation(s)
- Vafa Baradaran Rahimi
- Student Research Committee, Department of Pharmacology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad 91778-99191, Iran.
- Pharmacological Research Center of Medicinal Plants, Mashhad University of Medical Sciences, Mashhad 91778-99191, Iran.
| | - Vahid Reza Askari
- Student Research Committee, Department of Pharmacology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad 91778-99191, Iran.
- Pharmacological Research Center of Medicinal Plants, Mashhad University of Medical Sciences, Mashhad 91778-99191, Iran.
| | - Amineh Sadat Tajani
- Department of Pharmaceutical Control, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad 91778-99191, Iran.
| | - Azar Hosseini
- Pharmacological Research Center of Medicinal Plants, Mashhad University of Medical Sciences, Mashhad 91778-99191, Iran.
| | - Hassan Rakhshandeh
- Student Research Committee, Department of Pharmacology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad 91778-99191, Iran.
- Pharmacological Research Center of Medicinal Plants, Mashhad University of Medical Sciences, Mashhad 91778-99191, Iran.
| |
Collapse
|
41
|
Kalmbach DA, Cuamatzi-Castelan AS, Tonnu CV, Tran KM, Anderson JR, Roth T, Drake CL. Hyperarousal and sleep reactivity in insomnia: current insights. Nat Sci Sleep 2018; 10:193-201. [PMID: 30046255 PMCID: PMC6054324 DOI: 10.2147/nss.s138823] [Citation(s) in RCA: 163] [Impact Index Per Article: 27.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Hyperarousal is a key component in all modern etiological models of insomnia disorder. Overall patterns in the literature suggest that over-active neurobiological and psychological systems contribute to difficulty sleeping. Even so, mixed results regarding the specific mechanisms linking hyperarousal to sleep disturbance limit current etiological conceptualizations. Similar basal arousal profiles between individuals with high vs low risk for insomnia in the absence of stress exposure suggest that dysregulated stress "response" rather than general hyperarousal may be a more pertinent marker of risk. In this report, we discuss evidence for hyperarousal in insomnia and explore the role of sleep reactivity. A trait characteristic, sleep reactivity is the degree to which stress disrupts sleep, manifesting as difficulty falling and staying asleep. Premorbid sleep reactivity has been shown to identify individuals at risk for future insomnia disorder, such as highly reactive sleepers (whose sleep systems are sensitive to stress) who are at elevated disease risk. Research points to genetics, family history of insomnia, gender, and environmental stress as factors that influence sleep reactivity. Importantly, stress-related cognitive-emotional reactivity (e.g., rumination, worry) may exploit the vulnerability of a highly reactive sleep system. We propose that sleep reactivity and cognitive-emotional reactivity may share a bidirectional relationship, conferring an insalubrious environment for sleep in response to stress. Future research on sleep reactivity is needed to identify its neurobiology, characterize its relationship with cognitive-emotional reactivity, and explore the potential clinical utility of sleep reactivity in treatment planning.
Collapse
Affiliation(s)
- David A Kalmbach
- Thomas Roth Sleep Disorders and Research Center, Henry Ford Health System, Detroit, MI, USA,
| | | | - Christine V Tonnu
- Thomas Roth Sleep Disorders and Research Center, Henry Ford Health System, Detroit, MI, USA,
| | - Kieulinh Michelle Tran
- Thomas Roth Sleep Disorders and Research Center, Henry Ford Health System, Detroit, MI, USA,
| | - Jason R Anderson
- Department of Psychological Sciences, Kent State University, Kent, OH, USA
| | - Thomas Roth
- Thomas Roth Sleep Disorders and Research Center, Henry Ford Health System, Detroit, MI, USA,
| | - Christopher L Drake
- Thomas Roth Sleep Disorders and Research Center, Henry Ford Health System, Detroit, MI, USA,
| |
Collapse
|
42
|
Inslicht SS, Neylan TC. Patterns of Zolpidem Use in Male and Female Veterans Following Revised FDA Dosing Guidelines. J Clin Sleep Med 2018; 14:1093-1094. [PMID: 29991413 DOI: 10.5664/jcsm.7198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Accepted: 07/02/2018] [Indexed: 11/13/2022]
Affiliation(s)
- Sabra S Inslicht
- Department of Psychiatry, University of California, San Francisco, San Francisco, California; San Francisco VA Healthcare System, San Francisco, California; NCIRE-Veterans Health Research Institute, San Francisco, California
| | - Thomas C Neylan
- Department of Psychiatry, University of California, San Francisco, San Francisco, California; San Francisco VA Healthcare System, San Francisco, California; NCIRE-Veterans Health Research Institute, San Francisco, California
| |
Collapse
|
43
|
|
44
|
Rawtaer I, Mahendran R, Chan HY, Lei F, Kua EH. A nonpharmacological approach to improve sleep quality in older adults. Asia Pac Psychiatry 2018; 10:e12301. [PMID: 28994200 DOI: 10.1111/appy.12301] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Revised: 08/30/2017] [Accepted: 09/12/2017] [Indexed: 12/14/2022]
Abstract
OBJECTIVES Poor sleep quality is highly prevalent among older adults and is associated with poor quality of life, cognitive and physical decline, depression, and increased mortality. Medication options commonly used are not ideal, and alternative treatment strategies are needed. We evaluate a community-based psychosocial intervention program and its effect on sleep quality in older adults. METHOD Elderly participants aged 60 and above were included. Those with Geriatric Depression Scale and Geriatric Anxiety Inventory scores above 5 and 10, respectively, were excluded. The community program included tai chi exercise, art therapy, mindfulness awareness practice, and music reminiscence therapy. Pittsburgh Sleep Quality Index, Geriatric Depression Scale, and Geriatric Anxiety Inventory were administered at baseline and at 1 year. RESULTS A hundred and eighty-nine subjects (44 men, 145 women; mean age = 69 years, SD = 5.7, range = 60-89) participated. The proportion of participants with good sleep quality had increased from 58.2% to 64.6%. Sleep disturbance was significantly reduced (baseline, 1.04; postintervention, 0.76; mean difference 0.28; P < .01); men experienced greater improvement (P < .001). Improvements were independent of changes in depressive and anxiety symptoms. CONCLUSION Participation in this community program led to positive effects on sleep disturbances after a year. Psychosocial interventions have potential as a nondrug intervention approach for sleep problems, and further research is needed to understand its mediating mechanisms.
Collapse
Affiliation(s)
- Iris Rawtaer
- Department of Psychological Medicine, National University Hospital, Singapore
| | - Rathi Mahendran
- Department of Psychological Medicine, National University Hospital, Singapore.,Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Hui Yu Chan
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Feng Lei
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Ee Heok Kua
- Department of Psychological Medicine, National University Hospital, Singapore.,Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| |
Collapse
|
45
|
Sake FTN, Wong K, Bartlett DJ, Saini B. Integrated primary care insomnia management in Australia. Res Social Adm Pharm 2018; 14:170-179. [DOI: 10.1016/j.sapharm.2017.02.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Revised: 02/17/2017] [Accepted: 02/17/2017] [Indexed: 12/13/2022]
|
46
|
Morales-Muñoz I, Koskinen S, Partonen T. The effects of seasonal affective disorder and alcohol abuse on sleep and snoring functions in a population-based study in Finland. J Sleep Res 2017; 27:e12611. [PMID: 28901656 DOI: 10.1111/jsr.12611] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Revised: 08/21/2017] [Accepted: 08/21/2017] [Indexed: 11/26/2022]
Abstract
Seasonal affective disorder (SAD) is a recurrent depressive disorder with a seasonal pattern. In addition to some specific symptoms such as sad mood, low energy or carbohydrate craving, this mood disorder is also characterized by the presence of sleeping problems and alcohol disorders. Interestingly, there is a strong link between alcohol use and sleeping deficits. Although previous studies have focused extensively on the sleep patterns in SAD patients and patients with alcohol use disorder (AUD), no research has yet been conducted on subjects with comorbid SAD and AUD. The aim of this study was to examine the differences in sleep functioning between subjects with SAD, AUD and SAD+AUD. A total of 4554 Finnish subjects from the population-based Health 2011 survey were interviewed, and of these 2430 individuals completed all the questionnaires. We selected those participants who fulfilled the criteria for SAD (n = 298), AUD (n = 359), SAD+AUD (n = 69), controls 1 (no current alcohol use, n = 226) and controls 2 (current alcohol use but not AUD, n = 1445). Controls with a history of alcohol abuse were excluded (n = 33). All the participants completed the EuroQoL five-dimensions questionnaire (EQ-5), the Seasonal Pattern Assessment Questionnaire (SPAQ), the Alcohol Use Disorders Identification Test (AUDIT) and several questions about sleeping, based on the Basic Nordic Sleep Questionnaire (BNSQ). Our results showed that those subjects with SAD+AUD reported the highest levels of subjective sleeping problems compared to controls, SAD and AUD. These findings suggest the relevance of examining the comorbidity of SAD and AUD when studying sleep functioning in these groups of patients.
Collapse
Affiliation(s)
- Isabel Morales-Muñoz
- Department of Health, National Institute for Health and Welfare, Helsinki, Finland
| | - Seppo Koskinen
- Department of Health, National Institute for Health and Welfare, Helsinki, Finland
| | - Timo Partonen
- Department of Health, National Institute for Health and Welfare, Helsinki, Finland
| |
Collapse
|
47
|
Townsend EA, Platt DM, Rowlett JK, Roma PG, Freeman KB. Reinforcing effectiveness of midazolam, ethanol, and sucrose: behavioral economic comparison of a mixture relative to its component solutions. Behav Pharmacol 2017; 28:386-393. [PMID: 28537943 PMCID: PMC5648065 DOI: 10.1097/fbp.0000000000000308] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Benzodiazepines (BZs) are relatively safe when administered alone. However, these drugs can produce severe side effects when coadministered with ethanol. Despite these adverse consequences, rates of concurrent BZ and ethanol misuse are increasing, and it is unclear whether this behavior is maintained by an enhanced reinforcing effect of the mixture. To address this issue, the current study compared the reinforcing effectiveness of sucrose solutions mixed with midazolam, ethanol, or both. Eight male rats were trained to orally self-administer solutions of either sucrose (S), sucrose+midazolam (SM), sucrose+ethanol (SE), or sucrose+midazolam+ethanol (SME). The response requirement was increased between sessions until the number of reinforcers earned was zero and the relationship between response requirement and reinforcers earned was analyzed using the exponential model of demand. Although baseline intake was similar across drug conditions, consumption of SM was least affected by increases in cost, indicating that it possessed the highest reinforcing effectiveness (i.e. least elastic). The reinforcing effectiveness of S, SE, and SME did not differ significantly. The finding that the reinforcing effectiveness of the SME was less than that of SM does not support the supposition that BZ and ethanol coadministration is maintained by a higher reinforcing effectiveness of the mixture.
Collapse
Affiliation(s)
- E. Andrew Townsend
- Division of Neurobiology and Behavior Research, Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, Jackson, MS, United States
- Graduate Program in Neuroscience, University of Mississippi Medical Center, Jackson, MS, United States
| | - Donna M. Platt
- Division of Neurobiology and Behavior Research, Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, Jackson, MS, United States
| | - James K. Rowlett
- Division of Neurobiology and Behavior Research, Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, Jackson, MS, United States
| | - Peter G. Roma
- Institutes for Behavior Resources, Baltimore, MD 21218, United States
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Kevin B. Freeman
- Division of Neurobiology and Behavior Research, Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, Jackson, MS, United States
| |
Collapse
|
48
|
Sharma R, Sahota P, Thakkar MM. Lesion of the basal forebrain cholinergic neurons attenuates sleepiness and adenosine after alcohol consumption. J Neurochem 2017; 142:710-720. [DOI: 10.1111/jnc.14054] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Revised: 04/19/2017] [Accepted: 04/20/2017] [Indexed: 12/18/2022]
Affiliation(s)
- Rishi Sharma
- Harry S. Truman Memorial Veterans Hospital and Department of Neurology; University of Missouri; Columbia Missouri USA
| | - Pradeep Sahota
- Harry S. Truman Memorial Veterans Hospital and Department of Neurology; University of Missouri; Columbia Missouri USA
| | - Mahesh M. Thakkar
- Harry S. Truman Memorial Veterans Hospital and Department of Neurology; University of Missouri; Columbia Missouri USA
| |
Collapse
|
49
|
Herring WJ, Connor KM, Snyder E, Snavely DB, Zhang Y, Hutzelmann J, Matzura-Wolfe D, Benca RM, Krystal AD, Walsh JK, Lines C, Roth T, Michelson D. Suvorexant in Elderly Patients with Insomnia: Pooled Analyses of Data from Phase III Randomized Controlled Clinical Trials. Am J Geriatr Psychiatry 2017; 25:791-802. [PMID: 28427826 DOI: 10.1016/j.jagp.2017.03.004] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Revised: 03/06/2017] [Accepted: 03/06/2017] [Indexed: 11/20/2022]
Abstract
OBJECTIVE Suvorexant is an orexin receptor antagonist approved for treating insomnia at doses of 10-20 mg. Previously reported phase III results showed that suvorexant was effective and well-tolerated in a combined-age population (elderly and nonelderly adults). The present analysis evaluated the clinical profile of suvorexant specifically in the elderly. METHODS Prespecified subgroup analyses of pooled 3-month data from two (efficacy) and three (safety) randomized, double-blind, placebo-controlled, parallel-group trials. In each trial, elderly (≥65 years) patients with insomnia were randomized to suvorexant 30 mg, suvorexant 15 mg, and placebo. By design, fewer patients were randomized to 15 mg. Patient-reported and polysomnographic (subset of patients) sleep maintenance and onset endpoints were measured. RESULTS Suvorexant 30 mg (N = 319) was effective compared with placebo (N = 318) on patient-reported and polysomnographic sleep maintenance, and onset endpoints at Night 1 (polysomnographic endpoints)/Week 1 (patient-reported endpoints), Month 1, and Month 3. Suvorexant 15 mg (N = 202 treated) was also effective across these measures, although the onset effect was less evident at later time points. The percentages of patients discontinuing because of adverse events over 3 months were 6.4% for 30 mg (N = 627 treated), 3.5% for 15 mg (N = 202 treated), and 5.5% for placebo (N = 469 treated). Somnolence was the most common adverse event (8.8% for 30 mg, 5.4% for 15 mg, 3.2% for placebo). CONCLUSION Suvorexant generally improved sleep maintenance and onset over 3 months of nightly treatment and was well-tolerated in elderly patients with insomnia (clinicaltrials.gov; NCT01097616, NCT01097629, NCT01021813).
Collapse
Affiliation(s)
| | | | | | | | | | | | | | - Ruth M Benca
- Department of Psychiatry and Human Behavior, School of Medicine, University of California-Irvine, Irvine, CA
| | - Andrew D Krystal
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC
| | - James K Walsh
- Sleep Medicine and Research Center, St. Luke's Hospital, St. Louis, MO
| | | | - Thomas Roth
- Henry Ford Hospital Sleep Center, Detroit, MI
| | | |
Collapse
|
50
|
Harvey MP, Lorrain D, Martel M, Bergeron-Vezina K, Houde F, Séguin M, Léonard G. Can we improve pain and sleep in elderly individuals with transcranial direct current stimulation? - Results from a randomized controlled pilot study. Clin Interv Aging 2017; 12:937-947. [PMID: 28652716 PMCID: PMC5472413 DOI: 10.2147/cia.s133423] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Background The prevalence of chronic pain and sleep disturbances substantially increases with age. Pharmacotherapy remains the primary treatment option for these health issues. However, side effects and drug interactions are difficult to control in elderly individuals. Aims The objective of this study was to assess the feasibility of conducting a randomized sham-controlled trial and to collect preliminary data on the efficacy of transcranial direct current stimulation (tDCS) to reduce pain and improve sleep in older adults suffering from chronic pain. Methods Fourteen elderly individuals (mean age 71±7 years) suffering from chronic pain and sleep complaints were randomized to receive either anodal tDCS, applied over the primary motor cortex (2 mA, 20 minutes), or sham tDCS, for 5 consecutive days. Pain was measured with visual analog scales, pain logbooks and questionnaires, while sleep was assessed with actigraphy, sleep diaries and questionnaires. Results There were no missing data for pain and sleep measures, except for actigraphy, that generated several missing data. Blinding was maintained throughout the study, for both the evaluator and participants. Active but not sham tDCS significantly reduced pain (P<0.05). No change was observed in sleep parameters, in both the active and sham tDCS groups (all P≥0.18). Conclusion The present study provides guidelines for the implementation of future tDCS studies in larger populations of elderly individuals. M1 anodal tDCS in this population appears to be effective to reduce pain, but not to improve sleep.
Collapse
Affiliation(s)
- Marie-Philippe Harvey
- Research Centre on Aging, CIUSSS de l'Estrie-CHUS.,Faculty of Medicine and Health Sciences, Université de Sherbrooke
| | - Dominique Lorrain
- Research Centre on Aging, CIUSSS de l'Estrie-CHUS.,Department of Psychology, Université de Sherbrooke
| | - Marylie Martel
- Research Centre on Aging, CIUSSS de l'Estrie-CHUS.,Faculty of Medicine and Health Sciences, Université de Sherbrooke
| | | | - Francis Houde
- Research Centre on Aging, CIUSSS de l'Estrie-CHUS.,Faculty of Medicine and Health Sciences, Université de Sherbrooke
| | - Mario Séguin
- Faculty of Medicine and Health Sciences, Université de Sherbrooke.,Department of Neurosurgery, Centre Hospitalier Universitaire de Sherbrooke
| | - Guillaume Léonard
- Research Centre on Aging, CIUSSS de l'Estrie-CHUS.,Faculty of Medicine and Health Sciences, Université de Sherbrooke.,School of Rehabilitation, Université de Sherbrooke, Sherbrooke, QC, Canada
| |
Collapse
|