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Morin CM, Buysse DJ. Management of Insomnia. N Engl J Med 2024; 391:247-258. [PMID: 39018534 DOI: 10.1056/nejmcp2305655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/19/2024]
Affiliation(s)
- Charles M Morin
- From the School of Psychology and Centre de Recherche CERVO-BRAIN Research Center, Université Laval, Quebec, QC, Canada (C.M.M.); and the Department of Psychiatry, University of Pittsburgh Medical Center, Pittsburgh (D.J.B.)
| | - Daniel J Buysse
- From the School of Psychology and Centre de Recherche CERVO-BRAIN Research Center, Université Laval, Quebec, QC, Canada (C.M.M.); and the Department of Psychiatry, University of Pittsburgh Medical Center, Pittsburgh (D.J.B.)
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2
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Allison KC, Parnarouskis L, Moore MD, Minnick AM. Insomnia, Short Sleep, and Their Treatments: Review of Their Associations with Weight. Curr Obes Rep 2024; 13:203-213. [PMID: 38776004 PMCID: PMC11150288 DOI: 10.1007/s13679-024-00570-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/22/2024] [Indexed: 06/05/2024]
Abstract
PURPOSE OF REVIEW Insomnia and short sleep have been linked with weight gain and obesity. However, these findings have not been consistent across studies. We review recent evidence for the association between insomnia, short sleep, and weight gain, as well as the relationship between behavioral and pharmacological treatments for sleep and weight. RECENT FINDINGS The relationship between insomnia and obesity is mixed, with stronger associations between insomnia with short sleep and obesity than other presentations of insomnia. Short sleep is associated with weight gain. Z-drugs and benzodiazapines do not appear to impact weight, but many antidepressants and antipsychotics that are used for insomnia treatment do cause weight gain. The relationships between insomnia and short sleep with weight gain and obesity are inconsistent. More prospective trials are needed to identify mediators and moderators of this relationship to better develop and deliver effective interventions for both sleep and weight problems.
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Affiliation(s)
- Kelly C Allison
- Center for Weight and Eating Disorders, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3535 Market Street, Suite 3029, Philadelphia, PA, 19104-3309, USA.
| | - Lindsey Parnarouskis
- Center for Weight and Eating Disorders, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3535 Market Street, Suite 3029, Philadelphia, PA, 19104-3309, USA
- Department of Psychology, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Molly D Moore
- Center for Weight and Eating Disorders, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3535 Market Street, Suite 3029, Philadelphia, PA, 19104-3309, USA
| | - Alyssa M Minnick
- Center for Weight and Eating Disorders, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3535 Market Street, Suite 3029, Philadelphia, PA, 19104-3309, USA
- InBody BWA, Audubon, PA, 19403, USA
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3
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Okoroma NA, Nguyen P, Roeland EJ, Ma JD. Evaluating the Risk Index for Serious Prescription Opioid-Induced Respiratory Depression or Overdose in Patients with Cancer. J Pain Palliat Care Pharmacother 2024; 38:131-137. [PMID: 38722684 DOI: 10.1080/15360288.2024.2348620] [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: 10/26/2023] [Accepted: 04/23/2024] [Indexed: 06/06/2024]
Abstract
The Commercially Insured health Plan Risk Index for Overdose or Serious Opioid-induced Respiratory Depression (CIP-RIOSORD) is an evidence-based tool to determine serious opioid-induced respiratory depression (OIRD) or overdose risk. The CIP-RIOSORD total score determines a risk class and estimates the probability for an OIRD event within the next 6 months. We performed a single-center, retrospective analysis to determine CIP-RIOSORD baseline scores and the most common predictive factors in patients with cancer. Patients (n = 160) were split into new consultations (n = 83, Group 1) versus the first documented follow-up consultation (n = 77, Group 2). Most patients were Caucasian women with metastatic gastrointestinal cancer. CIP-RIOSORD scores for Group 1 patients were 14.8 ± 15.2 (mean ± SD, risk class 4). Group 2 patients had higher CIP-RIOSORD scores (16.6 ± 14.9, risk class 4). For Group 1, the most common CIP-RIOSORD predictive factors were use of a long-acting opioid formulation (n = 24, 29%) and daily oral morphine equivalent (OME) ≥100 (n = 20, 24%); for Group 2, predictive factors were use of an antidepressant (n = 34, 44%) and a long-acting opioid formulation (n = 27, 35%). Based on the CIP-RIOSORD, there is a 15% probability of experiencing a serious OIRD event or overdose within the next 6 months.
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Affiliation(s)
- Ngozi A Okoroma
- are with the Skaggs School of Pharmacy & Pharmaceutical Sciences, University of California (UC), San Diego, CA
| | - Phap Nguyen
- are with the Skaggs School of Pharmacy & Pharmaceutical Sciences, University of California (UC), San Diego, CA
| | - Eric J Roeland
- is with the Knight Cancer Institute, Oregon Health and Science University, Portland, ORJoseph D. Ma, PharmD a is with the Skaggs School of Pharmacy & Pharmaceutical Sciences, University of California (UC), San Diego, CA
| | - Joseph D Ma
- are with the Skaggs School of Pharmacy & Pharmaceutical Sciences, University of California (UC), San Diego, CA
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4
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Mills J. The Use of Trazodone for Insomnia and Other Sleep Disturbances. Issues Ment Health Nurs 2024; 45:658-662. [PMID: 38843027 DOI: 10.1080/01612840.2024.2356501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/20/2024]
Affiliation(s)
- Jeremy Mills
- College of Nursing, University of Tennessee, Knoxville, Tennessee, USA
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5
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Bushnell G, Ivanenko A, Horton DB, Lunsford-Avery JR, Posner J, Gerhard T, Suarez E, Olfson M. Psychiatric comorbidities and prescribing tendencies of sleep medications and related medications in young people with insomnia: a United States commercial claims-based analysis. Sleep 2024; 47:zsae057. [PMID: 38430553 PMCID: PMC11082474 DOI: 10.1093/sleep/zsae057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 02/05/2024] [Indexed: 03/04/2024] Open
Abstract
STUDY OBJECTIVES To characterize children and youth newly diagnosed with insomnia and to describe their use of sleep and other related prescription medications. METHODS Within a commercial claims database (January 1, 2016-December 31, 2021), we identified children and youth (2-24 years) with a newly recorded insomnia diagnosis (G47.0x; F51.0x) and examined psychiatric diagnoses in the prior 6 months. We evaluated sleep and related prescription medications dispensed in the week after new insomnia diagnoses (i.e. trazodone, other antidepressants, hydroxyzine, alpha-agonists, benzodiazepines, non-benzodiazepine hypnotics "z-drugs," antipsychotics, and others). Analyses were stratified by age and psychiatric comorbidities. RESULTS Among 68 698 children and 108 118 older youth (18-24 years) with a new insomnia diagnosis, three-quarters had a diagnosed comorbid psychiatric condition; anxiety disorders, depression, and ADHD were the most common. Among those without comorbid psychiatric diagnoses, 20.2% of children and 37.4% of older youth had a sleep or related medication dispensed in the following week. In children without a comorbid psychiatric diagnosis, alpha-agonists, hydroxyzine, and trazodone were the most common medications; in older youth, trazodone was the most common medication followed by hydroxyzine, z-drugs, and SSRIs. Sleep and related prescription medications were more commonly dispensed to those with psychiatric comorbidities. From 2017 to 2021, there was an increase in hydroxyzine prescriptions following a new insomnia diagnosis and decline in z-drug and benzodiazepine prescriptions. CONCLUSIONS Our findings from a nationwide sample of young people with insomnia highlight the high prevalence of psychiatric comorbidities and variety of sleep and related medications they receive. Characterizing prescribing tendencies informs guideline development and future research.
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Affiliation(s)
- Greta Bushnell
- Center for Pharmacoepidemiology and Treatment Sciences, Institute for Health, Health Care Policy and Aging Research; Rutgers University; New Brunswick, NJ, USA
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health; Piscataway, NJ, USA
| | - Anna Ivanenko
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine; Chicago, IL, USA
| | - Daniel B Horton
- Center for Pharmacoepidemiology and Treatment Sciences, Institute for Health, Health Care Policy and Aging Research; Rutgers University; New Brunswick, NJ, USA
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health; Piscataway, NJ, USA
- Department of Pediatrics, Rutgers Robert Wood Johnson Medical School; New Brunswick, NJ, USA
| | - Jessica R Lunsford-Avery
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine; Durham, NC, USA
| | - Jonathan Posner
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine; Durham, NC, USA
| | - Tobias Gerhard
- Center for Pharmacoepidemiology and Treatment Sciences, Institute for Health, Health Care Policy and Aging Research; Rutgers University; New Brunswick, NJ, USA
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health; Piscataway, NJ, USA
- Pharmacy Practice and Administration, Ernest Mario School of Pharmacy, Rutgers University; New Brunswick, NJ, USA
| | - Elizabeth Suarez
- Center for Pharmacoepidemiology and Treatment Sciences, Institute for Health, Health Care Policy and Aging Research; Rutgers University; New Brunswick, NJ, USA
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health; Piscataway, NJ, USA
| | - Mark Olfson
- Department of Psychiatry, Columbia University Irving Medical Center; New York, NY, USA
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Poluektov MG, Akarachkova ES, Dovgan EV, Kotova OV, Demidova TY, Klimenko AA, Kokorin VA, Ostroumova OD, Ostroumova TM. [Management of patients with insomnia and polymorbidity. A draft of the clinical guidelines]. Zh Nevrol Psikhiatr Im S S Korsakova 2024; 124:39-52. [PMID: 38934665 DOI: 10.17116/jnevro202412405239] [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] [Indexed: 06/28/2024]
Abstract
Insomnia is a serious and widespread public health problem, but is often undetected and patients do not receive needed treatment. Insomnia is often comorbid with other diseases and conditions, such as arterial hypertension, type 2 diabetes mellitus, pain syndromes, anxiety and depressive disorders, etc. A separate problem is drug-induced insomnia, when patients develop symptoms due to other diseases treatments. Insomnia has a negative effect on the prognosis of comorbid diseases, including an increased risk of death, more severe disease, and decreased quality of life. The presence of sleep disorders makes it difficult to effectively treat the underlying disease, so clinical guidelines draft for the evaluation and treatment of insomnia in multimorbid patients is proposed. Diagnostic methods are reviewed and recommendations are given for the treatment of acute and chronic insomnia and features of the treatment of insomnia in multimorbid patients. A clinical algorithm has been proposed to determine treatment tactics in multimorbid patients.
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Affiliation(s)
- M G Poluektov
- Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - E S Akarachkova
- LLC International society «Stress under control», Moscow, Russia
| | - E V Dovgan
- Smolensk Regional Clinical Hospital, Smolensk, Russia
| | - O V Kotova
- LLC International society «Stress under control», Moscow, Russia
- Peoples' Friendship University of Russia, Moscow, Russia
| | - T Yu Demidova
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - A A Klimenko
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - V A Kokorin
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - O D Ostroumova
- Russian Medical Academy of Continuous Professional Education, Moscow, Russia
| | - T M Ostroumova
- Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
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7
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Fornaro M, Caiazza C, De Simone G, Rossano F, de Bartolomeis A. Insomnia and related mental health conditions: Essential neurobiological underpinnings towards reduced polypharmacy utilization rates. Sleep Med 2024; 113:198-214. [PMID: 38043331 DOI: 10.1016/j.sleep.2023.11.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 11/05/2023] [Accepted: 11/21/2023] [Indexed: 12/05/2023]
Abstract
Insomnia represents a significant public health burden, with a 10% prevalence in the general population. Reduced sleep affects social and working functioning, productivity, and patient's quality of life, leading to a total of $100 billion per year in direct and indirect healthcare costs. Primary insomnia is unrelated to any other mental or medical illness; secondary insomnia co-occurs with other underlying medical, iatrogenic, or mental conditions. Epidemiological studies found a 40-50% comorbidity prevalence between insomnia and psychiatric disorders, suggesting a high relevance of mental health in insomniacs. Sleep disturbances also worsen the outcomes of several psychiatric disorders, leading to more severe psychopathology and incomplete remission, plausibly contributing to treatment-resistant conditions. Insomnia and psychiatric disorder coexistence can lead to polypharmacy, namely, the concurrent use of two or more medications in the same patient, regardless of their purpose or rationale. Polypharmacy increases the risk of using unnecessary drugs, the likelihood of drug interactions and adverse events, and reduces the patient's compliance due to regimen complexity. The workup of insomnia must consider the patient's sleep habits and inquire about any medical and mental concurrent conditions that must be handled to allow insomnia to be remitted adequately. Monotherapy or limited polypharmacy should be preferred, especially in case of multiple comorbidities, promoting multipurpose molecules with sedative properties and with bedtime administration. Also, non-pharmacological interventions for insomnia, such as sleep hygiene, relaxation training and Cognitive Behavioral Therapy may be useful in secondary insomnia to confront behaviors and thoughts contributing to insomnia and help optimizing the pharmacotherapy. However, insomnia therapy should always be patient-tailored, considering drug indications, contraindications, and pharmacokinetics, besides insomnia phenotype, clinical picture, patient preferences, and side effect profile.
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Affiliation(s)
- Michele Fornaro
- Clinical Section of Psychiatry and Psychology, Department of Neuroscience, Reproductive Sciences, and Odontostomatology, University School of Medicine Federico II, Naples, Italy
| | - Claudio Caiazza
- Clinical Section of Psychiatry and Psychology, Department of Neuroscience, Reproductive Sciences, and Odontostomatology, University School of Medicine Federico II, Naples, Italy.
| | - Giuseppe De Simone
- Clinical Section of Psychiatry and Psychology, Department of Neuroscience, Reproductive Sciences, and Odontostomatology, University School of Medicine Federico II, Naples, Italy; Laboratory of Molecular and Translational Psychiatry, University School of Medicine of Naples Federico II, Naples, Italy
| | - Flavia Rossano
- Clinical Section of Psychiatry and Psychology, Department of Neuroscience, Reproductive Sciences, and Odontostomatology, University School of Medicine Federico II, Naples, Italy
| | - Andrea de Bartolomeis
- Clinical Section of Psychiatry and Psychology, Department of Neuroscience, Reproductive Sciences, and Odontostomatology, University School of Medicine Federico II, Naples, Italy; Laboratory of Molecular and Translational Psychiatry, University School of Medicine of Naples Federico II, Naples, Italy
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8
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Riemann D, Espie CA, Altena E, Arnardottir ES, Baglioni C, Bassetti CLA, Bastien C, Berzina N, Bjorvatn B, Dikeos D, Dolenc Groselj L, Ellis JG, Garcia-Borreguero D, Geoffroy PA, Gjerstad M, Gonçalves M, Hertenstein E, Hoedlmoser K, Hion T, Holzinger B, Janku K, Jansson-Fröjmark M, Järnefelt H, Jernelöv S, Jennum PJ, Khachatryan S, Krone L, Kyle SD, Lancee J, Leger D, Lupusor A, Marques DR, Nissen C, Palagini L, Paunio T, Perogamvros L, Pevernagie D, Schabus M, Shochat T, Szentkiralyi A, Van Someren E, van Straten A, Wichniak A, Verbraecken J, Spiegelhalder K. The European Insomnia Guideline: An update on the diagnosis and treatment of insomnia 2023. J Sleep Res 2023; 32:e14035. [PMID: 38016484 DOI: 10.1111/jsr.14035] [Citation(s) in RCA: 43] [Impact Index Per Article: 43.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 08/21/2023] [Indexed: 11/30/2023]
Abstract
Progress in the field of insomnia since 2017 necessitated this update of the European Insomnia Guideline. Recommendations for the diagnostic procedure for insomnia and its comorbidities are: clinical interview (encompassing sleep and medical history); the use of sleep questionnaires and diaries (and physical examination and additional measures where indicated) (A). Actigraphy is not recommended for the routine evaluation of insomnia (C), but may be useful for differential-diagnostic purposes (A). Polysomnography should be used to evaluate other sleep disorders if suspected (i.e. periodic limb movement disorder, sleep-related breathing disorders, etc.), treatment-resistant insomnia (A) and for other indications (B). Cognitive-behavioural therapy for insomnia is recommended as the first-line treatment for chronic insomnia in adults of any age (including patients with comorbidities), either applied in-person or digitally (A). When cognitive-behavioural therapy for insomnia is not sufficiently effective, a pharmacological intervention can be offered (A). Benzodiazepines (A), benzodiazepine receptor agonists (A), daridorexant (A) and low-dose sedating antidepressants (B) can be used for the short-term treatment of insomnia (≤ 4 weeks). Longer-term treatment with these substances may be initiated in some cases, considering advantages and disadvantages (B). Orexin receptor antagonists can be used for periods of up to 3 months or longer in some cases (A). Prolonged-release melatonin can be used for up to 3 months in patients ≥ 55 years (B). Antihistaminergic drugs, antipsychotics, fast-release melatonin, ramelteon and phytotherapeutics are not recommended for insomnia treatment (A). Light therapy and exercise interventions may be useful as adjunct therapies to cognitive-behavioural therapy for insomnia (B).
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Affiliation(s)
- Dieter Riemann
- Department of Clinical Psychology and Psychophysiology, Centre for Mental Health (Department), Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Center for Basics in NeuroModulation (NeuroModulBasics), Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Colin A Espie
- Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neuroscience at the University of Oxford, Oxford, UK
| | | | - Erna Sif Arnardottir
- Reykjavik University Sleep Institute, School of Technology, Reykjavik University, Reykjavik, Iceland
- Landspitali - The National University Hospital of Iceland, Reykjavik, Iceland
| | - Chiara Baglioni
- Human Sciences Department, University of Rome Guglielmo Marconi Rome, Rome, Italy
| | | | - Celyne Bastien
- École de Psychologie, Université Laval, Québec, Québec, Canada
| | | | - Bjørn Bjorvatn
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Dimitris Dikeos
- First Department of Psychiatry, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Leja Dolenc Groselj
- Institute of Clinical Neurophysiology, University Medical Center Ljubljana, Ljubljana, Slovenia
| | - Jason G Ellis
- Northumbria Sleep Research Laboratory, Northumbria University, Newcastle, UK
| | | | | | | | | | - Elisabeth Hertenstein
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Kerstin Hoedlmoser
- Centre for Cognitive Neurosciences, University of Salzburg, Salzburg, Austria
| | - Tuuliki Hion
- East-Viru Central Hospital, Kohtla-Järve, Estonia
| | | | - Karolina Janku
- Center for Sleep and Chronobiology Research, National Institute of Mental Health, Klecany, Czech Republic
| | - Markus Jansson-Fröjmark
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden and Stockholm Health Care Services, Stockholm, Sweden
| | - Heli Järnefelt
- Finnish Institute of Occupational Health, Helsinki, Finland
| | - Susanna Jernelöv
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden and Stockholm Health Care Services, Stockholm, Sweden
| | - Poul Jørgen Jennum
- Department of Clinical Medicine, University of Copenhagen, Kobenhavn, Denmark
| | - Samson Khachatryan
- Department of Neurology and Neurosurgery, Armenian National Institute of Health, Yerevan, Armenia
| | - Lukas Krone
- Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neuroscience at the University of Oxford, Oxford, UK
- Department of Neurology, Inselspital, University of Bern, Berne, Switzerland
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Simon D Kyle
- Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neuroscience at the University of Oxford, Oxford, UK
| | - Jaap Lancee
- Department of Clinical Psychology, University of Amsterdam, Amsterdam, The Netherlands
| | - Damien Leger
- Université Paris Cité, APHP, Hôtel Dieu de Paris, Centre du Sommeil et de la Vigilance, Paris, France
| | - Adrian Lupusor
- Functional Neurology, Institute of Neurology and Neurosurgery, Chisinau, Moldova
| | - Daniel Ruivo Marques
- Department of Education and Psychology, University of Aveiro, Aveiro, Portugal
- CINEICC - Center for Research in Neuropsychology and Cognitive Behavioral Intervention, Faculty of Psychology and Educational Sciences, University of Coimbra, Coimbra, Portugal
| | - Christoph Nissen
- Department of Psychiatry, University Hospital Geneve, Geneve, Switzerland
| | - Laura Palagini
- Psychiatry Unit, Department of Clinical and Experimental Medicine, School of Medicine, University of Pisa, Pisa, Italy
| | - Tiina Paunio
- Department of Psychiatry and SleepWell Research Program, Faculty of Medicine, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland; Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland
| | | | - Dirk Pevernagie
- Department of Internal Medicine and Pediatrics, Ghent University, Ghent, Belgium
| | - Manuel Schabus
- Centre for Cognitive Neurosciences, University of Salzburg, Salzburg, Austria
| | - Tamar Shochat
- The Cheryl Spencer Institute of Nursing Research, University of Haifa, Haifa, Israel
| | - Andras Szentkiralyi
- Institute of Epidemiology and Social Medicine, University of Münster, Münster, Germany
| | - Eus Van Someren
- Department of Sleep and Cognition, Netherlands Institute for Neuroscience, Royal Netherlands Academy of Arts and Sciences, Amsterdam, The Netherlands
- Departments of Integrative Neurophysiology and Psychiatry, Center for Neurogenomics and Cognitive Research, Amsterdam UMC, Amsterdam Neuroscience, VU University, Amsterdam, The Netherlands
| | - Annemieke van Straten
- Department of Clinical, Neuro- and Developmental Psychology & Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Adam Wichniak
- Sleep Medicine Center and Third Department of Psychiatry, Institute of Psychiatry and Neurology, Warsaw, Poland
| | - Johan Verbraecken
- Multidisciplinary Sleep Disorders Centre, Antwerp University Hospital and University of Antwerp, Antwerp, Belgium
| | - Kai Spiegelhalder
- Department of Clinical Psychology and Psychophysiology, Centre for Mental Health (Department), Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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9
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Drager LF, Assis M, Bacelar AFR, Poyares DLR, Conway SG, Pires GN, de Azevedo AP, Carissimi A, Eckeli AL, Pentagna Á, Almeida CMO, Franco CMR, Sobreira EST, Stelzer FG, Mendes GM, Minhoto GR, Linares IMP, Sousa KMM, Gitaí LLG, Sukys-Claudino L, Sobreira-Neto MA, Zanini MA, Margis R, Martinez SCG. 2023 Guidelines on the Diagnosis and Treatment of Insomnia in Adults - Brazilian Sleep Association. Sleep Sci 2023; 16:507-549. [PMID: 38370879 PMCID: PMC10869237 DOI: 10.1055/s-0043-1776281] [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: 02/20/2024] Open
Abstract
Chronic insomnia disorder (simplified in this document as insomnia) is an increasingly common clinical condition in society and a frequent complaint at the offices of different areas of health practice (particularly Medicine and Psychology). This scenario has been accompanied by a significant evolution in treatment, as well as challenges in approaching patients in an appropriately way. This clinical guideline, coordinated by the Brazilian Sleep Association and the Brazilian Association of Sleep Medicine and counting on the active participation of various specialists in the area, encompasses an update on the diagnosis and treatment of insomnia in adults. To this end, it followed a structured methodology. Topics of interest related to diagnosis were written based on theoretical framework, evidence in the literature, and professional experience. As for the topics related to the treatment of insomnia, a series of questions were developed based on the PICO acronym (P - Patient, problem, or population; I - Intervention; C - Comparison, control, or comparator; O - Outcome). The work groups defined the eligible options within each of these parameters. Regarding pharmacological interventions, only the ones currently available in Brazil or possibly becoming available in the upcoming years were considered eligible. Systematic reviews were conducted to help prepare the texts and define the level of evidence for each intervention. The final result is an objective and practical document providing recommendations with the best scientific support available to professionals involved in the management of insomnia.
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Affiliation(s)
- Luciano Ferreira Drager
- Associação Brasileira do Sono, São Paulo, SP, Brazil.
- Unidades de HipertenSão, Instituto do Coração (InCor) e Disciplina de Nefrologia, Universidade de São Paulo, São Paulo, SP, Brazil.
| | - Márcia Assis
- Associação Brasileira do Sono, São Paulo, SP, Brazil.
- Clínica do Sono de Curitiba, Hospital São Lucas, Curitiba, Brazil.
| | - Andrea Frota Rego Bacelar
- Associação Brasileira do Sono, São Paulo, SP, Brazil.
- Clínica Bacelar - Neuro e Sono, Rio de Janeiro, RJ, Brazil.
| | - Dalva Lucia Rollemberg Poyares
- Departamento de Psicobiologia, Universidade Federal de São Paulo, São Paulo, Brazil.
- Instituto do Sono, São Paulo, SP, Brazil.
| | - Silvia Gonçalves Conway
- Instituto de Psiquiatria (IPq), Universidade de São Paulo, São Paulo, SP, Brazil.
- Departamento de Otoneurologia, Universidade de São Paulo, São Paulo, SP, Brazil.
- AkasA - Formação e Conhecimento, São Paulo, SP, Brazil.
| | - Gabriel Natan Pires
- Departamento de Psicobiologia, Universidade Federal de São Paulo, São Paulo, Brazil.
- Instituto do Sono, São Paulo, SP, Brazil.
| | | | - Alicia Carissimi
- Faculdade Dom Bosco, Porto Alegre, RS, Brazil.
- Cronosul Clínica de Psicologia do Sono, Psicoterapia e Neuropsicologia, Porto Alegre, RS, Brazil.
| | - Allan Luiz Eckeli
- Departamento de Neurociências e Ciências do Comportamento, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil.
| | - Álvaro Pentagna
- Hospital das Clínicas (HCFMUSP), Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil.
| | | | | | - Emmanuelle Silva Tavares Sobreira
- AkasA - Formação e Conhecimento, São Paulo, SP, Brazil.
- Universidade Federal do Ceará, Fortaleza, CE, Brazil.
- Clínica Sinapse Diagnóstico, Fortaleza, CE, Brazil.
| | - Fernando Gustavo Stelzer
- Departamento de Neurociências e Ciências do Comportamento, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil.
| | | | | | - Ila Marques Porto Linares
- Instituto de Psiquiatria (IPq), Universidade de São Paulo, São Paulo, SP, Brazil.
- Instituto da Criança, Faculdade de Medicina, Universidade de São Paulo (FMUSP), São Paulo, SP, Brazil.
| | - Ksdy Maiara Moura Sousa
- Departamento de Psicobiologia, Universidade Federal de São Paulo, São Paulo, Brazil.
- SleepUp Tecnologia e Saúde LTDA, São Paulo, SP, Brazil.
| | | | - Lucia Sukys-Claudino
- Disciplina de Neurologia, Universidade Federal de Santa Catarina (UFSC), Florianópolis, SC, Brazil.
| | | | - Marcio Andrei Zanini
- Instituto de Assistência Médica ao Servidor Público Estadual (IAMPSE), São Paulo, SP, Brazil.
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Morrone CD, Raghuraman R, Hussaini SA, Yu WH. Proteostasis failure exacerbates neuronal circuit dysfunction and sleep impairments in Alzheimer's disease. Mol Neurodegener 2023; 18:27. [PMID: 37085942 PMCID: PMC10119020 DOI: 10.1186/s13024-023-00617-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 03/29/2023] [Indexed: 04/23/2023] Open
Abstract
Failed proteostasis is a well-documented feature of Alzheimer's disease, particularly, reduced protein degradation and clearance. However, the contribution of failed proteostasis to neuronal circuit dysfunction is an emerging concept in neurodegenerative research and will prove critical in understanding cognitive decline. Our objective is to convey Alzheimer's disease progression with the growing evidence for a bidirectional relationship of sleep disruption and proteostasis failure. Proteostasis dysfunction and tauopathy in Alzheimer's disease disrupts neurons that regulate the sleep-wake cycle, which presents behavior as impaired slow wave and rapid eye movement sleep patterns. Subsequent sleep loss further impairs protein clearance. Sleep loss is a defined feature seen early in many neurodegenerative disorders and contributes to memory impairments in Alzheimer's disease. Canonical pathological hallmarks, β-amyloid, and tau, directly disrupt sleep, and neurodegeneration of locus coeruleus, hippocampal and hypothalamic neurons from tau proteinopathy causes disruption of the neuronal circuitry of sleep. Acting in a positive-feedback-loop, sleep loss and circadian rhythm disruption then increase spread of β-amyloid and tau, through impairments of proteasome, autophagy, unfolded protein response and glymphatic clearance. This phenomenon extends beyond β-amyloid and tau, with interactions of sleep impairment with the homeostasis of TDP-43, α-synuclein, FUS, and huntingtin proteins, implicating sleep loss as an important consideration in an array of neurodegenerative diseases and in cases of mixed neuropathology. Critically, the dynamics of this interaction in the neurodegenerative environment are not fully elucidated and are deserving of further discussion and research. Finally, we propose sleep-enhancing therapeutics as potential interventions for promoting healthy proteostasis, including β-amyloid and tau clearance, mechanistically linking these processes. With further clinical and preclinical research, we propose this dynamic interaction as a diagnostic and therapeutic framework, informing precise single- and combinatorial-treatments for Alzheimer's disease and other brain disorders.
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Affiliation(s)
- Christopher Daniel Morrone
- Brain Health Imaging Centre, Centre for Addiction and Mental Health, 250 College St., Toronto, ON, M5T 1R8, Canada.
| | - Radha Raghuraman
- Taub Institute, Columbia University Irving Medical Center, 630W 168th Street, New York, NY, 10032, USA
- Department of Pathology and Cell Biology, Columbia University Irving Medical Center, 630W 168th Street, New York, NY, 10032, USA
| | - S Abid Hussaini
- Taub Institute, Columbia University Irving Medical Center, 630W 168th Street, New York, NY, 10032, USA.
- Department of Pathology and Cell Biology, Columbia University Irving Medical Center, 630W 168th Street, New York, NY, 10032, USA.
| | - Wai Haung Yu
- Brain Health Imaging Centre, Centre for Addiction and Mental Health, 250 College St., Toronto, ON, M5T 1R8, Canada.
- Geriatric Mental Health Research Services, Centre for Addiction and Mental Health, 250 College St., Toronto, ON, M5T 1R8, Canada.
- Department of Pharmacology and Toxicology, University of Toronto, Medical Sciences Building, 1 King's College Circle, Toronto, ON, M5S 1A8, Canada.
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11
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Chen C, Yip HT, Leong KH, Yao WC, Hung CL, Su CH, Kuo CF, Tsai SY. Presence of depression and anxiety with distinct patterns of pharmacological treatments before the diagnosis of chronic fatigue syndrome: a population-based study in Taiwan. J Transl Med 2023; 21:98. [PMID: 36755267 PMCID: PMC9907887 DOI: 10.1186/s12967-023-03886-1] [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: 10/21/2022] [Accepted: 01/11/2023] [Indexed: 02/10/2023] Open
Abstract
OBJECTIVE An increased prevalence of psychiatric comorbidities (including depression and anxiety disorder) has been observed among patients with chronic fatigue syndrome (CFS). However, few studies have examined the presence of depression and anxiety disorder before the diagnosis of CFS. This study aimed to clarify the preexisting comorbidities and treatments associated with patients with subsequent CFS diagnosis in a population-based cohort in Taiwan. METHODS An analysis utilizing the National Health Insurance Research Database of Taiwan was conducted. Participants included were 6303 patients with CFS newly diagnosed between 2000 and 2010 and 6303 age-/sex-matched controls. RESULTS Compared with the control group, the CFS group had a higher prevalence of depression and anxiety disorder before the diagnosis of CFS. Sampled patients who took specific types of antidepressants, namely, selective serotonin reuptake inhibitors (adjusted odds ratio [aOR] = 1.21, 95% confidence interval [CI] 1.04-1.39), serotonin antagonists and reuptake inhibitors (SARI; aOR = 1.87, 95% CI 1.59-2.19), and tricyclic antidepressants (aOR = 1.46, 95% CI 1.09-1.95), had an increased risk of CFS. CFS risk was also higher among participants taking benzodiazepine, muscle relaxants, and analgesic drugs. A sub-group analysis revealed that SARI use was related to an increased risk of CFS in the depression, anxiety disorder, male, and female groups. In the depression and anxiety disorder groups, analgesic drug use was associated with an increased CFS risk. Nonpharmacological treatment administration differed between men and women. CONCLUSION This population-based retrospective cohort study revealed an increased risk of CFS among populations with preexisting depression and anxiety disorder, especially those taking SARI and analgesic drugs.
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Affiliation(s)
- Chi Chen
- grid.412094.a0000 0004 0572 7815Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan
| | - Hei-Tung Yip
- grid.411508.90000 0004 0572 9415Management Office for Health Data, China Medical University Hospital, Taichung, 404 Taiwan
| | - Kam-Hang Leong
- grid.452449.a0000 0004 1762 5613Department of Medicine, MacKay Medical College, New Taipei City, 252 Taiwan ,grid.413593.90000 0004 0573 007XDepartment of Laboratory Medicine, MacKay Memorial Hospital, Taipei, 104 Taiwan
| | - Wei-Cheng Yao
- grid.415675.40000 0004 0572 8359Department of Anesthesiology and Pain Medicine, Min-Sheng General Hospital, Taoyuan, Taiwan
| | - Chung-Lieh Hung
- grid.452449.a0000 0004 1762 5613Institute of Biomedical Sciences, MacKay Medical College, New Taipei City, Taiwan
| | - Ching-Huang Su
- grid.413593.90000 0004 0573 007XDepartment of Laboratory Medicine, MacKay Memorial Hospital, Taipei, 104 Taiwan
| | - Chien-Feng Kuo
- grid.452449.a0000 0004 1762 5613Department of Medicine, MacKay Medical College, New Taipei City, 252 Taiwan ,Department of Nursing, Nursing and Management, MacKay Junior College of Medicine, New Taipei City, 25245 Taiwan ,grid.413593.90000 0004 0573 007XDivision of Infectious Diseases, Department of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan
| | - Shin-Yi Tsai
- Department of Medicine, MacKay Medical College, New Taipei City, 252, Taiwan. .,Department of Laboratory Medicine, MacKay Memorial Hospital, Taipei, 104, Taiwan. .,Institute of Biomedical Sciences, MacKay Medical College, New Taipei City, Taiwan. .,Institute of Long-Term Care, MacKay Medical College, New Taipei City, Taiwan. .,Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, 615 N. Wolfe Street, Baltimore, MD, 21205, USA.
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12
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White B, Snyder HS, Patel MVB. Evaluation of Medications Used for Hospitalized Patients With Sleep Disturbances: A Frequency Analysis and Literature Review. J Pharm Pract 2023; 36:126-138. [PMID: 34096384 DOI: 10.1177/08971900211017857] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
PURPOSE Poor sleep during hospitalization is common and implicated in worse patient outcomes. Despite implementation of non-pharmacologic techniques, medications are still frequently required. The study objective is to assess the frequency of new medications administered for sleep in hospitalized patients and to review literature evaluating these drug therapies in the inpatient setting. METHODS This retrospective study included adult inpatients if they received a new medication for sleep during a 5-day period. Patients were excluded if the medication was continued from home or if sleep was not the documented indication. For the literature review, a MEDLINE search was conducted to identify studies pertaining to pharmacotherapy for sleep in hospitalized patients. RESULTS Of 1,968 patient-days reviewed, a medication for sleep was given for 166 patient-days (8.4%) in 78 patients. Melatonin was most commonly received (70.5%), followed by benzodiazepines (9.6%). A review of antihistamines, benzodiazepines, melatonin, quetiapine, trazodone, and Z-drugs (non-benzodiazepine hypnotics) was conducted and 23 studies were included. CONCLUSIONS Despite widespread use of pharmacotherapy for sleep, there is a paucity of data evaluating use in the inpatient setting. Although there is significant heterogeneity among studies, melatonin has the strongest evidence for use and is an attractive option given its lack of adverse reactions and drug interactions. Benzodiazepines and Z-drugs were also frequently utilized; however, their reduced clearance in the elderly and potential for compounded sedative effects should be weighed heavily against potential sleep benefits. Antipsychotic agents cannot be recommended for routine use due to limited data and the potential for significant adverse effects.
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Affiliation(s)
- Brittany White
- Department of Pharmacy, Erlanger Health-System, Chattanooga, TN, USA.,Department of Internal Medicine, The University of Tennessee Health Science Center College of Medicine-Chattanooga, TN, USA
| | - Heather S Snyder
- Department of Pharmacy, Emory University Hospital, Atlanta, GA, USA
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13
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Safety and efficacy of melatonin, clonazepam, and trazodone in patients with Parkinson’s disease and sleep disorders: a randomized, double-blind trial. Neurol Sci 2022; 43:6141-6148. [DOI: 10.1007/s10072-022-06188-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Accepted: 05/31/2022] [Indexed: 10/18/2022]
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14
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Matsuda Y, Morita T, Oya K, Tagami K, Naito AS, Kashiwagi H, Otani H. Drug Choice for Hyperactive Delirium in Terminally-Ill Cancer Patients: A Nationwide Survey. J Pain Symptom Manage 2022; 64:e231-e234. [PMID: 35772588 DOI: 10.1016/j.jpainsymman.2022.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 06/20/2022] [Indexed: 11/16/2022]
Affiliation(s)
- Yoshinobu Matsuda
- Department of Psychosomatic Internal Medicine, Kinki-Chuo Chest Medical Center, (Y.M.), Sakai, Japan; Palliative and Supportive Care Division, Seirei Mikatahara General Hospital, (T.M.), Hamamatsu, Japan; Peace Home Care Clinic, (K.O.), Otsu, Japan; Department of Palliative Medicine, (K.T.), Tohoku University School of Medicine, Sendai, Japan; Department of Palliative Care, Miyazaki Medical Association Hospital, (A.S.N.), Miyazaki, Japan; Aso Iizuka Hospital, Transitional and Palliative Care, (H.K.), Iizuka ciyu, Japan; Department of Palliative Care Team, and Palliative and Supportive Care, National Kyushu Cancer Center, (H.O.), Fukuoka, Japan; Department of Palliative Care Team, and Palliative and Supportive Care, St. Mary's Hospital, (H.O.), Kurume, Japan.
| | - Tatsuya Morita
- Department of Psychosomatic Internal Medicine, Kinki-Chuo Chest Medical Center, (Y.M.), Sakai, Japan; Palliative and Supportive Care Division, Seirei Mikatahara General Hospital, (T.M.), Hamamatsu, Japan; Peace Home Care Clinic, (K.O.), Otsu, Japan; Department of Palliative Medicine, (K.T.), Tohoku University School of Medicine, Sendai, Japan; Department of Palliative Care, Miyazaki Medical Association Hospital, (A.S.N.), Miyazaki, Japan; Aso Iizuka Hospital, Transitional and Palliative Care, (H.K.), Iizuka ciyu, Japan; Department of Palliative Care Team, and Palliative and Supportive Care, National Kyushu Cancer Center, (H.O.), Fukuoka, Japan; Department of Palliative Care Team, and Palliative and Supportive Care, St. Mary's Hospital, (H.O.), Kurume, Japan
| | - Kiyofumi Oya
- Department of Psychosomatic Internal Medicine, Kinki-Chuo Chest Medical Center, (Y.M.), Sakai, Japan; Palliative and Supportive Care Division, Seirei Mikatahara General Hospital, (T.M.), Hamamatsu, Japan; Peace Home Care Clinic, (K.O.), Otsu, Japan; Department of Palliative Medicine, (K.T.), Tohoku University School of Medicine, Sendai, Japan; Department of Palliative Care, Miyazaki Medical Association Hospital, (A.S.N.), Miyazaki, Japan; Aso Iizuka Hospital, Transitional and Palliative Care, (H.K.), Iizuka ciyu, Japan; Department of Palliative Care Team, and Palliative and Supportive Care, National Kyushu Cancer Center, (H.O.), Fukuoka, Japan; Department of Palliative Care Team, and Palliative and Supportive Care, St. Mary's Hospital, (H.O.), Kurume, Japan
| | - Keita Tagami
- Department of Psychosomatic Internal Medicine, Kinki-Chuo Chest Medical Center, (Y.M.), Sakai, Japan; Palliative and Supportive Care Division, Seirei Mikatahara General Hospital, (T.M.), Hamamatsu, Japan; Peace Home Care Clinic, (K.O.), Otsu, Japan; Department of Palliative Medicine, (K.T.), Tohoku University School of Medicine, Sendai, Japan; Department of Palliative Care, Miyazaki Medical Association Hospital, (A.S.N.), Miyazaki, Japan; Aso Iizuka Hospital, Transitional and Palliative Care, (H.K.), Iizuka ciyu, Japan; Department of Palliative Care Team, and Palliative and Supportive Care, National Kyushu Cancer Center, (H.O.), Fukuoka, Japan; Department of Palliative Care Team, and Palliative and Supportive Care, St. Mary's Hospital, (H.O.), Kurume, Japan
| | - Akemi Shirado Naito
- Department of Psychosomatic Internal Medicine, Kinki-Chuo Chest Medical Center, (Y.M.), Sakai, Japan; Palliative and Supportive Care Division, Seirei Mikatahara General Hospital, (T.M.), Hamamatsu, Japan; Peace Home Care Clinic, (K.O.), Otsu, Japan; Department of Palliative Medicine, (K.T.), Tohoku University School of Medicine, Sendai, Japan; Department of Palliative Care, Miyazaki Medical Association Hospital, (A.S.N.), Miyazaki, Japan; Aso Iizuka Hospital, Transitional and Palliative Care, (H.K.), Iizuka ciyu, Japan; Department of Palliative Care Team, and Palliative and Supportive Care, National Kyushu Cancer Center, (H.O.), Fukuoka, Japan; Department of Palliative Care Team, and Palliative and Supportive Care, St. Mary's Hospital, (H.O.), Kurume, Japan
| | - Hideyuki Kashiwagi
- Department of Psychosomatic Internal Medicine, Kinki-Chuo Chest Medical Center, (Y.M.), Sakai, Japan; Palliative and Supportive Care Division, Seirei Mikatahara General Hospital, (T.M.), Hamamatsu, Japan; Peace Home Care Clinic, (K.O.), Otsu, Japan; Department of Palliative Medicine, (K.T.), Tohoku University School of Medicine, Sendai, Japan; Department of Palliative Care, Miyazaki Medical Association Hospital, (A.S.N.), Miyazaki, Japan; Aso Iizuka Hospital, Transitional and Palliative Care, (H.K.), Iizuka ciyu, Japan; Department of Palliative Care Team, and Palliative and Supportive Care, National Kyushu Cancer Center, (H.O.), Fukuoka, Japan; Department of Palliative Care Team, and Palliative and Supportive Care, St. Mary's Hospital, (H.O.), Kurume, Japan
| | - Hiroyuki Otani
- Department of Psychosomatic Internal Medicine, Kinki-Chuo Chest Medical Center, (Y.M.), Sakai, Japan; Palliative and Supportive Care Division, Seirei Mikatahara General Hospital, (T.M.), Hamamatsu, Japan; Peace Home Care Clinic, (K.O.), Otsu, Japan; Department of Palliative Medicine, (K.T.), Tohoku University School of Medicine, Sendai, Japan; Department of Palliative Care, Miyazaki Medical Association Hospital, (A.S.N.), Miyazaki, Japan; Aso Iizuka Hospital, Transitional and Palliative Care, (H.K.), Iizuka ciyu, Japan; Department of Palliative Care Team, and Palliative and Supportive Care, National Kyushu Cancer Center, (H.O.), Fukuoka, Japan; Department of Palliative Care Team, and Palliative and Supportive Care, St. Mary's Hospital, (H.O.), Kurume, Japan
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15
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Swift KM, Thomas CL, Balkin TJ, Lowery-Gionta EG, Matson LM. Acute sleep interventions as an avenue for treatment of trauma-associated disorders. J Clin Sleep Med 2022; 18:2291-2312. [PMID: 35678060 PMCID: PMC9435330 DOI: 10.5664/jcsm.10074] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 04/13/2022] [Accepted: 04/14/2022] [Indexed: 11/13/2022]
Abstract
Scientific evidence that acute, posttrauma sleep disturbances (eg, nightmares and insomnia) can contribute significantly to the pathogenesis of trauma-induced disorders is compelling. Sleep disturbances precipitating from trauma are uniquely predictive of daytime posttrauma symptom occurrence and severity, as well as subsequent onset of mental health disorders, including post-traumatic stress disorder. Conversely, adequate sleep during the acute posttrauma period is associated with reduced likelihood of adverse mental health outcomes. These findings, which are broadly consistent with what is known about the role of sleep in the regulation of emotion, suggest that the acute posttrauma period constitutes a "window of opportunity" during which treatment of sleep disturbances may be especially effective for preventing or mitigating progression of aberrant psychophysiological processes. At this point, the weight of the scientific evidence supporting this possibility warrants initiation of clinical trials to confirm the benefits of targeted prophylactic sleep enhancement, and to establish treatment guidelines as appropriate. CITATION Swift KM, Thomas CL, Balkin TJ, Lowery-Gionta EG, Matson LM. Acute sleep interventions as an avenue for treatment of trauma-associated disorders. J Clin Sleep Med. 2022;18(9):2291-2312.
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Affiliation(s)
- Kevin M. Swift
- Medical Readiness Systems Biology, Walter Reed Army Institute of Research, Silver Spring, Maryland
| | - Connie L. Thomas
- Department of Sleep Medicine, Walter Reed National Military Medical Center, Bethesda, Maryland
- Department of Psychiatry, Uniformed Services University of Health Sciences, Bethesda, Maryland
| | - Thomas J. Balkin
- Behavioral Biology Branch, Walter Reed Army Institute of Research, Silver Spring, Maryland
| | - Emily G. Lowery-Gionta
- Behavioral Biology Branch, Walter Reed Army Institute of Research, Silver Spring, Maryland
| | - Liana M. Matson
- Behavioral Biology Branch, Walter Reed Army Institute of Research, Silver Spring, Maryland
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16
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Trazodone changed the polysomnographic sleep architecture in insomnia disorder: a systematic review and meta-analysis. Sci Rep 2022; 12:14453. [PMID: 36002579 PMCID: PMC9402537 DOI: 10.1038/s41598-022-18776-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 08/18/2022] [Indexed: 11/08/2022] Open
Abstract
Trazodone has been widely prescribed for off-label use as a sleep aid. Identifying how trazodone impacts the performance of polysomnographic sleep architecture in insomnia disorder will provide additional data that can be used to guide clinical application. To assess the efficacy of trazodone in altering the polysomnographic sleep architecture in insomnia disorder so that sleep can be facilitated. PubMed, EMBASE, Web of Science, PsycINFO, Cochrane Library, Chinese Biomedical Literature Database (SinoMed), China National Knowledge Infrastructure, Wanfang Database, and the China Science and Technology Journal Database were searched for articles published between inception and June 2022. RCTs in patients with insomnia disorder applying trazodone in one arm of interventions at least 1 week, and reporting PSG parameters in the outcomes were eligible. RoB 2 was used to evaluate the risk of bias. The results of quality of evidence assessed by the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. When I2 < 50%, the fixed effects model was used. When I2 ≥ 50%, the random effects model was used. The mean differences (MD) or standardized mean differences (SMD) and odds ratios (OR) with 95% confidence intervals (CIs) were estimated. Eleven randomized controlled trials were selected and participants were 466. Risk of bias was low in 5 trials (45.5%), and was moderate in 6 (54.5%). Compared with the control group, trazodone significantly increased total sleep time (TST, min) (MD = 39.88, 95% CI 14.44–65.32, P = 0.002) and non-rapid eye movement stage 3 (N3, mixed min and %) (SMD = 1.61, 95% CI 0.69–2.53, P = 0.0006); trazodone significantly decreased latency to onset of persistent sleep (LPS, min) (MD = − 19.30, 95% CI − 37.28 to − 1.32, P = 0.04), non-rapid eye movement stage 1 (N1, mixed min and %) (SMD = − 0.62, 95% CI − 1.13 to − 0.12, P = 0.02), the number of awakenings (NAs, including both arousal times and arousal index) (SMD = − 0.67, 95% CI − 0.91 to − 0.42, P < 0.00001), and waking time after persistent sleep onset (WASO, mixed min and %) (SMD = − 0.42, 95% CI − 0.81, − 0.03, P = 0.04), with no obvious effect on non-rapid eye movement stage 2 (N2, mixed min and %) (SMD = − 0.15, 95% CI − 0.41 to 0.11, P = 0.25), rapid eye movement (REM, mixed min and %) (SMD = 0.22, 95% CI − 0.26 to 0.70, P = 0.37), rapid eye movement latency (REML, min) (MD = 2.33, 95% CI − 27.56 to 32.22, P = 0.88), or apnea–hypopnea index (AHI) (MD = − 4.21, 95% CI − 14.02 to 5.59, P = 0.40). Daytime drowsiness (OR = 2.53, 95% CI 1.14–5.64, P = 0.02) and decreased appetite (OR = 2.81, 95% CI 1.14–6.92, P = 0.02) occurred with greater frequency in the trazodone group as compared to the control group, and the differences were significant. The results of quality of evidence were very low in TST, N3 and AHI, were low in LPS, WASO and REM, and were moderate in N1 and NAs. The sources of heterogeneity in TST and N3 were not found out from sensitive and subgroup analysis and there was no high quality of evidence in outcomes by GRADE Assessment. Trials with combination of other therapy could be a problem in this meta-analysis as the possibility of interactions were found from sungroup analysis. Trazodone could improve sleep by changing the sleep architecture in insomnia disorder, but it should be used with caution due to the adverse events that may occur. PROSPERO registration register name: The effect of trazodone on polysomnography sleep architecture in patients with insomnia: a systematic review and meta-analysis protocol; Registration Number CRD42020215332.
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Trazodone Prolonged-Release Monotherapy in Cannabis Dependent Patients during Lockdown Due to COVID-19 Pandemic: A Case Series. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19127397. [PMID: 35742646 PMCID: PMC9224499 DOI: 10.3390/ijerph19127397] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Revised: 06/15/2022] [Accepted: 06/15/2022] [Indexed: 02/04/2023]
Abstract
(1) Background: During the SARS-CoV-2 (COVID-19) pandemic, cannabis use increased relative to pre-pandemic levels, while forced home confinement frequently caused sleep/wake cycle disruptions, psychological distress, and maladaptive coping strategies with the consequent appearance of anxiety symptoms and their potential impact on substance use problems. (2) Aim: Long-acting trazodone (150 mg or 300 mg daily) has a potential benefit as monotherapy in patients with cannabis use disorder. The present work aims to investigate the effectiveness of trazodone in optimizing the condition of people with cannabis dependence under pandemic conditions. (3) Methods: All cases with cannabis use disorder were uniformly treated with long-acting trazodone 150 mg or 300 mg/day; their craving and clinical status were monitored through appropriate psychometric scales. Side effects were recorded as they were reported by patients. We described the cases of three young patients—one man and two women—who were affected by chronic cannabis use disorder and who experienced lockdown-related psychological distress and sought psychiatric help. (4) Results: The described cases highlight that the once-a-day formulation of trazodone seems to have a therapeutic role in patients with cannabis use disorder and to guarantee tolerability and efficacy over time. No significant side effects emerged. (5) Conclusions: The use of long-acting trazodone (150 mg or 300 mg daily) has a potential benefit as monotherapy in patients with cannabis use disorder. Trazodone deserves to be studied in terms of its efficacy for cannabis use disorder.
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18
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Mansour W, Knauert M. Adding Insult to Injury: Sleep Deficiency in Hospitalized Patients. Clin Chest Med 2022; 43:287-303. [PMID: 35659026 PMCID: PMC9177053 DOI: 10.1016/j.ccm.2022.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Sleep deficiency is a common problem in the hospital setting. Contributing factors include preexisting medical conditions, illness severity, the hospital environment, and treatment-related effects. Hospitalized patients are particularly vulnerable to the negative health effects of sleep deficiency that impact multiple organ systems. Objective sleep measurement is difficult to achieve in the hospital setting, posing a barrier to linking improvements in hospital outcomes with sleep promotion protocols. Key next steps in hospital sleep promotion include improvement in sleep measurement techniques and harmonization of study protocols and outcomes to strengthen existing evidence and facilitate data interpretation across studies.
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Affiliation(s)
- Wissam Mansour
- Department of Internal Medicine, Division of Pulmonary, Allergy and Critical Care Medicine, Duke University School of Medicine, 1821 Hillandale Road, Suite 25A, Durham, NC 27705, USA
| | - Melissa Knauert
- Department of Internal Medicine, Section of Pulmonary, Critical Care, and Sleep Medicine, Yale University School of Medicine, 300 Cedar Street, PO Box 208057, New Haven, CT 06520-8057, USA.
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19
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Amari DT, Juday TR, Frech FH, Wang W, Gor D, Atkins N, Wickwire EM. Fall Risk, Healthcare Resource Use, and Costs Among Adult Patients in the United States Treated for Insomnia with Zolpidem, Trazodone, or Benzodiazepines: A Retrospective Cohort Study. Adv Ther 2022; 39:1324-1340. [PMID: 35072889 DOI: 10.1007/s12325-022-02041-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 01/07/2022] [Indexed: 12/23/2022]
Abstract
INTRODUCTION Falls are a common cause for morbidity and mortality among patients taking prescription insomnia medication. The objective of this study is to compare the risk of falls, all-cause healthcare resource utilization (HCRU), and costs among patients treated with commonly used, older generation insomnia medications and non-sleep-disordered controls. METHODS This retrospective cohort study used the IBM® MarketScan® Commercial and Medicare Supplemental Databases to identify patients aged at least 18 years treated with commonly prescribed medications for insomnia (zolpidem, trazodone, benzodiazepines) between 1 January 2012 and 30 September 2017. The insomnia-treated cohort were age- and sex-matched (1:1) to non-sleep-disordered controls. Odds ratios (ORs) compared risk of falls in each cohort, adjusting for covariates. Costs were adjusted to 2018 dollars, the most recent year for the study data. RESULTS Relative to matched controls (n = 313,086), the insomnia-treated cohort had a higher rate of falls (3.34% vs. 1.33%), and higher risk of falls [OR = 2.36 (95% confidence interval 2.27-2.44)]. Relative to other index treatments, patients treated with trazodone had the greatest risk of falls. Compared with matched controls, the estimated mean number of inpatient visits, emergency department visits, outpatient visits, and mean length of inpatient stay were all significantly higher among patients treated for insomnia. Such patients incurred greater total costs per patient per month than matched controls ($2100 versus $888; estimated mean ratio, 2.36; 95% CI 2.35-2.38; p < 0.0001). CONCLUSIONS Relative to matched controls, the insomnia-treated cohort showed higher risk of falls with greater HCRU and costs. Each outcome measured was highest among patients treated with trazodone, relative to other index treatments. Findings suggest the need for new treatment options to optimize quality of care for patients with insomnia.
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Affiliation(s)
- Diana T Amari
- Genesis Research, 111 River Street, Ste 1120, Hoboken, NJ, 07030, USA
| | | | - Feride H Frech
- Eisai Inc., 100 Tice Blvd, Woodcliff Lake, NJ, 07677, USA
| | - Weiying Wang
- Genesis Research, 111 River Street, Ste 1120, Hoboken, NJ, 07030, USA
| | - Deval Gor
- Genesis Research, 111 River Street, Ste 1120, Hoboken, NJ, 07030, USA
| | - Norman Atkins
- Eisai Inc., 100 Tice Blvd, Woodcliff Lake, NJ, 07677, USA
| | - Emerson M Wickwire
- Department of Psychiatry, University of Maryland School of Medicine, 655 W. Baltimore Street, Baltimore, MD, 21201, USA
- Division of Pulmonary and Critical Care Medicine, Sleep Disorders Center, University of Maryland School of Medicine, 655 W. Baltimore Street, Baltimore, MD, 21201, USA
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20
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Management of Insomnia Disorder. Respir Med 2022. [DOI: 10.1007/978-3-030-93739-3_13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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21
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Pharmacology of Sleep. Respir Med 2022. [DOI: 10.1007/978-3-030-93739-3_2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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22
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Tsunemitsu T, Kataoka Y, Matsumoto M, Hashimoto T, Suzuki T. Effect of enterally administered sleep-promoting medication on the intravenous sedative dose and its safety and cost profile in mechanically ventilated patients: A retrospective cohort study. PLoS One 2021; 16:e0261305. [PMID: 34928967 PMCID: PMC8687529 DOI: 10.1371/journal.pone.0261305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 11/30/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The clinical effect of enteral administration of sleep-promoting medication (SPM) in mechanically ventilated patients remains unclear. This study aimed to investigate the relationship between enteral SPM administration and the intravenous sedative dose and examine the safety and cost of enteral SPM administration. METHODS This single-center retrospective cohort study was conducted in a Japanese tertiary hospital intensive care unit (ICU). The exposure was enteral SPM administration during mechanical ventilation. The outcome was the average daily propofol dose per body weight administered as a continuous sedative during mechanical ventilation. Patients were divided into three groups based on the timing of SPM administration at ICU admission: "administration within 48 hours (early administration [EA])," "administration after 48 hours (late administration [LA])," and "no administration (NA)." We used multiple linear regression models. RESULTS Of 123 included patients, 37, 50, and 36 patients were assigned to the EA, LA, and NA groups, respectively. The average daily propofol dose per body weight was significantly lower in the EA group than in the LA and NA groups (β -5.13 [95% confidence interval (CI) -8.93 to -1.33] and β -4.51 [95% CI -8.59 to -0.43], respectively). Regarding safety, enteral SPM administration did not increase adverse events, including self-extubation. The total cost of neuroactive drugs tended to be lower in the EA group than in the LA and NA groups. CONCLUSIONS Early enteral SPM administration reduced the average daily propofol dose per body weight without increasing adverse events.
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Affiliation(s)
- Takefumi Tsunemitsu
- Department of Emergency and Critical Care Medicine, Hyogo Prefectural Amagasaki General Medical Center, Hyogo, Japan
| | - Yuki Kataoka
- Hospital Care Research Unit, Hyogo Prefectural Amagasaki General Medical Center, Hyogo, Japan
| | - Masaru Matsumoto
- Department of Emergency and Critical Care Medicine, Hyogo Prefectural Amagasaki General Medical Center, Hyogo, Japan
| | - Takashi Hashimoto
- Department of Pharmacy, Hyogo Prefectural Amagasaki General Medical Center, Hyogo, Japan
| | - Takao Suzuki
- Department of Emergency and Critical Care Medicine, Hyogo Prefectural Amagasaki General Medical Center, Hyogo, Japan
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23
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Zheng Y, Qin Y, Lyu Y, Li L, Chen Y, Yao Z. Community promotion and application of Wuqinxi combined with brief behavioral therapy for insomnia: A study protocol. Medicine (Baltimore) 2021; 100:e28046. [PMID: 34889248 PMCID: PMC8663807 DOI: 10.1097/md.0000000000028046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 11/11/2021] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Brief behavioral therapy for insomnia (BBT-I) has been proven to be a simple and effective alternative to cognitive behavioral therapy. However, low adherence limits the application in Chinese primary medical institutions, resulting in delayed or irregular treatment for many patients. This study aimed to explore the efficacy of traditional Chinese medicine external treatments on the adherence to behavioral therapy for insomnia in Chinese primary healthcare institutions, with a particular focus on patients who live in regions with weak healthcare systems. METHODS This randomized controlled clinical trial will be conducted in primary medical institutions and will recruit 98 adult participants with insomnia. BBT-I will be used as the base treatment. The participants will be divided into experimental (combined with Wuqinxi and other traditional Chinese medicine [TCM] external treatment n = 49) and control (combined with trazodone treatment, n = 49) groups, and each group will be treated for 4 consecutive weeks. The severity index of insomnia will be used as the main indicator of disease evaluation, with an 8-point reduction in the score considered as effective and a score <8 considered as cured. The secondary indicators of the disease evaluation will include the Pittsburgh sleep quality index, Zung's self-rating anxiety scale, Zung's self-rating depression scale, treatment adherence, and adverse event reports. All participants will be followed up at the time of enrollment, 4 weeks after treatment, and 3 months after the end of treatment. DISCUSSION This clinical trial will provide evidence for the efficacy of traditional Chinese medicine external treatment on the adherence to behavioral therapy for insomnia in primary medical institutions. This cheap and accessible model may benefit insomnia patients in medically underserved areas. TRIAL REGISTRATION Chinese Clinical Trial Registry ChiCTR2100042845. Registered on 30 January 2021, dataset: http://www.chictr.org.cn/showproj.aspx?proj=65691. Official scientific title of the research topic: Wuqinxi and other external treatment of Chinese Medicine combined with brief behavior therapy for insomnia.
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Affiliation(s)
- Yongliang Zheng
- Jiangsu Vocational College of Medicine, Yancheng, Jiangsu, China
| | - Yiyu Qin
- Jiangsu Vocational College of Medicine, Yancheng, Jiangsu, China
| | - Yumeng Lyu
- Jiangsu Vocational College of Medicine, Yancheng, Jiangsu, China
| | - Liangliang Li
- Jiangsu Vocational College of Medicine, Yancheng, Jiangsu, China
| | - Ya Chen
- Community Health Service Center of Dongting Lake Street, China
| | - Zhaojuan Yao
- Community Health Service Center of Xindu Street, Yancheng, Jiangsu, China
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24
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Matsuo J, Yamaori S. Detecting drug-drug interactions that increase the incidence of long QT syndrome using a spontaneous reporting system. J Clin Pharm Ther 2021; 47:70-80. [PMID: 34664726 DOI: 10.1111/jcpt.13539] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 10/07/2021] [Indexed: 11/30/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVE Drug-induced long QT syndrome (diLQTS) is a rare but serious adverse drug reaction. Drug-drug interaction (DDI) is one of the risk factors for the development of diLQTS. However, the combinations of drugs that increase the risk of diLQTS have not been extensively investigated. This study was performed to analyse the potential DDIs that elevate the incidence of diLQTS using a spontaneous reporting system. METHODS The Japanese Adverse Drug Event Report database from April 2004 to January 2020 was used to assess adverse event reports. We calculated the reporting odds ratio and 95% confidence interval for signal detection. RESULTS AND DISCUSSION Signals for concomitant use risk were detected in 31 drug combinations. Combinations of antipsychotics and antidepressants were the most common (olanzapine & fluvoxamine, olanzapine & trazodone, quetiapine & paroxetine, sulpiride & fluvoxamine, sulpiride & trazodone). Sixteen, 17 and 21 combinations were designated as requiring precaution for concomitant use in at least one of the package inserts in Japan, the United States and the United Kingdom, respectively, although no such precautions were described for the remaining combinations. On the contrary, a combination of bepridil & clarithromycin was categorized as "X (avoid combination)" and two combinations (chlorpromazine & haloperidol, amiodarone & metildigoxin) were classified as "D (modify regimen)" in the Lexicomp® risk rating. WHAT IS NEW AND CONCLUSION This study identified 31 combinations of drugs that may elevate the risk of diLQTS. The use of these drug combinations should be monitored more carefully in future.
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Affiliation(s)
- Jun Matsuo
- Department of Pharmacy, Shinshu University Hospital, Matsumoto, Japan.,Department of Biochemical Pharmacology and Toxicology, Graduate School of Medicine, Shinshu University, Matsumoto, Japan
| | - Satoshi Yamaori
- Department of Pharmacy, Shinshu University Hospital, Matsumoto, Japan.,Department of Biochemical Pharmacology and Toxicology, Graduate School of Medicine, Shinshu University, Matsumoto, Japan
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25
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Rusz CM, Ősz BE, Jîtcă G, Miklos A, Bătrînu MG, Imre S. Off-Label Medication: From a Simple Concept to Complex Practical Aspects. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph181910447. [PMID: 34639747 PMCID: PMC8508135 DOI: 10.3390/ijerph181910447] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 09/12/2021] [Accepted: 09/30/2021] [Indexed: 12/16/2022]
Abstract
Off-label use of drugs is widely known as unapproved use of approved drugs, and it can be perceived as a relatively simple concept. Even though it has been in existence for many years, prescribing and dispensing of drugs in an off-label regimen is still a current issue, triggered especially by unmet clinical needs. Several therapeutic areas require off-label approaches; therefore, this practice is challenging for prescribing physicians. Meanwhile, the regulatory agencies are making efforts in order to ensure a safe practice. The present paper defines the off-label concept, and it describes its regulation, together with several complex aspects associated with clinical practices regarding rare diseases, oncology, pediatrics, psychiatry therapeutic areas, and the safety issues that arise. A systematic research of the literature was performed, using terms, such as “off-label”, ”prevalence”, ”rare diseases”, ”oncology”, ”psychiatry”, ”pediatrics”, and ”drug repurposing”. There are several reasons for which off-label practice remains indispensable in the present; therefore, efforts are made worldwide, by the regulatory agencies and governmental bodies, to raise awareness and to ensure safe practice, while also encouraging further research.
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Affiliation(s)
- Carmen-Maria Rusz
- Doctoral School of Medicine and Pharmacy, I.O.S.U.D., George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Târgu Mureș (UMPhST), 540142 Târgu Mureș, Romania; (C.-M.R.); (M.-G.B.)
| | - Bianca-Eugenia Ősz
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Târgu Mureș (UMPhST), 540142 Târgu Mureș, Romania;
- Correspondence:
| | - George Jîtcă
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Târgu Mureș (UMPhST), 540142 Târgu Mureș, Romania;
| | - Amalia Miklos
- Department of Biochemistry, Faculty of Pharmacy, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Târgu Mureș (UMPhST), 540142 Târgu Mureș, Romania;
| | - Mădălina-Georgiana Bătrînu
- Doctoral School of Medicine and Pharmacy, I.O.S.U.D., George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Târgu Mureș (UMPhST), 540142 Târgu Mureș, Romania; (C.-M.R.); (M.-G.B.)
| | - Silvia Imre
- Department of Analytical Chemistry and Drug Analysis, Faculty of Pharmacy, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Târgu Mureș (UMPhST), 540142 Târgu Mureș, Romania;
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Comorbid Insomnia and Obstructive Sleep Apnea (COMISA): Current Concepts of Patient Management. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18179248. [PMID: 34501836 PMCID: PMC8430469 DOI: 10.3390/ijerph18179248] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 08/27/2021] [Accepted: 08/28/2021] [Indexed: 01/15/2023]
Abstract
Obstructive sleep apnea (OSA) and insomnia are the two most common sleep disorders among the general population, and they may often coexist in patients with sleep-disordered breathing (SDB). The higher prevalence of insomnia symptoms in patients with OSA (40–60%) compared to that observed in the general population has thus led researchers to identify a new disorder named comorbid insomnia and OSA (COMISA), whose true burden has been so far largely underestimated. The combined treatment of COMISA patients with positive-airway pressure ventilation (PAP) with cognitive behavioral therapy for insomnia (CBTi) has shown a better patient outcome compared to that obtained with a single treatment. Furthermore, recent evidence has shown that an innovative patient-centered approach taking into consideration patient characteristics, treatment preferences and accessibility to treatment is recommended to optimize clinical management of COMISA patients. However, in this complex mosaic, many other sleep disorders may overlap with COMISA, so there is an urgent need for further research to fully understand the impact of these therapies on outcomes for OSA patients with comorbidity. In light of this need, this review focuses on the major sleep disorders comorbid with OSA and the recent advances in the management of these insomniac patients.
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27
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Zarini-Gakiye E, Amini J, Sanadgol N, Vaezi G, Parivar K. Recent Updates in the Alzheimer's Disease Etiopathology and Possible Treatment Approaches: A Narrative Review of Current Clinical Trials. Curr Mol Pharmacol 2021; 13:273-294. [PMID: 32321414 DOI: 10.2174/1874467213666200422090135] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Revised: 02/19/2020] [Accepted: 03/04/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND Alzheimer's disease (AD) is the most frequent subtype of incurable neurodegenerative dementias and its etiopathology is still not clearly elucidated. OBJECTIVE Outline the ongoing clinical trials (CTs) in the field of AD, in order to find novel master regulators. METHODS We strictly reviewed all scientific reports from Clinicaltrials.gov and PubMed databases from January 2010 to January 2019. The search terms were "Alzheimer's disease" or "dementia" and "medicine" or "drug" or "treatment" and "clinical trials" and "interventions". Manuscripts that met the objective of this study were included for further evaluations. RESULTS Drug candidates have been categorized into two main groups including antibodies, peptides or hormones (such as Ponezumab, Interferon β-1a, Solanezumab, Filgrastim, Levemir, Apidra, and Estrogen), and naturally-derived ingredients or small molecules (such as Paracetamol, Ginkgo, Escitalopram, Simvastatin, Cilostazo, and Ritalin-SR). The majority of natural candidates acted as anti-inflammatory or/and anti-oxidant and antibodies exert their actions via increasing amyloid-beta (Aβ) clearance or decreasing Tau aggregation. Among small molecules, most of them that are present in the last phases act as specific antagonists (Suvorexant, Idalopirdine, Intepirdine, Trazodone, Carvedilol, and Risperidone) or agonists (Dextromethorphan, Resveratrol, Brexpiprazole) and frequently ameliorate cognitive dysfunctions. CONCLUSION The presences of a small number of candidates in the last phase suggest that a large number of candidates have had an undesirable side effect or were unable to pass essential eligibility for future phases. Among successful treatment approaches, clearance of Aβ, recovery of cognitive deficits, and control of acute neuroinflammation are widely chosen. It is predicted that some FDA-approved drugs, such as Paracetamol, Risperidone, Escitalopram, Simvastatin, Cilostazoand, and Ritalin-SR, could also be used in off-label ways for AD. This review improves our ability to recognize novel treatments for AD and suggests approaches for the clinical trial design for this devastating disease in the near future.
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Affiliation(s)
- Elahe Zarini-Gakiye
- Department of Biology, Science and Research Branch, Islamic Azad University, Tehran, Iran
| | - Javad Amini
- Department of Biology, Faculty of Sciences, University of Zabol, Zabol, Iran
| | - Nima Sanadgol
- Department of Biology, Faculty of Sciences, University of Zabol, Zabol, Iran,Department of Biomolecular Sciences, School of Pharmaceutical Sciences of Ribeirao Preto, University of Sao Paulo, Ribeirao Preto, Brazil
| | - Gholamhassan Vaezi
- Department of Biology, Damghan Branch, Islamic Azad University, Damghan, Iran
| | - Kazem Parivar
- Department of Biology, Science and Research Branch, Islamic Azad University, Tehran, Iran
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28
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Flaxer JM, Heyer A, Francois D. Evidenced-Based Review and Evaluation of Clinical Significance: Nonpharmacological and Pharmacological Treatment of Insomnia in the Elderly. Am J Geriatr Psychiatry 2021; 29:585-603. [PMID: 33218915 DOI: 10.1016/j.jagp.2020.10.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 10/20/2020] [Indexed: 10/23/2022]
Abstract
Insomnia in the elderly is a prevalent condition that poses treatment challenges to practitioners across medical fields. There are many behavioral and other nonpharmacological therapies, 18 Food and Drug Administration-approved pharmacotherapies, and numerous off-label, over the counter and alternative treatments. Most reviews on this subject focus either on pharmacological treatments or behavioral treatments. The authors provide a combined review of available pharmacological and nonpharmacological treatments. The authors narratively reviewed each treatment from our literature search, tabled results with the highest level of available evidence on 5 major sleep outcomes and evaluated these results for clinical significance. The authors also evaluated the safety of pharmacotherapies within the context of the 2019 Beers Criteria for Potentially Inappropriate Medications in the Elderly. The authors found the most rigorous evidence supporting Cognitive Behavioral Therapy for Insomnia as a first-line treatment option, with longer lasting therapeutic effects than treatment with pharmacologic agents alone. The authors also found evidence of similar outcomes from other behavioral interventions, such as Brief Behavioral Therapy for Insomnia and relaxation training. The authors found 4 studies, 2 on relaxation training, 1 on sleep restriction, and 1 on stimulus control limited to the elderly with clinically significant results. The authors found no pharmacological studies limited to the elderly on treatments not contraindicated by Beers criteria with clinically significant results. The authors discussed the challenges of determining clinical significance in sleep studies, the lack of studies restricted to the elderly, and the role of placebo effect.
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Affiliation(s)
- Joseph M Flaxer
- Zucker School of Medicine at Hostra/Northwell (JMF), Glen Oaks, NY
| | - Arianna Heyer
- Sidney Kimmel Medical College (AH), Thomas Jefferson University, Philadelphia, PA
| | - Dimitry Francois
- Weill Cornell Medicine (DF), New York Presbyterian/Westchester, White Plains, NY.
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29
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Vgontzas AN, Puzino K, Fernandez-Mendoza J, Krishnamurthy VB, Basta M, Bixler EO. Effects of trazodone versus cognitive behavioral therapy in the insomnia with short sleep duration phenotype: a preliminary study. J Clin Sleep Med 2021; 16:2009-2019. [PMID: 32780015 DOI: 10.5664/jcsm.8740] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
STUDY OBJECTIVES The insomnia with objective short sleep duration phenotype is associated with increased risk for adverse health outcomes, physiological hyperarousal, and a blunted response to cognitive behavioral therapy for insomnia (CBT-I). Whether insomnia with objective short sleep duration responds better to pharmacological treatment compared to CBT-I has not been examined. METHODS Participants included 15 patients with chronic insomnia (86.7% female), aged 45.3 ± 8.1 years. Eight patients were randomized to CBT-I and 7 to trazodone. Patients were examined with 2 weeks of actigraphy, salivary cortisol, and the insomnia severity index at 3 time points (pretreatment, 3-month posttreatment, and 6-month follow-up). Mixed between-within-subjects analysis of variance and univariate analysis of covariance were conducted to assess the impact of trazodone and CBT-I on patients' total sleep time, salivary cortisol, and insomnia severity index scores across the 3 time points. RESULTS Trazodone, but not CBT-I, significantly lengthened total sleep time (when measured with actigraphy) both at posttreatment (51.01 minutes vs -11.73 minutes; P = .051; Cohen's d = 1.383) and at follow-up (50.35 minutes vs -7.56 minutes; P = .012; Cohen's d = 1.725), respectively. In addition, trazodone, but not CBT-I, showed a clinically meaningful decrease in salivary cortisol from pretreatment to posttreatment (-36.07% vs -11.70%; Cohen's d = 0.793) and from pretreatment to follow-up (-21.37% vs -5.79%; Cohen's d = 0.284), respectively. Finally, there were no differences on insomnia severity index scores between the trazodone and the CBT-I groups. CONCLUSIONS The current preliminary, open-label, randomized trial suggests that trazodone, but not CBT-I, significantly improves objective sleep duration and reduces hypothalamic-pituitary-adrenal axis activation, suggesting a differential treatment response in the insomnia with objective short sleep duration phenotype. CLINICAL TRIAL REGISTRATION Registry: ClinicalTrials.gov; Name: Study of Trazodone & Cognitive Behavioral Therapy to Treat Insomnia; URL: https://clinicaltrials.gov/ct2/show/NCT01348542; Identifier: NCT01348542.
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Affiliation(s)
- Alexandros N Vgontzas
- Sleep Research and Treatment Center, Penn State Health Milton S. Hershey Medical Center, Pennsylvania State University, College of Medicine, Hershey, Pennsylvania
| | - Kristina Puzino
- Sleep Research and Treatment Center, Penn State Health Milton S. Hershey Medical Center, Pennsylvania State University, College of Medicine, Hershey, Pennsylvania
| | - Julio Fernandez-Mendoza
- Sleep Research and Treatment Center, Penn State Health Milton S. Hershey Medical Center, Pennsylvania State University, College of Medicine, Hershey, Pennsylvania
| | - Venkatesh Basappa Krishnamurthy
- Sleep Research and Treatment Center, Penn State Health Milton S. Hershey Medical Center, Pennsylvania State University, College of Medicine, Hershey, Pennsylvania
| | - Maria Basta
- Department of Psychiatry, University of Crete, University Hospital of Heraklion, Heraklion, Crete, Greece
| | - Edward O Bixler
- Sleep Research and Treatment Center, Penn State Health Milton S. Hershey Medical Center, Pennsylvania State University, College of Medicine, Hershey, Pennsylvania
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Review of Pharmacologic Sleep Agents for Critically Ill Patients. Crit Care Nurs Clin North Am 2021; 33:145-153. [PMID: 34023082 DOI: 10.1016/j.cnc.2021.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Sleep is a dynamic restorative process that is frequently disrupted in critically ill patients. Inadequate sleep can contribute to delirium and impaired healing. The etiology is multifactorial and practitioners often use a combination of nonpharmacologic and pharmacologic therapies to promote a healthy sleep cycle. There are many pharmacologic agents that may be used to promote sleep, and they display varying degrees of efficacy and safety. The selection of agent(s) should be based on patient- and disease-specific factors. All members of the treatment team can aid in assessing and optimizing sleep for critically ill patients.
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Maeda I, Inoue S, Uemura K, Tanimukai H, Hatano Y, Yokomichi N, Amano K, Tagami K, Yoshiuchi K, Ogawa A, Iwase S. Low-Dose Trazodone for Delirium in Patients with Cancer Who Received Specialist Palliative Care: A Multicenter Prospective Study. J Palliat Med 2021; 24:914-918. [PMID: 33577386 DOI: 10.1089/jpm.2020.0610] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Background: Clinical usefulness of trazodone for delirium in patients receiving palliative care is unclear. Objectives: To examine the safety and effectiveness of trazodone for delirium. Design: A secondary analysis of a multicenter prospective observational study. Setting/Subjects: The setting involves nine psycho-oncology consultation services and 14 inpatient palliative care units in Japan. Measurements: The measurement involves the Delirium Rating Scale (DRS) Revised-98 for effectiveness and the CTCAE (Common Terminology Criteria for Adverse Events) version 4 for safety assessments. Results: Thirty-eight patients enrolled the study. Mean age was 75 years. After three-day observation, the DRS total score (11.6 ± 5.3 to 8.7 ± 6.5 [difference -2.9, 95% confidence interval -5.3 to -0.5, p = 0.02]); sleep-wake cycle disturbance (p = 0.047), lability of affect (p < 0.001), and motor agitation subscales (p < 0.001) were significantly decreased. The most frequent adverse event was somnolence (n = 9). Conclusions: Low-dose trazodone treatment was generally safe and may be effective in reducing delirium severity.
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Affiliation(s)
- Isseki Maeda
- Department of Palliative Care, Senri-Chuo Hospital, Toyonaka, Japan
| | - Shinichiro Inoue
- Department of Neuropsychiatry, Okayama University Hospital, Okayama, Japan
| | - Keiichi Uemura
- Department of Psychiatry, Tonan Hospital, Sapporo, Japan
| | - Hitoshi Tanimukai
- Faculty of Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yutaka Hatano
- Department of Palliative Care, Daini Kyoritsu Hospital, Kawanishi, Japan
| | - Naosuke Yokomichi
- Department of Palliative and Supportive Care, Seirei Mikatahara General Hospital, Hamamatsu, Japan
| | - Koji Amano
- Department of Palliative Medicine, National Cancer Center Hospital, Chuo-ku, Japan
| | - Keita Tagami
- Department of Palliative Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kazuhiro Yoshiuchi
- Department of Stress Sciences and Psychosomatic Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Asao Ogawa
- Department of Psycho-Oncology Service, National Cancer Center Hospital East, Kashiwa, Japan
| | - Satoru Iwase
- Department of Palliative Medicine, Saitama Medical University, Saitama Medical University, Iruma-gun, Japan
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Choi H, Youn S, Um YH, Kim TW, Ju G, Lee HJ, Lee C, Lee SD, Bae K, Kim SJ, Lee JH, Kim T, Chung S. Korean Clinical Practice Guideline for the Diagnosis and Treatment of Insomnia in Adults. Psychiatry Investig 2020; 17:1048-1059. [PMID: 33198436 PMCID: PMC7711116 DOI: 10.30773/pi.2020.0146] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 08/06/2020] [Accepted: 10/07/2020] [Indexed: 01/15/2023] Open
Abstract
OBJECTIVE We aim to present a clinical guideline for the diagnosis and treatment of insomnia in adults by reviewing and integrating existing clinical guidelines. The purpose of this guideline is to assist clinicians who perform evidence-based insomnia treatment. METHODS We selected literature that may be appropriate for use in guideline development from evidence-based practice guidelines that have been issued by an academic or governmental institution within the last five years. The core question of this guideline was made in sentence form including Patient/Problem, Intervention, Comparison, Outcome (PICO) elements. After searching PubMed, EMBASE, and medical guideline issuing agencies, three guidelines were judged to be the most appropriately reviewed, up-to-date, and from trusted sources. RESULTS The Appraisal of Guidelines for Research and Evaluation (AGREE) II tool was used to evaluate the quality of the three clinical guidelines. The final outcome of the guideline development process is a total of 15 recommendations that report the strength of the recommendation, the quality of evidence, a summary of content, and considerations in applying the recommendation. CONCLUSION It is vital for clinical guidelines for insomnia to be developed and continually updated in order to provide more accurate evidence-based treatments to patients.
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Affiliation(s)
- Hayun Choi
- Department of Psychiatry, Veteran Health Service Medical Center, Seoul, Republic of Korea
| | - Soyoung Youn
- Clearspring Psychiatric Clinic, Seoul, Republic of Korea
| | - Yoo Hyun Um
- Department of Psychiatry, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Tae Won Kim
- Department of Psychiatry, St. Vincent’s Hospital, The Catholic University of Korea, Suwon, Republic of Korea
| | - Gawon Ju
- Department of Psychiatry, Chungbuk National University Hospital, Cheongju, Republic of Korea
| | - Hyuk Joo Lee
- Department of Psychiatry, Ulsan University Hospital, Ulsan, Republic of Korea
| | - Chungsuk Lee
- Clearspring Psychiatric Clinic, Seoul, Republic of Korea
| | - Sang Don Lee
- Department of Psychiatry, Armed Forces Capital Hospital, Seongnam, Republic of Korea
| | - Kyungyeol Bae
- Department of Psychiatry, Damyang Chamsarang Hospital, Damyang, Republic of Korea
| | - Seong Jae Kim
- Department of Psychiatry, Doeun Hospital, Jincheon, Republic of Korea
| | - Ji Hyun Lee
- Department of Psychiatry, Dream Sleep Clinic, Seoul, Republic of Korea
| | - Tae Kim
- Department of Biomedical Science and Engineering, Gwangju Institute of Science and Technology, Gwangju, Republic of Korea
| | - Seockhoon Chung
- Department of Psychiatry, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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Dhuna NA, Malkani RG. Antidepressants and Their Impact on Sleep. CURRENT SLEEP MEDICINE REPORTS 2020. [DOI: 10.1007/s40675-020-00189-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Understanding Sleep Dysfunction after Traumatic Brain Injury. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2020. [DOI: 10.1007/s40141-020-00299-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Evaluation and management of insomnia in women with breast cancer. Breast Cancer Res Treat 2020; 181:269-277. [PMID: 32314110 DOI: 10.1007/s10549-020-05635-0] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Accepted: 04/07/2020] [Indexed: 12/16/2022]
Abstract
PURPOSE Insomnia is a common issue among patients with breast cancer with a potentially devastating impact on quality of life. It can be caused or exacerbated by multiple disease and treatment-related factors. Despite the prevalence and impact of insomnia, it is rarely addressed systematically in the oncology clinic. We conducted a comprehensive review of insomnia to guide clinical care of patient's with breast cancer and insomnia. METHODS This manuscript reviews the prevalence, etiology, emerging science and both non-pharmacologic and pharmacologic options for treatment of insomnia among patients with breast cancer. RESULTS Multiple factors contribute to insomnia among patients with breast cancer including endocrine therapy and hotflashes, pain and discomfort from local therapy, and fear of recurrence. If we do identify insomnia, there are treatment options and strategies available to help patients. In particular, there is now a considerable body of evidence supporting the use of psychosocial interventions and behavioral treatments, such as cognitive behavioral therapy for insomnia (CBT-I), yoga, and mind-body programs. It is also important for oncology providers to be educated regarding available pharmacologic therapies and emerging data for cannabis-based therapy. CONCLUSION This manuscript provides an up-to-date and comprehensive review of the prevalence, etiology, and treatment approaches available for insomnia for clinicians treating patients with breast cancer. We also address strategies and goals for cancer care delivery and future research.
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Pyke RE. Trazodone in Sexual Medicine: Underused and Overdosed? Sex Med Rev 2020; 8:206-216. [DOI: 10.1016/j.sxmr.2018.08.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Revised: 07/26/2018] [Accepted: 08/05/2018] [Indexed: 11/30/2022]
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Hassinger AB, Bletnisky N, Dudekula R, El-Solh AA. Selecting a pharmacotherapy regimen for patients with chronic insomnia. Expert Opin Pharmacother 2020; 21:1035-1043. [PMID: 32202451 DOI: 10.1080/14656566.2020.1743265] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Chronic insomnia, whether it is primary or in combination with another medical or psychiatric disorder, is a prevalent condition associated with significant morbidity, reduced productivity, increased risk of accidents, and poor quality of life. Pharmacologic and behavioral treatments have equivalent efficacy with each having its own advantages and limitations. AREAS COVERED The purpose of this perspective is to delineate the limitations encountered in implementing cognitive behavioral therapy (CBT) and to review the pharmacological treatments designed to target the different phenotypes of insomnia. The discussions address how to choose the optimal medication or combination thereof based on patients' characteristics, available medications, and the presence of comorbid conditions. Selective nonbenzodiazepine sedative 'Z-drug' hypnotics, melatonin receptor agonist-ramelteon, and low-dose doxepin are the agents of choice for treatment of primary and comorbid insomnia. EXPERT OPINION A pharmacological intervention should be offered if cognitive behavioral therapy for insomnia is not available or has failed to achieve its goals. Increasing evidence of the significant adverse consequences of long-term benzodiazepines should limit the prescription of these agents to specific conditions. Testing novel dosing regimens with a combination of hypnotic classes augmented with CBT deserve further investigation.
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Affiliation(s)
- Amanda B Hassinger
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo , Buffalo, NY, USA.,VA Western New York Healthcare System , Buffalo, NY, USA
| | - Nikolas Bletnisky
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo , Buffalo, NY, USA.,VA Western New York Healthcare System , Buffalo, NY, USA
| | - Rizwan Dudekula
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo , Buffalo, NY, USA.,VA Western New York Healthcare System , Buffalo, NY, USA
| | - Ali A El-Solh
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo , Buffalo, NY, USA.,VA Western New York Healthcare System , Buffalo, NY, USA.,Department of Epidemiology and Environmental Health, Research and Development, School of Public Health, University at Buffalo , Buffalo, NY, USA
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Mysliwiec V, Martin JL, Ulmer CS, Chowdhuri S, Brock MS, Spevak C, Sall J. The Management of Chronic Insomnia Disorder and Obstructive Sleep Apnea: Synopsis of the 2019 U.S. Department of Veterans Affairs and U.S. Department of Defense Clinical Practice Guidelines. Ann Intern Med 2020; 172:325-336. [PMID: 32066145 DOI: 10.7326/m19-3575] [Citation(s) in RCA: 57] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
DESCRIPTION In September 2019, the U.S. Department of Veterans Affairs (VA) and the U.S. Department of Defense (DoD) approved a new joint clinical practice guideline for assessing and managing patients with chronic insomnia disorder and obstructive sleep apnea (OSA). This guideline is intended to give health care teams a framework by which to screen, evaluate, treat, and manage the individual needs and preferences of VA and DoD patients with either of these conditions. METHODS In October 2017, the VA/DoD Evidence-Based Practice Work Group initiated a joint VA/DoD guideline development effort that included clinical stakeholders and conformed to the Institute of Medicine's tenets for trustworthy clinical practice guidelines. The guideline panel developed key questions, systematically searched and evaluated the literature, created three 1-page algorithms, and advanced 41 recommendations using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) system. RECOMMENDATIONS This synopsis summarizes the key recommendations of the guideline in 3 areas: diagnosis and assessment of OSA and chronic insomnia disorder, treatment and management of OSA, and treatment and management of chronic insomnia disorder. Three clinical practice algorithms are also included.
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Affiliation(s)
- Vincent Mysliwiec
- University of Texas Health Science Center at San Antonio, San Antonio, Texas (V.M.)
| | - Jennifer L Martin
- David Geffen School of Medicine at UCLA and VA Greater Los Angeles Healthcare System, Los Angeles, California (J.L.M.)
| | - Christi S Ulmer
- Durham VA Healthcare System and Duke University School of Medicine, Durham, North Carolina (C.S.U.)
| | - Susmita Chowdhuri
- John D. Dingell VA Sleep Wake Disorders Center and Wayne State University, Detroit, Michigan (S.C.)
| | - Matthew S Brock
- U.S. Army SAMHS Sleep Medicine Service, San Antonio, Texas, and Wilford Hall Ambulatory Surgical Center, Lackland Air Force Base, Texas (M.S.B.)
| | - Christopher Spevak
- Walter Reed National Military Medical Center/Defense Health Agency, Bethesda, Maryland (C.S.)
| | - James Sall
- Department of Veterans Affairs, Washington, DC (J.S.)
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Ettcheto M, Olloquequi J, Sánchez-López E, Busquets O, Cano A, Manzine PR, Beas-Zarate C, Castro-Torres RD, García ML, Bulló M, Auladell C, Folch J, Camins A. Benzodiazepines and Related Drugs as a Risk Factor in Alzheimer's Disease Dementia. Front Aging Neurosci 2020; 11:344. [PMID: 31969812 PMCID: PMC6960222 DOI: 10.3389/fnagi.2019.00344] [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: 06/27/2019] [Accepted: 11/26/2019] [Indexed: 12/21/2022] Open
Abstract
Benzodiazepines (BZDs) and Z-drugs are compounds widely prescribed in medical practice due to their anxiolytic, hypnotic, and muscle relaxant properties. Yet, their chronic use is associated with cases of abuse, dependence, and relapse in many patients. Furthermore, elderly people are susceptible to alterations in pharmacodynamics, pharmacokinetics as well as to drug interaction due to polypharmacy. These situations increase the risk for the appearance of cognitive affectations and the development of pathologies like Alzheimer's disease (AD). In the present work, there is a summary of some clinical studies that have evaluated the effect of BZDs and Z-drugs in the adult population with and without AD, focusing on the relationship between their use and the loss of cognitive function. Additionally, there is an assessment of preclinical studies focused on finding molecular proof on the pathways by which these drugs could be involved in AD pathogenesis. Moreover, available data (1990-2019) on BZD and Z-drug use among elderly patients, with and without AD, was compiled in this work. Finally, the relationship between the use of BZD and Z-drugs for the treatment of insomnia and the appearance of AD biomarkers was analyzed. Results pointed to a vicious circle that would worsen the condition of patients over time. Likewise, it put into relevance the need for close monitoring of those patients using BZDs that also suffer from AD. Consequently, future studies should focus on optimizing strategies for insomnia treatment in the elderly by using other substances like melatonin agonists, which is described to have a much more significant safety profile.
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Affiliation(s)
- Miren Ettcheto
- Departament de Farmacologia, Toxicologia i Química Terapèutica, Facultat de Farmàcia i Ciències de l'Alimentació, Universitat de Barcelona, Barcelona, Spain
- Departament de Bioquímica i Biotecnologia, Facultat de Medicina i Ciències de la Salut, Universitat Rovira i Virgili, Reus, Spain
- Institut de Neurociències, Universitat de Barcelona, Barcelona, Spain
- Biomedical Research Networking Centre in Neurodegenerative Diseases (CIBERNED), Madrid, Spain
| | - Jordi Olloquequi
- Laboratory of Cellular and Molecular Pathology, Facultad de Ciencias de la Salud, Instituto de Ciencias Biomédicas, Universidad Autónoma de Chile, Talca, Chile
| | - Elena Sánchez-López
- Biomedical Research Networking Centre in Neurodegenerative Diseases (CIBERNED), Madrid, Spain
- Unitat de Farmàcia, Tecnologia Farmacèutica i Fisico-química, Facultat de Farmàcia i Ciències de l'Alimentació, Universitat de Barcelona, Barcelona, Spain
- Institute of Nanoscience and Nanotechnology (IN2UB), Universitat de Barcelona, Barcelona, Spain
| | - Oriol Busquets
- Departament de Farmacologia, Toxicologia i Química Terapèutica, Facultat de Farmàcia i Ciències de l'Alimentació, Universitat de Barcelona, Barcelona, Spain
- Departament de Bioquímica i Biotecnologia, Facultat de Medicina i Ciències de la Salut, Universitat Rovira i Virgili, Reus, Spain
- Institut de Neurociències, Universitat de Barcelona, Barcelona, Spain
- Biomedical Research Networking Centre in Neurodegenerative Diseases (CIBERNED), Madrid, Spain
| | - Amanda Cano
- Biomedical Research Networking Centre in Neurodegenerative Diseases (CIBERNED), Madrid, Spain
- Unitat de Farmàcia, Tecnologia Farmacèutica i Fisico-química, Facultat de Farmàcia i Ciències de l'Alimentació, Universitat de Barcelona, Barcelona, Spain
- Institute of Nanoscience and Nanotechnology (IN2UB), Universitat de Barcelona, Barcelona, Spain
| | | | - Carlos Beas-Zarate
- Laboratorio de Regeneración y Desarrollo Neural, Departamento de Biología Celular y Molecular, Instituto de Neurobiología, CUCBA, Guadalajara, Mexico
| | - Rubén D. Castro-Torres
- Laboratorio de Regeneración y Desarrollo Neural, Departamento de Biología Celular y Molecular, Instituto de Neurobiología, CUCBA, Guadalajara, Mexico
| | - Maria Luisa García
- Biomedical Research Networking Centre in Neurodegenerative Diseases (CIBERNED), Madrid, Spain
- Unitat de Farmàcia, Tecnologia Farmacèutica i Fisico-química, Facultat de Farmàcia i Ciències de l'Alimentació, Universitat de Barcelona, Barcelona, Spain
- Institute of Nanoscience and Nanotechnology (IN2UB), Universitat de Barcelona, Barcelona, Spain
| | - Mónica Bulló
- Departament de Bioquímica i Biotecnologia, Facultat de Medicina i Ciències de la Salut, Universitat Rovira i Virgili, Reus, Spain
- Institut d'Investigació Sanitària Pere Virgili (IISPV), Reus, Spain
- Centro de Investigación Biomédica en Red Fisiopatologia de la Obesidad y la Nutrición (CIBEROBN), Institut de Salud Carlos III, Madrid, Spain
| | - Carme Auladell
- Institut de Neurociències, Universitat de Barcelona, Barcelona, Spain
- Biomedical Research Networking Centre in Neurodegenerative Diseases (CIBERNED), Madrid, Spain
- Departament de Biologia Cellular, Fisiologia i Immunologia, Facultat de Biologia, Universitat de Barcelona, Barcelona, Spain
| | - Jaume Folch
- Departament de Bioquímica i Biotecnologia, Facultat de Medicina i Ciències de la Salut, Universitat Rovira i Virgili, Reus, Spain
- Biomedical Research Networking Centre in Neurodegenerative Diseases (CIBERNED), Madrid, Spain
| | - Antonio Camins
- Departament de Farmacologia, Toxicologia i Química Terapèutica, Facultat de Farmàcia i Ciències de l'Alimentació, Universitat de Barcelona, Barcelona, Spain
- Institut de Neurociències, Universitat de Barcelona, Barcelona, Spain
- Biomedical Research Networking Centre in Neurodegenerative Diseases (CIBERNED), Madrid, Spain
- Laboratory of Cellular and Molecular Pathology, Facultad de Ciencias de la Salud, Instituto de Ciencias Biomédicas, Universidad Autónoma de Chile, Talca, Chile
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Wang J, Liu S, Zhao C, Han H, Chen X, Tao J, Lu Z. Effects of Trazodone on Sleep Quality and Cognitive Function in Arteriosclerotic Cerebral Small Vessel Disease Comorbid With Chronic Insomnia. Front Psychiatry 2020; 11:620. [PMID: 32714220 PMCID: PMC7344257 DOI: 10.3389/fpsyt.2020.00620] [Citation(s) in RCA: 5] [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: 03/08/2020] [Accepted: 06/15/2020] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Chronic insomnia is common in patients with arteriosclerotic cerebral small vessel disease (CSVD) and aggravates the cognitive impairment caused by CSVD. Low-dose trazodone is effective in treating insomnia, but it is unclear whether it can also improve cognitive function in CSVD patients. This study was performed to explore the effects of trazodone on sleep quality and cognitive function in CSVD comorbid with chronic insomnia. METHODS This was a randomized, double-blind, placebo-controlled pilot study. Forty patients suffering from arteriosclerotic CSVD and insomnia were recruited from an outpatient clinic. Participants were randomized individually to receive either trazodone (study group) or a placebo (control group) for 4 weeks. The primary outcome was the cognitive score on the Montreal Cognitive Assessment scale (MoCA). Secondary outcomes included sleep parameters measured with polysomnography (PSG) and the Pittsburgh Sleep Quality Index. RESULTS Trazodone caused significantly better improvements in concentration and recall abilities, measured with MoCA, as well as in PSG parameters such as sleep efficiency, N3 sleep ratio, and sleep continuity than the placebo, with no significant differences in the occurrence of side effects. The improvement of sleep quality was correlated with increased concentration and recall abilities. CONCLUSIONS A low dose of trazodone seems acceptable and effective in reducing insomnia severity and improving concentration and recall abilities in this pilot study. The improvement of cognition could be achieved by alleviation of insomnia severity. Considering the high incidence of insomnia in CSVD patients, the results of this preliminary study support the use of low-dose trazodone to deal with insomnia and cognitive impairment in CSVD.
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Affiliation(s)
- Jihui Wang
- Department of Psychiatry, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Sanxin Liu
- Department of Neurology, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Chongbang Zhao
- Department of Psychiatry, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Hongying Han
- Department of Psychiatry, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xiaodong Chen
- Department of Neurology, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jiong Tao
- Department of Psychiatry, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Zhengqi Lu
- Department of Neurology, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
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Barbosa-Méndez S, Salazar-Juarez A. Melatonin does not produce sedation in rats: A chronobiological study. Chronobiol Int 2019; 37:353-374. [DOI: 10.1080/07420528.2019.1702554] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- Susana Barbosa-Méndez
- Molecular Neurobiology and Neurochemistry of Addiction, Ramón de la Fuente Muñiz National Institute of Psychiatry, Ciudad de México, México
| | - Alberto Salazar-Juarez
- Molecular Neurobiology and Neurochemistry of Addiction, Ramón de la Fuente Muñiz National Institute of Psychiatry, Ciudad de México, México
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Adamo D, Pecoraro G, Fortuna G, Amato M, Marenzi G, Aria M, Mignogna MD. Assessment of oral health‐related quality of life, measured by OHIP‐14 and GOHAI, and psychological profiling in burning mouth syndrome: A case‐control clinical study. J Oral Rehabil 2019; 47:42-52. [DOI: 10.1111/joor.12864] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 07/09/2019] [Accepted: 07/18/2019] [Indexed: 12/12/2022]
Affiliation(s)
- Daniela Adamo
- Department of Neurosciences, Reproductive and Odontostomatological Sciences Federico II University Naples Italy
| | - Giuseppe Pecoraro
- Department of Neurosciences, Reproductive and Odontostomatological Sciences Federico II University Naples Italy
| | - Giulio Fortuna
- Department of Neurosciences, Reproductive and Odontostomatological Sciences Federico II University Naples Italy
| | - Massimo Amato
- Dentistry Unit, Department of Medicine, Surgery and Dentistry University of Salerno Fisciano Italy
| | - Gaetano Marenzi
- Department of Neurosciences, Reproductive and Odontostomatological Sciences Federico II University Naples Italy
| | - Massimo Aria
- Department of Economics and Statistics Federico II University Naples Italy
| | - Michele Davide Mignogna
- Department of Neurosciences, Reproductive and Odontostomatological Sciences Federico II University Naples Italy
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Burke SL, Hu T, Spadola CE, Burgess A, Li T, Cadet T. Treatment of Sleep Disturbance May Reduce the Risk of Future Probable Alzheimer's Disease. J Aging Health 2019; 31:322-342. [PMID: 30160576 PMCID: PMC6328323 DOI: 10.1177/0898264318795567] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
OBJECTIVE This study explored two research questions: (a) Does sleep medication neutralize or provide a protective effect against the hazard of Alzheimer's disease (AD)? (b) Do apolipoprotein (APOE) e4 carriers reporting a sleep disturbance experience an increased risk of AD? METHOD This study is a secondary analysis of the National Alzheimer's Coordinating Center's Uniform Data Set ( n = 6,782) using Cox proportional hazards regression. RESULTS Sleep disturbance was significantly associated with eventual AD development. Among the subset of participants taking general sleep medications, no relationship between sleep disturbance and eventual AD was observed. Among individuals not taking sleep medications, the increased hazard between the two variables remained. Among APOE e4 carriers, sleep disturbance and AD were significant, except among those taking zolpidem. DISCUSSION Our findings support the emerging link between sleep disturbance and AD. Our findings also suggest a continued need to elucidate the mechanisms that offer protective factors against AD development.
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Affiliation(s)
| | - Tianyan Hu
- Florida International University, Miami, USA
| | | | | | - Tan Li
- Florida International University, Miami, USA
| | - Tamara Cadet
- Simmons College, Boston, MA, USA
- Harvard School of Dental Medicine, Boston, MA, USA
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44
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Driver S, Stork R. Pharmacological management of sleep after traumatic brain injury. NeuroRehabilitation 2018; 43:347-353. [DOI: 10.3233/nre-182536] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- Sangeeta Driver
- Brain Injury Medicine and Rehabilitation Program, Shirley Ryan Abilitylab, Chicago, IL, USA
- Department of Physical Medicine & Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Ryan Stork
- Department of Physical Medicine & Rehabilitation, University of Michigan Medical School, Ann Arbor, MI, USA
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