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Liu L, Jin Q, Chen Y, Yin P. Perioperative non-pharmaceutical therapies for insomnia in cancer survivors: a systematic review and network meta-analysis protocol. BMJ Open 2024; 14:e080140. [PMID: 39122388 DOI: 10.1136/bmjopen-2023-080140] [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] [Indexed: 08/12/2024] Open
Abstract
INTRODUCTION The presence of perioperative insomnia is common but yet often overlooked among cancer survivors. Non-pharmaceutical therapies have shown promise in treating cancer-related insomnia during the perioperative period; however, the existing evidence from various studies remains inconsistent. Therefore, this study aims to systematically review and assess the effectiveness of a wide range of non-pharmaceutical interventions during perioperative period for cancer-related insomnia. Findings from this study will help to make evidence-based treatment decisions. METHODS AND ANALYSIS A comprehensive electronic search will be conducted to identify relevant articles from multiple databases, including PubMed, MEDLINE, Embase, Web of Science, Cochrane Central Register of Controlled Trials and Chinese literature databases such as CNKI, VIP, Wanfang from inception to 1 December 2023. Language restrictions will not be imposed to ensure inclusivity. The change of the Pittsburgh Sleep Quality Index or the Insomnia Severity Index from baseline will be used as the primary outcome of the study. Studies using these as secondary outcomes are also acceptable. Pairwise meta-analysis and network meta-analysis will be conducted using Stata V.15.0 software. The Cochrane collaboration tool for assessing the Risk of Bias and Risk of Bias in Non-randomised Studies of Interventions will be used for risk and bias assessment. Additionally, the Grading of Recommendations, Assessment, Development and Evaluation scale will be employed to evaluate the quality of the evidence. ETHICS AND DISSEMINATION Ethical approval is not required for this study since it involves the analysis of existing studies. The anticipated results will be disseminated through publication in a peer-reviewed journal. PROSPERO REGISTRATION NUMBER CRD42023437356.
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Affiliation(s)
- Lumin Liu
- Department of Sleep Medicine Center, Longhua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Qi Jin
- Acupuncture Department, Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai, China
| | - Yuelai Chen
- Department of Sleep Medicine Center, Longhua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Ping Yin
- Department of Sleep Medicine Center, Longhua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai, China
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Cruz-Sanabria F, Bruno S, Crippa A, Frumento P, Scarselli M, Skene DJ, Faraguna U. Optimizing the Time and Dose of Melatonin as a Sleep-Promoting Drug: A Systematic Review of Randomized Controlled Trials and Dose-Response Meta-Analysis. J Pineal Res 2024; 76:e12985. [PMID: 38888087 DOI: 10.1111/jpi.12985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 01/03/2024] [Accepted: 05/30/2024] [Indexed: 06/20/2024]
Abstract
Previous studies have reported inconsistent results about exogenous melatonin's sleep-promoting effects. A possible explanation relies on the heterogeneity in administration schedule and dose, which might be accountable for differences in treatment efficacy. In this paper, we undertook a systematic review and meta-analysis of double-blind, randomized controlled trials performed on patients with insomnia and healthy volunteers, evaluating the effect of melatonin administration on sleep-related parameters. The standardized mean difference between treatment and placebo groups in terms of sleep onset latency and total sleep time were used as outcomes. Dose-response and meta-regression models were estimated to explore how time of administration, dose, and other treatment-related parameters might affect exogenous melatonin's efficacy. We included 26 randomized controlled trials published between 1987 and 2020, for a total of 1689 observations. Dose-response meta-analysis showed that melatonin gradually reduces sleep onset latency and increases total sleep time, peaking at 4 mg/day. Meta-regression models showed that insomnia status (β = 0.50, p < 0.001) and time between treatment administration and the sleep episode (β = -0.16, p = 0.023) were significant predictors of sleep onset latency, while the time of day (β = -0.086, p < 0.01) was the only significant predictor of total sleep time. Our results suggest that advancing the timing of administration (3 h before the desired bedtime) and increasing the administered dose (4 mg/day), as compared to the exogenous melatonin schedule most used in clinical practice (2 mg 30 min before the desired bedtime), might optimize the efficacy of exogenous melatonin in promoting sleep.
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Affiliation(s)
- Francy Cruz-Sanabria
- Department of Developmental Neuroscience, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Fondazione Stella Maris, Pisa, Italy
| | - Simone Bruno
- Department of Translational Research and of New Surgical and Medical Technologies, University of Pisa, Pisa, Italy
| | - Alessio Crippa
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Paolo Frumento
- Department of Political Sciences, University of Pisa, Pisa, Italy
| | - Marco Scarselli
- Department of Translational Research and of New Surgical and Medical Technologies, University of Pisa, Pisa, Italy
| | - Debra J Skene
- Chronobiology, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
| | - Ugo Faraguna
- Department of Developmental Neuroscience, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Fondazione Stella Maris, Pisa, Italy
- Department of Translational Research and of New Surgical and Medical Technologies, University of Pisa, Pisa, Italy
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Lindström AC, von Oelreich E, Eriksson J, Eriksson M, Mårtensson J, Larsson E, Oldner A. Onset of Prolonged High-Potency Benzodiazepine Use Among ICU Survivors: A Nationwide Cohort Study. Crit Care Explor 2024; 6:e1124. [PMID: 38984149 PMCID: PMC11233102 DOI: 10.1097/cce.0000000000001124] [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: 07/11/2024] Open
Abstract
OBJECTIVES Exposure to critical illness and intensive care may lead to long-term psychologic and physical impairments. To what extent ICU survivors become prolonged users of benzodiazepines after exposure to critical care is not fully explored. This study aimed to describe the extent of onset of prolonged high-potency benzodiazepine use among ICU survivors not using these drugs before admission, identify factors associated with this use, and analyze whether such usage is associated with increased mortality. DESIGN Retrospective cohort study. SETTING Sweden, including all registered ICU admissions between 2010 and 2017. PATIENTS ICU patients surviving for at least 3 months, not using high-potency benzodiazepine before admission, were eligible for inclusion. INTERVENTIONS Admission to intensive care. MEASUREMENTS AND MAIN RESULTS A total of 237,904 patients were screened and 137,647 were included. Of these 5338 (3.9%) became prolonged users of high-potency benzodiazepines after ICU discharge. A peak in high-potency benzodiazepine prescriptions was observed during the first 3 months, followed by sustained usage throughout the follow-up period of 18 months. Prolonged usage was associated with older age, female sex, and a history of both somatic and psychiatric comorbidities, including substance abuse. Additionally, a longer ICU stay, a high estimated mortality rate, and prior consumption of low-potency benzodiazepines were associated with prolonged use. The risk of death between 6 and 18 months post-ICU admission was significantly higher among high-potency benzodiazepine users, with an adjusted hazard ratio of 1.8 (95% CI, 1.7-2.0; p < 0.001). No differences were noted in causes of death between users and nonusers. Conclusions Despite the lack of evidence supporting long-term treatment, prolonged usage of high-potency benzodiazepines 18 months following ICU care was notable and associated with an increased risk of death. Considering the substantial number of ICU admissions, prevention of benzodiazepine misuse may improve long-term outcomes following critical care.
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Affiliation(s)
- Ann-Charlotte Lindström
- Department of Perioperative Medicine and Intensive Care, Karolinska University Hospital, Solna, Stockholm, Sweden
- Section of Anaesthesiology and Intensive Care Medicine, Department of Physiology and Pharmacology, Karolinska Institute, Stockholm, Sweden
| | - Erik von Oelreich
- Department of Perioperative Medicine and Intensive Care, Karolinska University Hospital, Solna, Stockholm, Sweden
- Section of Anaesthesiology and Intensive Care Medicine, Department of Physiology and Pharmacology, Karolinska Institute, Stockholm, Sweden
| | - Jesper Eriksson
- Department of Perioperative Medicine and Intensive Care, Karolinska University Hospital, Solna, Stockholm, Sweden
- Section of Anaesthesiology and Intensive Care Medicine, Department of Physiology and Pharmacology, Karolinska Institute, Stockholm, Sweden
| | - Mikael Eriksson
- Department of Anaesthesia and Intensive Care, Uppsala University Hospital, Uppsala, Sweden
- Department of Surgical Sciences, Anaesthesia and Intensive Care, Uppsala University, Uppsala, Sweden
| | - Johan Mårtensson
- Department of Perioperative Medicine and Intensive Care, Karolinska University Hospital, Solna, Stockholm, Sweden
- Section of Anaesthesiology and Intensive Care Medicine, Department of Physiology and Pharmacology, Karolinska Institute, Stockholm, Sweden
| | - Emma Larsson
- Department of Perioperative Medicine and Intensive Care, Karolinska University Hospital, Solna, Stockholm, Sweden
- Section of Anaesthesiology and Intensive Care Medicine, Department of Physiology and Pharmacology, Karolinska Institute, Stockholm, Sweden
| | - Anders Oldner
- Department of Perioperative Medicine and Intensive Care, Karolinska University Hospital, Solna, Stockholm, Sweden
- Section of Anaesthesiology and Intensive Care Medicine, Department of Physiology and Pharmacology, Karolinska Institute, Stockholm, Sweden
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Elder GJ, Santhi N, Robson AR, Alfonso-Miller P, Spiegelhalder K, Ellis JG. An online behavioral self-help intervention rapidly improves acute insomnia severity and subjective mood during the coronavirus disease-2019 pandemic: a stratified randomized controlled trial. Sleep 2024; 47:zsae059. [PMID: 38430544 PMCID: PMC11168762 DOI: 10.1093/sleep/zsae059] [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: 10/06/2023] [Revised: 02/20/2024] [Indexed: 03/04/2024] Open
Abstract
STUDY OBJECTIVES Stressful life events, such as the coronavirus disease-2019 (COVID-19) pandemic, can cause acute insomnia. Cognitive behavioral therapy for acute insomnia is effective but is both time and resource-intensive. This study investigated if an online behavioral self-help intervention, which has been successfully used alongside sleep restriction for acute insomnia, reduced insomnia severity and improved mood in acute insomnia. This study also assessed good sleepers to explore if a "sleep vaccination" approach was feasible. METHODS In this online stratified randomized controlled trial, 344 participants (103 good sleepers and 241 participants with DSM-5 acute insomnia) were randomized to receive the intervention/no intervention (good sleepers) or intervention/intervention after 28 days (poor sleepers). Insomnia severity was assessed using the ISI (primary outcome), and anxiety and depression using the GAD-7/PHQ-9 (secondary outcomes) at baseline, 1 week, 1 month, and 3-month follow-up. RESULTS In people with acute insomnia, relative to baseline, there were significant reductions in ISI (dz = 1.17), GAD-7 (dz = 0.70), and PHQ-9 (dz = 0.60) scores at 1-week follow-up. ISI, GAD-7, and PHQ-9 scores were significantly lower at all follow-up time points, relative to baseline. Subjective diary-derived sleep continuity was unaffected. No beneficial effects on sleep or mood were observed in good sleepers. CONCLUSIONS An online behavioral self-help intervention rapidly reduces acute insomnia severity (within 1 week), and benefits mood in people with acute insomnia. These beneficial effects are maintained up to 3 months later. Although the use of the intervention is feasible in good sleepers, their subjective sleep was unaffected. CLINICAL TRIAL REGISTRATION Testing an early online intervention for the treatment of disturbed sleep during the COVID-19 pandemic; prospectively registered at ISRCTN on 8 April 2020 (identifier: ISRCTN43900695).
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Affiliation(s)
- Greg J Elder
- Northumbria Sleep Research, Northumbria University, Newcastle upon Tyne, UK
| | - Nayantara Santhi
- Northumbria Sleep Research, Northumbria University, Newcastle upon Tyne, UK
| | - Amelia R Robson
- Northumbria Sleep Research, Northumbria University, Newcastle upon Tyne, UK
| | | | - Kai Spiegelhalder
- Department of Psychiatry and Psychotherapy, Faculty of Medicine, Medical Center - University of Freiburg, Freiburg, Germany
| | - Jason G Ellis
- Northumbria Sleep Research, Northumbria University, Newcastle upon Tyne, UK
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Hirohama K, Imura T, Hori T, Deguchi N, Mitsutake T, Tanaka R. The effects of nonpharmacological sleep hygiene on sleep quality in nonelderly individuals: A systematic review and network meta-analysis of randomized controlled trials. PLoS One 2024; 19:e0301616. [PMID: 38837997 DOI: 10.1371/journal.pone.0301616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Accepted: 03/19/2024] [Indexed: 06/07/2024] Open
Abstract
The prevalence of locomotive syndrome naturally increases with age, but approximately half of nonelderly individuals also meet the criteria for locomotive syndrome, suggesting that even younger people need to pay attention to their own health status. Sleep is important for physical, cognitive, and psychological health. Some individuals with poor sleep quality may be at risk of developing negative health status. Although the effects of sleep hygiene strategies for elderly individuals have been well investigated, optimal nonpharmacological sleep hygiene strategies for improving sleep quality in nonelderly individuals has not been identified. We conducted a systematic review and network meta-analysis (NMA) of randomized controlled trials aimed to elucidate the effects of various nonpharmacological interventions on sleep quality in nonelderly individuals and to identify the optimal intervention. Cochrane Central Register of Controlled Trials, Medline, Cumulative Index to Nursing and Allied Health Literature, Physiotherapy Evidence Database, and Scopus were comprehensively searched. We identified 27 studies focusing on the effects of various nonpharmacological sleep hygiene strategies in nonelderly individuals, and 24 studies were applied into NMA. The present results showed that resistance training was the most effective intervention for improving sleep quality in nonelderly individuals. In addition, this study revealed the effects of nonpharmacological interventions, such as physical activity, nutritional intervention, as well as exercise interventions. This is the first report that utilized NMA to compare the effects of various nonpharmacological interventions on sleep quality in nonelderly individuals.
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Affiliation(s)
- Kenta Hirohama
- Graduate School of Humanities and Social Sciences, Hiroshima University, Hiroshima, Japan
- Department of Rehabilitation, Sakamidorii Hospital, Hiroshima, Japan
| | - Takeshi Imura
- Department of Rehabilitation, Faculty of Health Sciences, Hiroshima Cosmopolitan University, Hiroshima, Japan
| | - Tomonari Hori
- Graduate School of Humanities and Social Sciences, Hiroshima University, Hiroshima, Japan
- Department of Rehabilitation, Fukuyama Rehabilitation Hospital, Fukuyama, Japan
| | - Naoki Deguchi
- Graduate School of Humanities and Social Sciences, Hiroshima University, Hiroshima, Japan
- Research Team for Promoting Independence and Mental Health, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Itabashi, Tokyo, Japan
| | | | - Ryo Tanaka
- Graduate School of Humanities and Social Sciences, Hiroshima University, Hiroshima, Japan
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Mayer G, Frohnhofen H, Jokisch M, Hermann DM, Gronewold J. Associations of sleep disorders with all-cause MCI/dementia and different types of dementia - clinical evidence, potential pathomechanisms and treatment options: A narrative review. Front Neurosci 2024; 18:1372326. [PMID: 38586191 PMCID: PMC10995403 DOI: 10.3389/fnins.2024.1372326] [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: 01/17/2024] [Accepted: 03/11/2024] [Indexed: 04/09/2024] Open
Abstract
Due to worldwide demographic change, the number of older persons in the population is increasing. Aging is accompanied by changes of sleep structure, deposition of beta-amyloid (Aß) and tau proteins and vascular changes and can turn into mild cognitive impairment (MCI) as well as dementia. Sleep disorders are discussed both as a risk factor for and as a consequence of MCI/dementia. Cross-sectional and longitudinal population-based as well as case-control studies revealed sleep disorders, especially sleep-disorderded breathing (SDB) and excessive or insufficient sleep durations, as risk factors for all-cause MCI/dementia. Regarding different dementia types, SDB was especially associated with vascular dementia while insomnia/insufficient sleep was related to an increased risk of Alzheimer's disease (AD). Scarce and still inconsistent evidence suggests that therapy of sleep disorders, especially continuous positive airway pressure (CPAP) in SDB, can improve cognition in patients with sleep disorders with and without comorbid dementia and delay onset of MCI/dementia in patients with sleep disorders without previous cognitive impairment. Regarding potential pathomechanisms via which sleep disorders lead to MCI/dementia, disturbed sleep, chronic sleep deficit and SDB can impair glymphatic clearance of beta-amyloid (Aß) and tau which lead to amyloid deposition and tau aggregation resulting in changes of brain structures responsible for cognition. Orexins are discussed to modulate sleep and Aß pathology. Their diurnal fluctuation is suppressed by sleep fragmentation and the expression suppressed at the point of hippocampal atrophy, contributing to the progression of dementia. Additionally, sleep disorders can lead to an increased vascular risk profile and vascular changes such as inflammation, endothelial dysfunction and atherosclerosis which can foster neurodegenerative pathology. There is ample evidence indicating that changes of sleep structure in aging persons can lead to dementia and also evidence that therapy of sleep disorder can improve cognition. Therefore, sleep disorders should be identified and treated early.
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Affiliation(s)
- Geert Mayer
- Department of Neurology, Philipps-Universität Marburg, Marburg, Germany
| | - Helmut Frohnhofen
- Department of Orthopedics and Trauma Surgery, University Hospital Düsseldorf, Heinrich Heine University, Düsseldorf, Germany
- Department of Medicine, Geriatrics, Faculty of Health, University Witten-Herdecke, Witten, Germany
| | - Martha Jokisch
- Department of Neurology and Center for Translational Neuro-and Behavioral Sciences (C-TNBS), University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Dirk M. Hermann
- Department of Neurology and Center for Translational Neuro-and Behavioral Sciences (C-TNBS), University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Janine Gronewold
- Department of Neurology and Center for Translational Neuro-and Behavioral Sciences (C-TNBS), University Hospital Essen, University Duisburg-Essen, Essen, Germany
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Daniel LC, Wang H, Brinkman TM, Ruble K, Zhou ES, Palesh O, Stremler R, Howell R, Mulrooney DA, Crabtree VM, Mostoufi-Moab S, Oeffinger K, Neglia J, Yasui Y, Armstrong GT, Krull K. Mechanisms of sleep disturbances in long-term cancer survivors: a childhood cancer survivor study report. JNCI Cancer Spectr 2024; 8:pkae010. [PMID: 38366608 PMCID: PMC10932943 DOI: 10.1093/jncics/pkae010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 01/26/2024] [Accepted: 02/10/2024] [Indexed: 02/18/2024] Open
Abstract
BACKGROUND Sleep problems following childhood cancer treatment may persist into adulthood, exacerbating cancer-related late effects and putting survivors at risk for poor physical and psychosocial functioning. This study examines sleep in long-term survivors and their siblings to identify risk factors and disease correlates. METHODS Childhood cancer survivors (≥5 years from diagnosis; n = 12 340; 51.5% female; mean [SD] age = 39.4 [9.6] years) and siblings (n = 2395; 57.1% female; age = 44.6 [10.5] years) participating in the Childhood Cancer Survivor Study completed the Pittsburgh Sleep Quality Index (PSQI). Multivariable Poisson-error generalized estimating equation compared prevalence of binary sleep outcomes between survivors and siblings and evaluated cancer history and chronic health conditions (CHC) for associations with sleep outcomes, adjusting for age (at diagnosis and current), sex, race/ethnicity, and body mass index. RESULTS Survivors were more likely to report clinically elevated composite PSQI scores (>5; 45.1% vs 40.0%, adjusted prevalence ratio [PR] = 1.20, 95% CI = 1.13 to 1.27), symptoms of insomnia (38.8% vs 32.0%, PR = 1.26, 95% CI = 1.18 to 1.35), snoring (18.0% vs 17.4%, PR = 1.11, 95% CI = 1.01 to 1.23), and sleep medication use (13.2% vs 11.5%, PR = 1.28, 95% CI = 1.12 to 1.45) compared with siblings. Within cancer survivors, PSQI scores were similar across diagnoses. Anthracycline exposure (PR = 1.13, 95% CI = 1.03 to 1.25), abdominal radiation (PR = 1.16, 95% CI = 1.04 to 1.29), and increasing CHC burden were associated with elevated PSQI scores (PRs = 1.21-1.48). CONCLUSIONS Among survivors, sleep problems were more closely related to CHC than diagnosis or treatment history, although longitudinal research is needed to determine the direction of this association. Frequent sleep-promoting medication use suggests interest in managing sleep problems; behavioral sleep intervention is advised for long-term management.
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Affiliation(s)
- Lauren C Daniel
- Department of Psychology, Rutgers University Camden, Camden, NJ, USA
| | - Huiqi Wang
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN, USA
| | - Tara M Brinkman
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN, USA
- Department of Psychology and Biobehavioral Sciences, St. Jude Children’s Research Hospital, Memphis, TN, USA
| | - Kathy Ruble
- Department of Oncology, Johns Hopkins University, Baltimore, MD, USA
| | - Eric S Zhou
- Division of Sleep Medicine and Department of Psychiatry, Harvard Medical School, Boston, MA, USA
- Department of Pediatrics, Dana Farber Cancer Institute, Boston, MA, USA
| | - Oxana Palesh
- Department of Psychiatry, Virginia Commonwealth University Massey Cancer Center, Richmond, VA, USA
| | - Robyn Stremler
- Lawrence Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
| | - Rebecca Howell
- Department of Radiation Physics, MD Anderson, Houston, TX, USA
| | - Daniel A Mulrooney
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN, USA
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, TN, USA
| | - Valerie M Crabtree
- Department of Psychology and Biobehavioral Sciences, St. Jude Children’s Research Hospital, Memphis, TN, USA
| | - Sogol Mostoufi-Moab
- Division of Oncology, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Pediatrics, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA, USA
| | - Kevin Oeffinger
- Department of Medicine, Duke University and Duke Cancer Institute, Durham, NC, USA
| | - Joseph Neglia
- Department of Pediatrics, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Yutaka Yasui
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN, USA
| | - Gregory T Armstrong
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN, USA
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, TN, USA
| | - Kevin Krull
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN, USA
- Department of Psychology and Biobehavioral Sciences, St. Jude Children’s Research Hospital, Memphis, TN, USA
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Liu L, Yin P, Dong Y, Fan Q, Huai Y, Zhang S, Lv S, Wang X, Chen Y. Neurological mechanism and efficacy of acupuncture for breast cancer-related insomnia: a study protocol for randomized clinical trial. Front Neurol 2023; 14:1278564. [PMID: 38187141 PMCID: PMC10771825 DOI: 10.3389/fneur.2023.1278564] [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: 08/16/2023] [Accepted: 12/04/2023] [Indexed: 01/09/2024] Open
Abstract
Background Breast cancer survivors (BCSs) are at a higher risk of developing insomnia. The negative effects of cancer-related insomnia (CRI) include depression, anxiety, fatigue, aggressive pain, impaired immune functioning, decreased quality of life, and even increased cancer mortality. Although preliminary progress has been made in the treatment of CRI with acupuncture, the evidence is insufficient and the neurological mechanism underlying the effect of acupuncture is still unclear. Methods The study employs a single-blinded, randomized, controlled trial design. A total of 80 participants will be randomly allocated in a 1:1 ratio to either the treatment group (n = 40) or the control group (n = 40). The former will receive acupuncture treatment, while the latter will receive sham acupuncture treatment. Both groups will receive 12 sessions over a 4-week period, three times per week (every other day), and each session will last for 30 min. Follow-up assessments will be conducted in week 8. The primary outcome will be the treatment response rate. Secondary outcomes include the change in Insomnia Severity Index (ISI), the treatment remission rate, actigraphy sleep assessment, Generalized Anxiety Disorder Scale (GAD-7), Patient Health Questionnaire-9 (PHQ-9), Quality of Life Core Scale (QLQ-C30), the weekly usage of remedial drugs, and functional magnetic resonance imaging (fMRI) analysis. Data for the outcomes will be collected at week 0 (the baseline), week 1 (the intervention period), week 4 (the post-treatment period), and week 8 (the follow-up period). Discussion The objective of this study is to assess the efficacy of acupuncture for patients with CRI in comparison with sham acupuncture. Additionally, the research aims to explore the neuropathological mechanisms of CRI and provide the first evidence on the characteristics of acupuncture treatment using fMRI. We expect that the results of this study will provide valuable scientific evidence of acupuncture treatment for CRI.Clinical trial registration: Chinese Clinical Trial Registry, identifier ChiCTR2300070349: https://www.chictr.org.cn/showproj.html?proj=188677.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Yuelai Chen
- LongHua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai, China
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Lin CL, Su MC, Kao CH, Lin CL, Yang TY. Estimating the incidence rate ratio of common cold among patients with non-apnea sleep disorders: a retrospective cohort study. PSYCHOL HEALTH MED 2023; 28:2897-2907. [PMID: 35282723 DOI: 10.1080/13548506.2022.2050269] [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: 09/02/2020] [Accepted: 03/01/2022] [Indexed: 10/18/2022]
Abstract
The purpose was to explore the potential effects of nonapnea sleep disorders (NSDs) and hypnotic use on the incidence of common cold. This study adapted population-based retrospective cohort study designed. We used the data from the Taiwan National Health Insurance Research Database between 1998 and 2011. In total, 59,476 patients with NSDs were included in the study cohort, and the reference cohort comprised 59,476 propensity score-matched patients. We conducted a Poisson regression analysis to assess the incidence of common cold. The overall incidence of common cold was significantly higher than that in the reference cohort. Compared with the patients of the reference cohort without hypnotic use, those of the NSDs cohort with benzodiazepines and zolpidem use had higher incidence of common cold. In conclusion, study cohort had a higher incidence of developing common cold, and particularly pronounced in NSDs with hypnotic use.
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Affiliation(s)
- Chia-Ling Lin
- Department of Nursing, Chang Gung University of Science and Technology, Taoyuan, Taiwan
| | - Mei-Chen Su
- Department of Nursing, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
| | - Chia-Hung Kao
- Department of Medicine, China Medical University, Taichung, Taiwan
| | - Cheng-Li Lin
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
| | - Tse-Yen Yang
- Department of Medical Research, China Medical University Hospital, Taichung, Taiwan
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10
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El-Solh AA, Lawson Y, Wilding GE. Association Between Hypnotic Use and All-Cause Mortality in Patients with Chronic Obstructive Pulmonary Disease and Insomnia. Int J Chron Obstruct Pulmon Dis 2023; 18:2393-2404. [PMID: 37942297 PMCID: PMC10629458 DOI: 10.2147/copd.s430609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 10/27/2023] [Indexed: 11/10/2023] Open
Abstract
Purpose Hypnotics are commonly prescribed in patients with COPD to manage insomnia. Given the considerable risks associated with these drugs, the aim of the study was to evaluate the risk of all-cause mortality associated with hypnotics in a cohort of veterans with COPD presenting with insomnia. Methods We conducted a retrospective cohort study that used Veterans Health Administration Corporate Data Warehouse with data supplemented by linkage to Medicare, Medicaid, and National Death Index data from 2010 through 2019. The primary outcome was all-cause mortality. Analyses were conducted using propensity score 1:1 matching to balance baseline characteristics. Results Of the 5759 veterans with COPD (mean [SD] age, 71.7 [11.2]; 92% men), 3585 newly initiated hypnotic agents during the study period. During a mean follow-up of 7.4 (SD, 2.7) years, a total of 2301 deaths occurred, with 65.2 and 48.7 total deaths per 1000 person-years among hypnotic users and nonusers, respectively. After propensity matching, hypnotic use was associated with a 22% increased risk of mortality compared with hypnotic nonusers (hazard ratio [HR] 1.22; 95% confidence interval [CI],1.11-1.35). The benzodiazepine receptor agonists (BZRAs) group experienced a higher incidence rate of all-cause mortality compared to hypnotic nonusers (Incidence rate ratio [IRR] 1.27; 95% CI, 1.14-1.43). Conversely, the mortality rate of non-BZRA hypnotics decreased after the first 2 years and was not significantly different for hypnotic nonusers (IRR 1.04; 95% CI, 0.82-1.11). Conclusion Among patients with COPD and insomnia, treatment with hypnotics was associated with a higher risk of all-cause mortality. The association was observed in patients prescribed BZRAs. The risk of mortality for non-BZRAs moderated after the first 2 years, indicating a class effect.
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Affiliation(s)
- Ali A El-Solh
- Research Department, VA Western New York Healthcare System, Buffalo, NY, USA
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine; Jacobs School of Medicine, Buffalo, NY, USA
- Department of Epidemiology and Environmental Health, School of Public Health and Health Professions; University at Buffalo, Buffalo, NY, USA
| | - Yolanda Lawson
- Research Department, VA Western New York Healthcare System, Buffalo, NY, USA
| | - Gregory E Wilding
- Department of Biostatistics, School of Public Health and Health Professions; University at Buffalo, Buffalo, NY, USA
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11
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Mayer G, Stenmanns C, Doeppner TR, Hermann DM, Gronewold J. [Sleep and dementia]. Z Gerontol Geriatr 2023; 56:556-560. [PMID: 37676320 DOI: 10.1007/s00391-023-02237-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/10/2023] [Indexed: 09/08/2023]
Abstract
Aging is associated with changes in sleep structure and cerebral deposition of amyloid beta and tau proteins. Sleep disturbances precede the onset of dementia by years. Comorbid sleep disorders, such as insomnia and sleep-disordered breathing, a family history of dementia and epigenetic factors can contribute to the development of dementia. This article explores the question of the interaction between sleep and dementia based on the existing literature. Alterations caused by slow wave sleep lead to changes in the glymphatic clearance of amyloid beta, tau proteins and other proteins. Transient and chronic sleep disorders cause disturbances in the brain areas responsible for cognition and behavior. Sleep-regulating brain areas are the first to be affected in the neurodegenerative process and accelerate the risk of dementia. Circadian age-related changes in amyloid beta and tau proteins affect the amount and depth of sleep and vice versa. Amyloid beta in cerebrospinal fluid shows an inverse correlation with sleep. Orexins modulate amyloid beta and sleep.
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Affiliation(s)
- Geert Mayer
- Philipps-Universität Marburg, Marburg, Deutschland.
- , Privatweg 2, 34582, Borken, Deutschland.
| | - Carla Stenmanns
- Klinik für Orthopädie und Unfallchirurgie, Altersmedizin, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Deutschland
| | - Thorsten R Doeppner
- Klinik für Neurologie, Universitätsklinkum Gießen und Marburg, Gießen, Deutschland
| | - Dirk M Hermann
- Klinik für Neurologie, Universitätsklinikum Essen, Essen, Deutschland
| | - Janine Gronewold
- Klinik für Neurologie, Universitätsklinikum Essen, Essen, Deutschland
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12
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Arimoto N, Nishimura R, Kobayashi T, Asaeda M, Naito T, Kojima M, Umemura O, Yokota M, Hanada N, Kawamura T, Wakai K, Naito M. Effects of oral health-related quality of life on total mortality: a prospective cohort study. BMC Oral Health 2023; 23:708. [PMID: 37789315 PMCID: PMC10548558 DOI: 10.1186/s12903-023-03451-8] [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: 02/07/2023] [Accepted: 09/25/2023] [Indexed: 10/05/2023] Open
Abstract
BACKGROUND The effects of oral health on mortality have been reported; however, the association between mortality and Oral Health-Related Quality of Life (OHQOL) is unknown. We investigated the effect of OHQOL on total mortality in a cohort consisting of dentists. METHODS In this cohort study, we analyzed data from the Longitudinal Evaluation of Multi-phasic, Odonatological and Nutritional Associations in Dentists study. We conducted a baseline survey of general and oral health factors. We called for 31,178 participants and collected responses from 10,256 participants. We followed up with 10,114 participants (mean age ± standard deviation, 52.4 ± 12.1 years; females, 8.9%) for 7.7 years, until March 2014, to determine the average total mortality. OHQOL was assessed using the General Oral Health Assessment Index (GOHAI). The total score was divided into quartiles (Q1 ≤ 51.6, Q2 = 51.7-56.7, Q3 = 56.8-59.9, and Q4 = 60.0), with higher GOHAI scores indicating better OHQOL (score range, 12-60). The association between OHQOL and total mortality was analyzed using the Cox proportional hazards model. RESULTS We documented 460 deaths. Males with low GOHAI scores possessed a remarkably high risk of total mortality. The multivariate adjusted-hazard ratios (aHRs), were 1.93 (95% confidence interval [CI], 1.07 - 3.48) for Q1, 1.69 (95% CI, 0.90 - 3.17) for Q2, and 0.65 (95% CI, 0.29 - 1.46) for Q3, relative to Q4 (trend p = 0.001). The aHRs in the multivariate model with all background variables were 1.69 (95% CI, 1.15-2.46) for Q1, 1.53 (95% CI, 1.04-2.27) for Q2, and 1.09 (95% CI, 0.71-1.70) for Q3, relative to Q4 (trend p = 0.001). In females, there was no significant association between the quartiles, in both the multivariate-adjusted model (trend p = 0.52) and multivariate-adjusted model with all background variables (trend p = 0.79). CONCLUSIONS A lower OHQOL indicated an increased risk of total mortality in dentists. OHQOL may be used as an indicator for selecting treatment plans and personalized care interventions, thus contributing to increased healthy life expectancy. TRIAL REGISTRATION Aichi Cancer Center, Nagoya University Graduate School of Medicine, and Hiroshima University (Approval numbers: 33, 632-3, 8-21, and E2019-1603).
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Affiliation(s)
- Nishiki Arimoto
- Department of Oral Epidemiology, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan.
| | - Rumi Nishimura
- Department of Oral Epidemiology, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Teruo Kobayashi
- Department of Dentistry and Oral Surgery, Asahi General Hospital, Asahi, Chiba, Japan
| | - Mayuka Asaeda
- Department of Oral Health, Faculty of Health Sciences, Kobe Tokiwa University, Kobe, Hyogo, Japan
| | - Toru Naito
- Section of Geriatric Dentistry, Department of General Dentistry, Fukuoka Dental College, Fukuoka, Japan
| | | | | | | | - Nobuhiro Hanada
- Photocatalysis International Research Center, University of Shanghai for Science and Technology, Shanghai, P.R. China
| | - Takashi Kawamura
- Department of Preventive Services, Kyoto University School of Public Health, Kyoto, Japan
| | - Kenji Wakai
- Department of Preventive Medicine, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Mariko Naito
- Department of Oral Epidemiology, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
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Rosenqvist TW, Osler M, Wium-Andersen MK, Wium-Andersen IK. Sedative drug-use in Denmark, 2000 to 2019: a nationwide drug utilization study. Soc Psychiatry Psychiatr Epidemiol 2023; 58:1493-1502. [PMID: 36562827 DOI: 10.1007/s00127-022-02409-5] [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: 05/27/2022] [Accepted: 12/12/2022] [Indexed: 12/24/2022]
Abstract
AIM To describe trends in and characteristics of sedative drug use from 2000 through 2019 in relation to the introduction of central regulations and new drugs. METHODS In this descriptive study, we used individual prescription data on the entire Danish population from the Danish National Prescription Registry to calculate yearly incidence and prevalence of use of benzodiazepines, benzodiazepine-related drugs (Z-drugs), melatonin, olanzapine, low-dose quetiapine, mianserin/mirtazapine, pregabalin, and promethazine from 2000 through 2019. From the Danish National Patient Registry, we obtained data on drug users' psychiatric and somatic comorbidity. RESULTS The use of benzodiazepines and Z-drugs declined gradually from 2000 through 2019, whereas the newer alternatives, melatonin, low-dose quetiapine, pregabalin and promethazine, increased in use, while the use of olanzapine and mianserin/mirtazapine was relatively stable. This development was seen in both men and women and across all age groups except for hypnotic benzodiazepines which showed a steep increase in the oldest age group from 2010. For all sedative drugs depression, anxiety, alcohol and misuse disorder, pain and cancer were the most prevalent comorbidities. During our study period, the number of individuals without any of the selected diagnoses increased. CONCLUSION In Denmark different central regulations have influenced prescription practice toward more restrictive use of Z-drugs and benzodiazepines, except for hypnotic benzodiazepine prescriptions increased after the introduction of special palliative care. An increase in use of newer sedative drugs, however, indicates that the regulations do not remove the need for sedative drugs in the population.
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Affiliation(s)
- Thomas Wolff Rosenqvist
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospitals, Nordre Fasanvej 57, 2000, Frederiksberg, Denmark.
| | - Merete Osler
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospitals, Nordre Fasanvej 57, 2000, Frederiksberg, Denmark
- Section of Epidemiology, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, 1014, Copenhagen K, Denmark
| | - Marie Kim Wium-Andersen
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospitals, Nordre Fasanvej 57, 2000, Frederiksberg, Denmark
| | - Ida Kim Wium-Andersen
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospitals, Nordre Fasanvej 57, 2000, Frederiksberg, Denmark
- Psychiatric Centre Copenhagen, Dept. O, Rigshospital, Edel Sauntes Allé 10, 2100, Copenhagen Ø, Denmark
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El-Solh AA, Lawson Y, Wilding GE. The risk of major adverse cardiovascular events associated with the use of hypnotics in patients with insomnia. Sleep Health 2023; 9:717-725. [PMID: 37393143 DOI: 10.1016/j.sleh.2023.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 04/19/2023] [Accepted: 05/05/2023] [Indexed: 07/03/2023]
Abstract
OBJECTIVES To examine whether hypnotic use in patients with insomnia reduces major adverse cardiovascular events, including all-cause mortality and nonfatal major adverse cardiovascular events. METHODS Using the Veterans Affairs Corporate Data Warehouse, we conducted a retrospective cohort study of 16,064 patients who were newly diagnosed with insomnia between January 1, 2010, and December 31, 2019. A pair of 3912 hypnotic users and nonusers were selected based on a 1:1 propensity score methodology. The primary outcome was extended major adverse cardiovascular events, a composite of the first occurrence of all-cause mortality or nonfatal major adverse cardiovascular events. RESULTS During the median follow-up of 4.8 years, a total of 2791 composite events occurred, including 2033 deaths and 762 nonfatal major adverse cardiovascular events. Although the incidence rates of major adverse cardiovascular events were comparable between hypnotic users and nonusers in the propensity-matched cohort, users of benzodiazepines and Z-drugs had a higher risk of all-cause mortality (hazard ratio 1.47 [95% CI, 1.17-1.88] and 1.20 [95% CI, 1.03-1.39], respectively), while serotonin antagonist and reuptake inhibitors users had a survival advantage (hazard ratio 0.79 [95% CI, 0.69-0.91]) compared with nonusers. There were no differences in the risk of nonfatal major adverse cardiovascular events between all classes of hypnotics. Male patients and those aged 60 years or younger who were using benzodiazepines or Z-drugs experienced higher major adverse cardiovascular events than their counterparts. CONCLUSIONS In patients with newly diagnosed insomnia, treatment with hypnotics resulted in higher extended major adverse cardiovascular events but not nonfatal major adverse cardiovascular events with benzodiazepine and Z-drug users compared with nonusers. The use of serotonin antagonist and reuptake inhibitors agents had a protective effect against major adverse cardiovascular events warranting further investigation.
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Affiliation(s)
- Ali A El-Solh
- The Veterans Affairs Western New York Healthcare System, Western New York Respiratory Research Center, Division of Pulmonary, Critical Care, and Sleep Medicine, Buffalo, NY, USA; Department of Medicine, Jacobs School of Medicine and Biomedical Sciences and School of Public Health and Health Professions, Buffalo, NY, USA; Department of Epidemiology and Environmental Health, Jacobs School of Medicine and Biomedical Sciences and School of Public Health and Health Professions, Buffalo, NY, USA.
| | - Yolanda Lawson
- The Veterans Affairs Western New York Healthcare System, Western New York Respiratory Research Center, Division of Pulmonary, Critical Care, and Sleep Medicine, Buffalo, NY, USA.
| | - Gregory E Wilding
- Department of Biostatistics; Jacobs School of Medicine and Biomedical Sciences and School of Public Health and Health Professions, Buffalo, CY, USA.
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15
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Cornwell AC, Tisdale AA, Venkat S, Maraszek KE, Alahmari AA, George A, Attwood K, George M, Rempinski D, Franco-Barraza J, Seshadri M, Parker MD, Cortes Gomez E, Fountzilas C, Cukierman E, Steele NG, Feigin ME. Lorazepam Stimulates IL6 Production and Is Associated with Poor Survival Outcomes in Pancreatic Cancer. Clin Cancer Res 2023; 29:3793-3812. [PMID: 37587561 PMCID: PMC10502465 DOI: 10.1158/1078-0432.ccr-23-0547] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 05/31/2023] [Accepted: 07/19/2023] [Indexed: 08/18/2023]
Abstract
PURPOSE This research investigates the association between benzodiazepines (BZD) and cancer patient survival outcomes, the pancreatic cancer tumor microenvironment, and cancer-associated fibroblast (CAF) signaling. EXPERIMENTAL DESIGN Multivariate Cox regression modeling was used to retrospectively measure associations between Roswell Park cancer patient survival outcomes and BZD prescription records. IHC, H&E, Masson's trichrome, RNAscope, and RNA sequencing were used to evaluate the impact of lorazepam (LOR) on the murine PDAC tumor microenvironment. ELISA and qPCR were used to determine the impact of BZDs on IL6 expression or secretion by human-immortalized pancreatic CAFs. PRESTO-Tango assays, reanalysis of PDAC single-cell sequencing/TCGA data sets, and GPR68 CRISPRi knockdown CAFs were used to determine the impact of BZDs on GPR68 signaling. RESULTS LOR is associated with worse progression-free survival (PFS), whereas alprazolam (ALP) is associated with improved PFS, in pancreatic cancer patients receiving chemotherapy. LOR promotes desmoplasia (fibrosis and extracellular matrix protein deposition), inflammatory signaling, and ischemic necrosis. GPR68 is preferentially expressed on human PDAC CAFs, and n-unsubstituted BZDs, such as LOR, significantly increase IL6 expression and secretion in CAFs in a pH and GPR68-dependent manner. Conversely, ALP and other GPR68 n-substituted BZDs decrease IL6 in human CAFs in a pH and GPR68-independent manner. Across many cancer types, LOR is associated with worse survival outcomes relative to ALP and patients not receiving BZDs. CONCLUSIONS We demonstrate that LOR stimulates fibrosis and inflammatory signaling, promotes desmoplasia and ischemic necrosis, and is associated with decreased pancreatic cancer patient survival.
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Affiliation(s)
- Abigail C. Cornwell
- Department of Pharmacology and Therapeutics, Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - Arwen A. Tisdale
- Department of Pharmacology and Therapeutics, Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - Swati Venkat
- Department of Pharmacology and Therapeutics, Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - Kathryn E. Maraszek
- Department of Pharmacology and Therapeutics, Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - Abdulrahman A. Alahmari
- Department of Pharmacology and Therapeutics, Roswell Park Comprehensive Cancer Center, Buffalo, New York
- Department of Medical Laboratory Sciences, College of Applied Medical Sciences, Prince Sattam Bin Abdulaziz University, Alkharj, Saudi Arabia
| | - Anthony George
- Department of Biostatistics and Bioinformatics, Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - Kristopher Attwood
- Department of Biostatistics and Bioinformatics, Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - Madison George
- Department of Surgery, Henry Ford Pancreatic Cancer Center, Henry Ford Health, Detroit, Michigan
| | - Donald Rempinski
- Department of Surgery, Henry Ford Pancreatic Cancer Center, Henry Ford Health, Detroit, Michigan
| | - Janusz Franco-Barraza
- Cancer Signaling and Microenvironment Program, Institute for Cancer Research, Fox Chase Cancer Center, Philadelphia, Pennsylvania
- Marvin and Concetta Greenberg Pancreatic Cancer Institute, Institute for Cancer Research, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - Mukund Seshadri
- Department of Oral Oncology, Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - Mark D. Parker
- Department of Physiology and Biophysics, University at Buffalo, Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York
- Department of Ophthalmology, University at Buffalo, Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York
| | - Eduardo Cortes Gomez
- Department of Biostatistics and Bioinformatics, Roswell Park Comprehensive Cancer Center, Buffalo, New York
- Department of Biostatistics, State University of New York at Buffalo, Buffalo, New York
| | - Christos Fountzilas
- Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - Edna Cukierman
- Cancer Signaling and Microenvironment Program, Institute for Cancer Research, Fox Chase Cancer Center, Philadelphia, Pennsylvania
- Marvin and Concetta Greenberg Pancreatic Cancer Institute, Institute for Cancer Research, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - Nina G. Steele
- Department of Surgery, Henry Ford Pancreatic Cancer Center, Henry Ford Health, Detroit, Michigan
| | - Michael E. Feigin
- Department of Pharmacology and Therapeutics, Roswell Park Comprehensive Cancer Center, Buffalo, New York
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16
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Sun Y, Tsai MK, Wen CP. Association of sleep duration and sleeping pill use with mortality and life expectancy: A cohort study of 484,916 adults. Sleep Health 2023; 9:354-362. [PMID: 37045661 DOI: 10.1016/j.sleh.2023.01.017] [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: 05/28/2022] [Revised: 01/15/2023] [Accepted: 01/31/2023] [Indexed: 04/14/2023]
Abstract
OBJECTIVES To compare mortality risk and life expectancy among individuals with different sleep durations and sleeping pill use. METHODS A cohort of 484,916 community-dwelling adults in Taiwan was recruited into a health screening program from 1994 to 2011. Subjects were categorized by daily sleep duration into 4 groups: extremely short (<4 hours), short (4-6 hours), medium (6-8 hours), and long (>8 hours). Cox proportional hazards models were used to investigate the associations of mortality risk with sleep duration and sleeping pill use. Models were adjusted for sociodemographic characteristics, lifestyle, and comorbidities. Life expectancy tables were calculated among sleeping pill users and nonusers with different sleep durations. RESULTS With 6- 8 hours of daily sleep, sleeping pill nonusers had the lowest mortality risk. Sleeping pill users, even with this optimal amount of sleep, had a 55% (p < .001, 95% CI, 1.38-1.73) higher mortality risk than nonusers. The life expectancy of 30-year-old male sleeping pill users with extremely short or long sleep durations was 12-13 years shorter than sleeping pill nonusers who had 6-8 hours of sleep. On average, life expectancy in individuals using sleeping pills (vs. nonusers) was shorter by 5.3 (95% CI, 4.10-6.32) years in men and 5.7 (95% CI, 5.28-7.98) years in women. CONCLUSIONS This study suggests that the use of sleeping pills is associated with an increased risk of mortality and shortened life expectancy, especially in extreme sleepers. Regular users should be aware of potential harms from sleeping pills.
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Affiliation(s)
- Yu Sun
- Department of Neurology, En Chu Kong Hospital, New Taipei City, Taiwan; Department of Neurology, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan.
| | - Min-Kuang Tsai
- Institute of Population Health Sciences, National Health Research Institutes, Miaoli, Taiwan
| | - Chi-Pang Wen
- Institute of Population Health Sciences, National Health Research Institutes, Miaoli, Taiwan; China Medical University, Taichung, Taiwan.
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17
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Dawson SC, Krakow B, Haynes PL, Rojo-Wissar DM, McIver ND, Ulibarri VA. Use of Sleep Aids in Insomnia: The Role of Time Monitoring Behavior. Prim Care Companion CNS Disord 2023; 25:22m03344. [PMID: 37227396 PMCID: PMC11166003 DOI: 10.4088/pcc.22m03344] [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: 05/26/2023] Open
Abstract
Objective: Over-the-counter (OTC) and prescription sleep medications are frequently used as treatments for chronic insomnia, despite risks and limited long-term efficacy. Investigating mechanisms underlying this predilection for pharmacotherapy may uncover strategies to decrease reliance on sleep aids. The objective of this study was to determine how time monitoring behavior (TMB; clock-watching) and associated frustration may interact with insomnia symptoms to drive the use of sleep aids. Methods: Patients (N = 4,886) presenting for care at a community-based, private sleep medical center between May 2003 and October 2013 completed the Insomnia Severity Index (ISI) and Time Monitoring Behavior-10 (TMB-10) and reported their frequency of sleep medication use (OTC and prescription, separately). Mediation analyses examined how clock-watching and related frustration could be associated with insomnia symptoms and medication use. Results: The relationship between TMB and sleep medication use was significantly explained by ISI (P < .05), in that TMB (especially related frustration) appears to aggravate insomnia, which in turn leads to sleep aid use. Similarly, but to a lesser extent, the relationship between ISI and sleep medication use was explained by TMB, in that ISI may lead to increased TMB, which may in turn lead to sleep aid use. Conclusions: TMB and the associated frustration it engenders may perpetuate a negative cycle of insomnia and sleep aid use. Future longitudinal and interventional research is necessary to examine the developmental course of these clinical symptoms and behaviors and to test whether decreasing frustration by limiting TMB reduces the proclivity for pharmacotherapy.
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Affiliation(s)
- Spencer C Dawson
- Department of Psychological and Brain Sciences, Indiana University, Bloomington, Indiana
| | - Barry Krakow
- Sleep and Human Health Institute, Savannah, Georgia
- Sleep Arts & Sciences, Savannah, Georgia
- Department of Psychiatry and Behavioral Health, Mercer University School of Medicine, Savannah, Georgia
- Corresponding author: Barry Krakow, MD, 211 Early St, Savannah, GA 31405
| | | | - Darlynn M Rojo-Wissar
- The Initiative on Stress, Trauma, and Resilience (STAR), Department of Psychiatry and Human Behavior, Center for Behavioral and Preventive Medicine, The Miriam Hospital, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Natalia D McIver
- Sleep and Human Health Institute, Savannah, Georgia
- Department of Orthopaedics and Rehabilitation, The University of New Mexico, Albuquerque, New Mexico
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Han H, Kim D, Kim JS, Kwac LK, Hyeon J, Oh J. A novel sleep aid device to reduce sleep latency using air-CO 2 mixed gas. Front Neurol 2023; 14:1163904. [PMID: 37251228 PMCID: PMC10213737 DOI: 10.3389/fneur.2023.1163904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 04/19/2023] [Indexed: 05/31/2023] Open
Abstract
Introduction Sleep is an indispensable component of human life. However, in modern times, the number of people suffering from sleep disorders, such as insomnia and sleep deprivation, has increased significantly. Therefore, to alleviate the discomfort to the patient due to lack of sleep, sleeping pills and various sleep aids are being introduced and used. However, sleeping drugs are prescribed only to a limited extent due to the side effects posed by them and resistance to such drugs developed by patients in the long term, and the majority of sleep aids are scientifically groundless products. This study aimed to develop a device that induced sleep by spraying a mixed gas of carbon dioxide and air to create an environment that could induce sleep, similar to the inside of a sealed vehicle, to control oxygen saturation in the body. Methods Based on the stipulated safety standards and the human tidal volume, the target concentration of carbon dioxide was determined to be of three types: 15,000, 20,000, and 25,000 ppm. After analyzing diverse structures for safely mixing gases, the most appropriate shape, the reserve tank, was selected as the best suited structure. Various variables, such as spraying angle and distance, flow rate, atmospheric temperature, and nozzle length, were comprehensively measured and tested. Furthermore based on this aspect, diffusion simulation of carbon dioxide concentration and actual experiments were conducted. To secure the stability and reliability of the developed product, an accredited test was performed to investigate the error rate of carbon dioxide concentration. Furthermore, clinical trials comprising polysomnography and questionnaires confirmed the effectiveness of the developed product not only in reducing sleep latency but also in enhancing the overall sleep quality. Results When the developed device was put to use in reality, sleep latency was decreased by 29.01%, on average, for those with a sleep latency of 5 min or more, compared to when the device was not in use. Moreover, the total sleep time was increased by 29.19 min, WASO was decreased by 13.17%, and sleep efficiency was increased by 5.48%. We also affirmed that the ODI and 90% ODI did not decrease when the device was used. Although different questions may be raised about the safety of using a gas such as carbon dioxide (CO2), the result that tODI was not reduced shows that sleep aids using CO2 mixtures do not adversely affect human health. Discussion The results of this study suggest a new method that can be used to treat sleep disorders including insomnia.
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Affiliation(s)
- Hyewon Han
- Department of Computer Engineering, Hongik University, Seoul, Republic of Korea
| | | | | | - Lee Ku Kwac
- Department of Carbon Convergence Engineering, Jeonju University, Jeonju, Republic of Korea
| | - Janghun Hyeon
- Semiconductor Research Institute, Korea University, Seoul, Republic of Korea
| | - Junhyoung Oh
- Institute for Business Research and Education, Korea University, Seoul, Republic of Korea
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Abstract
Despite sleep's fundamental role in maintaining and improving physical and mental health, many people get less than the recommended amount of sleep or suffer from sleeping disorders. This review highlights sleep's instrumental biological functions, various sleep problems, and sleep hygiene and lifestyle interventions that can help improve sleep quality. Quality sleep allows for improved cardiovascular health, mental health, cognition, memory consolidation, immunity, reproductive health, and hormone regulation. Sleep disorders, such as insomnia, sleep apnea, and circadian-rhythm-disorders, or disrupted sleep from lifestyle choices, environmental conditions, or other medical issues can lead to significant morbidity and can contribute to or exacerbate medical and psychiatric conditions. The best treatment for long-term sleep improvement is proper sleep hygiene through behavior and sleep habit modification. Recommendations to improve sleep include achieving 7 to 9 h of sleep, maintaining a consistent sleep/wake schedule, a regular bedtime routine, engaging in regular exercise, and adopting a contemplative practice. In addition, avoiding many substances late in the day can help improve sleep. Caffeine, alcohol, heavy meals, and light exposure later in the day are associated with fragmented poor-quality sleep. These sleep hygiene practices can promote better quality and duration of sleep, with corresponding health benefits.
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Elder GJ, Altena E, Palagini L, Ellis JG. Stress and the hypothalamic-pituitary-adrenal axis: How can the COVID-19 pandemic inform our understanding and treatment of acute insomnia? J Sleep Res 2023:e13842. [PMID: 36748346 DOI: 10.1111/jsr.13842] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 01/09/2023] [Accepted: 01/16/2023] [Indexed: 02/08/2023]
Abstract
Stress and sleep are very closely linked, and stressful life events can trigger acute insomnia. The ongoing COVID-19 pandemic is highly likely to represent one such stressful life event. Indeed, a wide range of cross-sectional studies demonstrate that the pandemic is associated with poor sleep and sleep disturbances. Given the high economic and health burden of insomnia disorder, strategies that can prevent and treat acute insomnia, and also prevent the transition from acute insomnia to insomnia disorder, are necessary. This narrative review outlines why the COVID-19 pandemic is a stressful life event, and why activation of the hypothalamic-pituitary-adrenal axis, as a biological marker of psychological stress, is likely to result in acute insomnia. Further, this review outlines how sleep disturbances might arise as a result of the COVID-19 pandemic, and why simultaneous hypothalamic-pituitary-adrenal axis measurement can inform the pathogenesis of acute insomnia. In particular, we focus on the cortisol awakening response as a marker of hypothalamic-pituitary-adrenal axis function, as cortisol is the end-product of the hypothalamic-pituitary-adrenal axis. From a research perspective, future opportunities include identifying individuals, or particular occupational or societal groups (e.g. frontline health staff), who are at high risk of developing acute insomnia, and intervening. From an acute insomnia treatment perspective, priorities include testing large-scale online behavioural interventions; examining if reducing the impact of stress is effective and, finally, assessing whether "sleep vaccination" can maintain good sleep health by preventing the occurrence of acute insomnia, by preventing the transition from acute insomnia to insomnia disorder.
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Affiliation(s)
- Greg J Elder
- Northumbria Sleep Research, Northumbria University, Newcastle upon Tyne, UK
| | - Ellemarije Altena
- Institut de Neurosciences Cognitives et Intégratives d'Aquitaine-UMR 5287 CNRS, Team Neuroimaging and Human Cognition, Université de Bordeaux, Bordeaux, France
| | - Laura Palagini
- Department of Neuroscience and Rehabilitation, Psychiatric Section University of Ferrara, Ferrara, Italy.,Department of Clinical and Experimental Medicine, Psychiatric Section, University of Pisa, Azienda Ospedaliera Universitaria Pisana (AOUP), Pisa, Italy
| | - Jason G Ellis
- Northumbria Sleep Research, Northumbria University, Newcastle upon Tyne, UK
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21
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Judge DJ, Miller CB, Bartlett DJ, Jomaa I, Wong KKW, Saini B, Semsarian CR, Espie CA, Kyle SD, Grunstein RR, Yee BJ, Marshall NS. Armodafinil to reduce the sleepiness related side-effects of sleep restriction therapy being used to treat insomnia disorder: An open label clinical trial pilot study compared with historical controls. J Sleep Res 2023; 32:e13699. [PMID: 36003019 PMCID: PMC10909410 DOI: 10.1111/jsr.13699] [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: 03/14/2022] [Revised: 06/27/2022] [Accepted: 06/29/2022] [Indexed: 02/03/2023]
Abstract
Sleep restriction therapy (SRT) is an effective stand-alone behavioural intervention for insomnia disorder. However, its daytime side effects, particularly sleepiness, may be troubling for patients and/or may be a necessary part of the patient's treatment journey. This pilot trial aims to explore the potential benefit of armodafinil, a wakefulness promoter. Patients were treated with SRT with open label adjunctive armodafinil (150 mg/day). Thirty-three patients from previous studies that have undergone exactly the same SRT intervention acted as controls. The primary outcome measure was the insomnia severity index (ISI), and secondary outcomes were the Epworth sleepiness scale, sleep restriction adherence scale (SRAS), and safety from baseline through to 12 weeks. We recruited 25 patients into the trial. Data for the primary end point (ISI at 12 weeks) was available for 20 of the participants. The baseline insomnia severity index was 20.2 (SD 3.3) and decreased to 9.1 (SE 1.1), with no change, to 10.2 and 11.2 at weeks 6 and 12 respectively (all p > 0.05 compared with baseline). The insomnia severity index values for armodafinil patients were statistically inferior to historical controls at the primary time point of 12 weeks (11.2 vs. 6.7, p < 0.01). Sleep restriction therapy plus armodafinil treatment was associated with frequent minor side effects but was generally safe and acceptable to patients. Sleep restriction therapy was associated with a robust clinical response in the insomnia severity index values for insomnia patients. Based upon historical control data, armodafinil does not appear to have beneficial adjunctive effects in addition to sleep restriction therapy alone.
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Affiliation(s)
- Daniel J. Judge
- NeuroSleep and Woolcock Institute of Medical ResearchUniversity of Sydney, SydneyNew South WalesAustralia
- Department of Respiratory and Sleep Medicine, RPAHSydney Local Health DistrictSydneyNew South WalesAustralia
- Department of Respiratory and Sleep MedicineCairns HospitalQueenslandAustralia
| | - Christopher B. Miller
- NeuroSleep and Woolcock Institute of Medical ResearchUniversity of Sydney, SydneyNew South WalesAustralia
- Big Health LtdLondonUK
| | - Delwyn J. Bartlett
- NeuroSleep and Woolcock Institute of Medical ResearchUniversity of Sydney, SydneyNew South WalesAustralia
- Faculty of Medicine and HealthUniversity of SydneySydneyNew South WalesAustralia
| | - Ibrahim Jomaa
- NeuroSleep and Woolcock Institute of Medical ResearchUniversity of Sydney, SydneyNew South WalesAustralia
- Faculty of Medicine and HealthUniversity of SydneySydneyNew South WalesAustralia
| | - Keith K. W. Wong
- NeuroSleep and Woolcock Institute of Medical ResearchUniversity of Sydney, SydneyNew South WalesAustralia
- Department of Respiratory and Sleep Medicine, RPAHSydney Local Health DistrictSydneyNew South WalesAustralia
- Faculty of Medicine and HealthUniversity of SydneySydneyNew South WalesAustralia
| | - Bandana Saini
- NeuroSleep and Woolcock Institute of Medical ResearchUniversity of Sydney, SydneyNew South WalesAustralia
- Faculty of Medicine and HealthUniversity of SydneySydneyNew South WalesAustralia
| | - Caitlin R. Semsarian
- NeuroSleep and Woolcock Institute of Medical ResearchUniversity of Sydney, SydneyNew South WalesAustralia
- Faculty of Medicine and HealthUniversity of SydneySydneyNew South WalesAustralia
| | - Colin A. Espie
- Nuffield Department of Clinical Neurosciences and Sleep & Circadian Neuroscience InstituteUniversity of OxfordOxfordUK
| | - Simon D. Kyle
- Nuffield Department of Clinical Neurosciences and Sleep & Circadian Neuroscience InstituteUniversity of OxfordOxfordUK
| | - Ron R. Grunstein
- NeuroSleep and Woolcock Institute of Medical ResearchUniversity of Sydney, SydneyNew South WalesAustralia
- Department of Respiratory and Sleep Medicine, RPAHSydney Local Health DistrictSydneyNew South WalesAustralia
- Faculty of Medicine and HealthUniversity of SydneySydneyNew South WalesAustralia
| | - Brendon J. Yee
- NeuroSleep and Woolcock Institute of Medical ResearchUniversity of Sydney, SydneyNew South WalesAustralia
- Department of Respiratory and Sleep Medicine, RPAHSydney Local Health DistrictSydneyNew South WalesAustralia
- Faculty of Medicine and HealthUniversity of SydneySydneyNew South WalesAustralia
| | - Nathaniel S. Marshall
- NeuroSleep and Woolcock Institute of Medical ResearchUniversity of Sydney, SydneyNew South WalesAustralia
- Faculty of Medicine and HealthUniversity of SydneySydneyNew South WalesAustralia
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22
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Gozda K, Leung J, Baum L, Singer A, Konrad G, McMillan DE, Falk J, Kosowan L, Leong C. Insights into patient characteristics and documentation of the use of sedative-hypnotic/anxiolytics in primary care: a retrospective chart review study. BMC PRIMARY CARE 2022; 23:111. [PMID: 35538427 PMCID: PMC9087974 DOI: 10.1186/s12875-022-01724-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 04/25/2022] [Indexed: 11/10/2022]
Abstract
Abstract
Background
Despite the known safety risks of long-term use of sedative-hypnotic/anxiolytic medications, there has been limited guidance for the safe and effective use of their chronic use in a primary care clinic setting. Understanding the characteristics of patients who receive sedative-hypnotic/anxiolytic medication and the clinical documentation process in primary care is the first step towards understanding the nature of the problem and will help inform future strategies for clinical research and practice.
Objectives
Characterize patients who received a sedative-hypnotic/anxiolytic prescription in primary care, and (2) gain an understanding of the clinical documentation of sedative-hypnotic/anxiolytic indication and monitoring in electronic medical records (EMR).
Methods
A random selection of patients who received a prescription for a benzodiazepine or Z-drug hypnotic between January 2014 and August 2016 from four primary care clinics in Winnipeg were included. Data was collected retrospectively using the EMR (Accuro®). Patient variables recorded included sex, age, comorbidities, medications, smoking status, and alcohol status. Treatment variables included drug type, indication, pattern of use, dose, adverse events, psychosocial intervention, tapering attempts, social support, life stressor, and monitoring parameters for sedative-hypnotic use. Demographic and clinical characteristics were described using descriptive statistics.
Results
Records from a sample of 200 primary care patients prescribed sedative-hypnotic/anxiolytics were analyzed (mean age 55.8 years old, 61.5% ≥ 65 years old, 61.0% female). Long-term chronic use (≥ 1 year) of a sedative-hypnotic/anxiolytic agent was observed in 29.5% of the sample. Zopiclone (30.7%) and lorazepam (28.7%) were the most common agents prescribed. Only 9.5% of patients had documentation of a past tapering attempt of their sedative-hypnotic/anxiolytic. The most common indications for sedative-hypnotic/anxiolytic use recorded were anxiety (33.0%) and sleep (18.0%), but indication was undetermined for 57.0% of patients. Depression (33.5%) and falls (18.5%) were reported by patients after the initiation of these agents.
Conclusions
A higher proportion of females and users 65 years and older received a prescription for a sedative-hypnotic/anxiolytic, consistent with previous studies on sedative-hypnotic use. We found inconsistencies in the documentation surrounding sedative-hypnotic/anxiolytic use. The indication for their use was unclear in a large number of patients. These findings will help us understand the state of the problem in primary care and inform future strategies for clinical research.
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23
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Sogawa R, Shimanoe C, Tanaka K, Hara M, Nishida Y, Furukawa T, Nagayoshi M, Hishida A, Kubo Y, Kato Y, Oze I, Ito H, Nakamura Y, Kusakabe M, Tanoue S, Koriyama C, Suzuki S, Otani T, Matsui D, Watanabe I, Kuriki K, Takashima N, Kadota A, Watanabe T, Arisawa K, Ikezaki H, Otonari J, Wakai K, Matsuo K. Sex- and age-specific all-cause mortality in insomnia with hypnotics: Findings from Japan multi-institutional Collaborative Cohort Study. Sleep Med 2022; 100:410-418. [PMID: 36240602 DOI: 10.1016/j.sleep.2022.09.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Revised: 09/07/2022] [Accepted: 09/21/2022] [Indexed: 01/12/2023]
Abstract
OBJECTIVE Findings on the increased mortality risk in individuals with insomnia are inconsistent across studies. Rather than improving insomnia by sleep control, hypnotic use may be one factor in the increased risk of death; however, the effects of hypnotics on mortality remains unclear. This study aimed to examine the association between all-cause mortality and hypnotic use in a large sample, while adjusting for the effects of comorbidities. METHODS Overall, 92,527 individuals aged 35-69 years were followed up for mortality in the Japan Multi-Institutional Collaborative Cohort Study. Regular use of hypnotics was assessed using a self-administered questionnaire. Since cancer history carries a substantial risk of death and is associated with the treatment of insomnia with hypnotics, participants with a cancer history were excluded. The hazard ratio (HR) and 95% confidence interval (CI) for all-cause mortality related to hypnotic use were estimated using a Cox proportional hazard model with adjustments for covariates including sleeping hours and comorbidities (body mass index, ischemic heart disease, stroke, and diabetes). RESULTS During the follow-up (mean, 8.4 ± 2.5 years), 1,492 mortalities were recorded, and the prevalence of taking hypnotics was 4.2%. Hypnotic use was associated with significantly greater risk of all-cause mortality, even after adjustment for the covariates (HR, 1.32; 95% CI, 1.07-1.63). The association between hypnotic use and all-cause mortality was robust in males (HR, 1.51; 95% CI, 1.15-1.96), and participants aged <60 years (HR, 1.75; 95% CI, 1.21-2.54). CONCLUSIONS Our study revealed sex-age specific associations between hypnotic use and all-cause mortality.
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Affiliation(s)
- Rintaro Sogawa
- Department of Pharmacy, Saga University Hospital, Saga, Japan
| | - Chisato Shimanoe
- Department of Pharmacy, Saga University Hospital, Saga, Japan; Department of Preventive Medicine, Faculty of Medicine, Saga University, Saga, Japan.
| | - Keitaro Tanaka
- Department of Preventive Medicine, Faculty of Medicine, Saga University, Saga, Japan
| | - Megumi Hara
- Department of Preventive Medicine, Faculty of Medicine, Saga University, Saga, Japan
| | - Yuichiro Nishida
- Department of Preventive Medicine, Faculty of Medicine, Saga University, Saga, Japan
| | - Takuma Furukawa
- Department of Preventive Medicine, Faculty of Medicine, Saga University, Saga, Japan; Clinical Research Center, Saga University Hospital, Saga, Japan
| | - Mako Nagayoshi
- Department of Preventive Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Asahi Hishida
- Department of Preventive Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yoko Kubo
- Department of Preventive Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yasufumi Kato
- Department of Preventive Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Isao Oze
- Division of Cancer Epidemiology and Prevention, Aichi Cancer Center Research Institute, Nagoya, Japan
| | - Hidemi Ito
- Division of Cancer Information and Control, Aichi Cancer Center Research Institute, Nagoya, Japan
| | - Yohko Nakamura
- Cancer Prevention Center, Chiba Cancer Center Research Institute, Chiba, Japan
| | - Miho Kusakabe
- Cancer Prevention Center, Chiba Cancer Center Research Institute, Chiba, Japan
| | - Shiroh Tanoue
- Department of Epidemiology and Preventive Medicine, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Chihaya Koriyama
- Department of Epidemiology and Preventive Medicine, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Sadao Suzuki
- Department of Public Health, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Takahiro Otani
- Department of Public Health, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Daisuke Matsui
- Department of Epidemiology for Community Health and Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Isao Watanabe
- Department of Epidemiology for Community Health and Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Kiyonori Kuriki
- Laboratory of Public Health, Division of Nutritional Sciences, School of Food and Nutritional Sciences, University of Shizuoka, Shizuoka, Japan
| | - Naoyuki Takashima
- Department of Public Health, Faculty of Medicine, Kindai University, Osaka, Japan; NCD Epidemiology Research Center, Shiga University of Medical Science, Shiga, Japan
| | - Aya Kadota
- NCD Epidemiology Research Center, Shiga University of Medical Science, Shiga, Japan
| | - Takeshi Watanabe
- Department of Preventive Medicine, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Kokichi Arisawa
- Department of Preventive Medicine, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Hiroaki Ikezaki
- Department of Comprehensive General Internal Medicine, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan; Department of General Internal Medicine, Kyushu University Hospital, Fukuoka, Japan
| | - Jun Otonari
- Department of Psychosomatic Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Kenji Wakai
- Department of Preventive Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Keitaro Matsuo
- Division of Cancer Epidemiology and Prevention, Aichi Cancer Center Research Institute, Nagoya, Japan; Department of Cancer Epidemiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
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24
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Effects of Audio Brain Entrainment on Korean People with Mild Insomnia. Appl Psychophysiol Biofeedback 2022; 48:207-216. [PMID: 36445544 PMCID: PMC9707213 DOI: 10.1007/s10484-022-09570-2] [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] [Accepted: 11/04/2022] [Indexed: 12/03/2022]
Abstract
Sleep health has become an important healthy lifestyle. Research has shown that almost one-fifth of the Korean adult population does not have sufficient sleep. The lack of sleep is associated with significant medical, psychological, social, and economic issues. People are not only yearning for sufficient sleep but the quality of sleep as well. Usually, the obvious choice will be the use of pharmaceuticals however, these often have various side effects, and the lasting use of these medications could become a concern. Therefore, new non-drug alternatives are sought after. Audio brain entrainment is a procedure that modules neural activities by synchronizing brainwave frequency with pulse tones. By producing frequency tones for the deep sleep stage, it promotes a good night's sleep. In this paper, we developed a pillow integrated with the audio speakers that produce alpha and theta beats that should help improve sleep. Sleep polysomnography was performed on 10 people to compare the effects of the audio stimulus. Initial results showed a positive effect on sleep onset latency, indicating that sleep induction happened. This noninvasive stimulation technique can be a promising candidate for wearable bioelectronics medicine and further neuroscience research.
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25
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Khan H, Garg A, Yasmeen, Agarwal NB, Yadav DK, Ashif Khan M, Hussain S. Zolpidem use and risk of suicide: A systematic review and meta-analysis. Psychiatry Res 2022; 316:114777. [PMID: 35985088 DOI: 10.1016/j.psychres.2022.114777] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 07/29/2022] [Accepted: 08/07/2022] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Zolpidem is one of the most commonly prescribed nonbenzodiazepine hypnotic drugs for insomnia. Published epidemiological studies linked zolpidem with the risk of suicide. However, to date, no meta-analysis investigated this association. Hence, we systematically reviewed and meta-analysed the current evidence from real-world studies reporting the risk of suicide with the use of zolpidem. METHODS Medline (Ovid), Embase (Ovid), and PsycINFO databases were searched from inception till June 2021 for real-world evidence studies reporting the risk of suicide with the use of zolpidem. The quality assessment of included studies was assessed using the New-Castle Ottawa Scale (NOS). Random-effect meta-analysis was performed using a generic inverse variance method. RESULTS This meta-analysis was based on four studies with 344,753 participants, of which 42,279 were zolpidem users. The methodological quality of all the included studies was of high quality. A significantly increased risk of suicide or suicide attempt was found in zolpidem users compared to non-users, with a pooled relative risk of 1.88 (95% CI: 1.54 - 2.30). Furthermore, an increased risk of suicidal death was observed in zolpidem users compared to non-users, with a pooled relative risk of 1.82 (95% CI: 1.43 - 2.30). Dose-response analysis also revealed a significantly increased risk of suicide in patients receiving ≥ 180cDDD (cumulative defined daily doses) of zolpidem (124 times), followed by 90-179cDDD (113 times) and <90cDDD (93 times) of zolpidem compared to non-users. CONCLUSION In conclusion, zolpidem use was associated with an increased risk of suicide or suicide attempt and suicidal death. Therefore, careful prescribing practices must be followed by considering the risk-benefit profile.
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Affiliation(s)
- Hiba Khan
- Centre for Translational & Clinical Research, School of Chemical and Life Sciences, Jamia Hamdard, New Delhi 110062, India
| | - Aakriti Garg
- Centre for Translational & Clinical Research, School of Chemical and Life Sciences, Jamia Hamdard, New Delhi 110062, India
| | - Yasmeen
- Department of Pharmaceutics, School of Pharmaceutical Education and Research, Jamia Hamdard, New Delhi 110062, India
| | - Nidhi B Agarwal
- Centre for Translational & Clinical Research, School of Chemical and Life Sciences, Jamia Hamdard, New Delhi 110062, India
| | | | - Mohd Ashif Khan
- Centre for Translational & Clinical Research, School of Chemical and Life Sciences, Jamia Hamdard, New Delhi 110062, India.
| | - Salman Hussain
- Czech National Centre for Evidence-Based Healthcare and Knowledge Translation (Cochrane Czech Republic, Czech EBHC: JBI Centre of Excellence, Masaryk University GRADE Centre), Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czech Republic
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26
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Yoo JI, Jang SY, Cha Y, Gwak JH, Kim JT, Park CH, Choy WS. Association between antidepressants, benzodiazepine and all-cause mortality in elderly hip fracture: A Korean nationwide cohort study. J Orthop Sci 2022; 27:1089-1095. [PMID: 34391618 DOI: 10.1016/j.jos.2021.07.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 06/22/2021] [Accepted: 07/02/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND The purpose of this study was to analyze the association between the preoperative and postoperative use of antidepressant and benzodiazepine and all-cause mortality in elderly hip fracture patients. METHODS Patients who underwent surgical treatment for hip fracture over 65 years old were classified into Past-user, Current-user, and Non-users for each period according to use history for antidepressants or benzodiazepines. And, for the subgroup analysis, patients were classified by presence of past history for psychiatric medication. A multivariable-adjusted Cox proportional hazards model was used to investigate the effects of antidepressants and benzodiazepines on all-cause mortality. RESULTS A total of 15,576 patients were included in this study. Past users of antidepressants and benzodiazepines were 5699 (36.59%) patients and 11,319 (72.67%) patients, respectively. Current users of antidepressants and benzodiazepines were 2888 (18.54%) patients and 6287 (40.36%) patients, respectively. There were no statistically significant differences in the adjusted hazard for death compared to the non-users for both the past and the current users (p > 0.05). In the subgroup analysis, there were 12,502 once-users and 3074 never-users according to psychiatric medication. Current uses of antidepressants and benzodiazepine in the once-user did not increase adjusted hazard for death compared to the non-users (p>0.05). However, current uses of antidepressants by never-users increased the adjusted hazard for death compared to the non-user (adjusted hazard ratio, 1.31; 95% CI, 1.08-1.59; p = 0.007). CONCLUSIONS No association was observed between the uses of antidepressants and benzodiazepines after hip fracture and mortality risk in elderly patients who received psychiatric medication before hip fracture. However, the use of these medications was associated with increased all-cause mortality risk in patients who had no history of psychiatric medication before hip fracture. LEVEL OF EVIDENCE III, retrospective cohort study.
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Affiliation(s)
- Jun-Il Yoo
- Department of Orthopaedic Surgery, Gyeongsang National University Hospital, Jinju, South Korea
| | - Suk-Yong Jang
- Department of Preventive Medicine, Eulji University College of Medicine, Daejeon, South Korea
| | - Yonghan Cha
- Department of Orthopaedic Surgery, Eulji University Hospital, Daejeon, South Korea.
| | - Joon-Hyeok Gwak
- Department of Orthopaedic Surgery, Eulji University Hospital, Daejeon, South Korea
| | - Jung-Taek Kim
- Department of Orthopaedic Surgery, Ajou University Medical Center, Suwon, South Korea
| | - Chan Ho Park
- Department of Orthopaedic Surgery, Yeungnam University Medical Center, Daegu, South Korea
| | - Won-Sik Choy
- Department of Orthopaedic Surgery, Eulji University Hospital, Daejeon, South Korea
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Abstract
BACKGROUND Insomnia is a common problem in modern society. It is associated with reduced quality of life and impairments in physical and mental health. Listening to music is widely used as a sleep aid, but it remains unclear if it can actually improve insomnia in adults. This Cochrane Review is an update of a review published in 2015. OBJECTIVES To assess the effects of listening to music on sleep in adults with insomnia and to assess the influence of specific variables that may moderate the effect. SEARCH METHODS For this update, we searched CENTRAL, MEDLINE, Embase, nine other databases and two trials registers up to December 2021. In addition, we handsearched reference lists of included studies, and contacted authors of published studies to identify additional studies eligible for inclusion, including any unpublished or ongoing trials. SELECTION CRITERIA Randomised controlled trials comparing the effects of listening to music with no treatment or treatment as usual (TAU) in adults complaining of sleep difficulties. DATA COLLECTION AND ANALYSIS Two review authors independently screened records for eligibility, selected studies for inclusion, extracted data and assessed risk of bias of the included studies. We assessed the certainty of the evidence using GRADE. The primary outcomes were sleep quality, insomnia severity, sleep-onset latency, total sleep time, sleep interruption, sleep efficiency and adverse events. Data on the predefined outcome measures were included in meta-analyses when consistently reported by at least two studies that were homogeneous in terms of participants, interventions and outcomes. We undertook meta-analyses using random-effects models. MAIN RESULTS We included 13 studies (eight studies new to this update) comprising 1007 participants. The studies examined the effect of listening to prerecorded music daily, for 25 to 60 minutes, for a period of three days to three months. The risk of bias within the studies varied, with all studies being at high risk of performance bias, because of limited possibilities to blind participants to the music intervention. Some studies were at high risk of detection bias or other bias. Four studies reported funding from national research councils, three studies reported financial support from university sources and one study reported a grant from a private foundation. Five studies did not report any financial support. At the end of the intervention, we found moderate-certainty evidence for improved sleep quality measured with the Pittsburgh Sleep Quality Index (PSQI) in themusic groups compared to no intervention or TAU (mean difference (MD) -2.79, 95% confidence interval (CI) -3.86 to -1.72; 10 studies, 708 participants). The PSQI scale ranges from 0 to 21 with higher scores indicating poorer sleep. The size of the effect indicates an increase in sleep quality of the size of about one standard deviation in favour of the intervention. We found no clear evidence of a difference in the effects of listening to music compared to no treatment or TAU on insomnia severity (MD -6.96, 95% CI -15.21 to 1.28; 2 studies, 63 participants; very low-certainty evidence). We found low-certainty evidence that, compared to no treatment or TAU, listening to music may reduce problems with sleep-onset latency (MD -0.60, 95% CI -0.83 to -0.37; 3 studies, 197 participants), total sleep time (MD -0.69, 95% CI -1.16 to -0.23; 3 studies, 197 participants) and sleep efficiency (MD -0.96, 95% CI -1.38 to -0.54; 3 studies, 197 participants), but may have no effect on perceived sleep interruption (MD -0.53, 95% CI -1.47 to 0.40; 3 studies, 197 participants). In addition, three studies (136 participants) included objective measures of sleep-onset latency, total sleep time, sleep efficiency and sleep interruption and showed that listening to music may not improve these outcomes compared to no treatment or TAU. None of the included studies reported any adverse events. AUTHORS' CONCLUSIONS The findings of this review provide evidence that music may be effective for improving subjective sleep quality in adults with symptoms of insomnia. More research is needed to establish the effect of listening to music on other aspects of sleep as well as the daytime consequences of insomnia.
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Affiliation(s)
- Kira V Jespersen
- Center for Music in the Brain, Department of Clinical Medicine, Aarhus University & The Royal Academy of Music Aarhus/Aalborg, Aarhus, Denmark
| | - Victor Pando-Naude
- Center for Music in the Brain, Department of Clinical Medicine, Aarhus University & The Royal Academy of Music Aarhus/Aalborg, Aarhus, Denmark
| | - Julian Koenig
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Poul Jennum
- Danish Centre of Sleep Medicine, Department of Clinical Neurophysiology, Glostrup Hospital, Glostrup, Denmark
| | - Peter Vuust
- Center for Music in the Brain, Department of Clinical Medicine, Aarhus University & The Royal Academy of Music Aarhus/Aalborg, Aarhus, Denmark
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28
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Insomnia in primary care: a survey conducted on Italian patients older than 50 years—results from the “Sonno e Salute” study. Neurol Sci 2022; 43:6487-6494. [PMID: 35925456 PMCID: PMC9362688 DOI: 10.1007/s10072-022-06309-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 07/28/2022] [Indexed: 10/27/2022]
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Duffy JF, Wang W, Ronda JM, Czeisler CA. High dose melatonin increases sleep duration during nighttime and daytime sleep episodes in older adults. J Pineal Res 2022; 73:e12801. [PMID: 35436355 PMCID: PMC9288519 DOI: 10.1111/jpi.12801] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 03/30/2022] [Accepted: 04/11/2022] [Indexed: 11/29/2022]
Abstract
Aging is associated with changes in sleep, and improving sleep may have important consequences for the health, cognition, and quality of life of older adults. Many prescription sleep aids increase the risk of nighttime falls, have adverse effects on next-day cognition, and are associated with increased mortality. Melatonin, a hormone secreted at night, increases sleep duration in young adults but only when administered during the day when endogenous levels are low. In a month-long cross-over study, we randomized 24 healthy older (age >55, mean 64.2 ± 6.3 years) participants to receive 2 weeks of placebo and 2 weeks of either a low (0.3 mg) or high (5.0 mg) dose of melatonin 30 min before lights out. Sleep was polysomnographically recorded and was scheduled during both the biological day and night using a forced desynchrony design. Although 0.3 mg melatonin had a trend towards increasing sleep efficiency (SE) overall, this was due to its effects on sleep during the biological day. In contrast, 5 mg melatonin significantly increased SE during both biological day and night, mainly by increasing the duration of Stage 2 non-rapid eye movement sleep and slightly shortening awakenings. Melatonin should be further explored as a sleep aid for older adults.
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Affiliation(s)
- Jeanne F. Duffy
- address for correspondence: Jeanne F. Duffy, Division of Sleep and Circadian Disorders, 221 Longwood Avenue, BLI438, Boston, MA 02115, Tel: 617-732-7995, Fax: 617-732-4015,
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Chung KM, Suh YJ, Chin S, Seo D, Yu ES, Lee HJ, Kim JH, Kim SW, Koh SJ. A Pilot Study Testing the Efficacy of dCBT in Patients With Cancer Experiencing Sleep Problems. Front Psychol 2022; 13:699168. [PMID: 35756310 PMCID: PMC9216201 DOI: 10.3389/fpsyg.2022.699168] [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] [Received: 04/23/2021] [Accepted: 04/07/2022] [Indexed: 11/15/2022] Open
Abstract
Objective This pilot study aimed to evaluate the efficacy of a digital cognitive behavioral therapy (dCBT) in patients with cancer experiencing sleep problems. Methods A total of 57 participants aged 25–65 years (6M/51F with a mean of 42.80 years and a standard deviation of 14.15 years) were randomly assigned to three groups—21 participants to a dCBT program (HARUToday Sleep), 20 participants to an app-based attentional control program (HARUCard Sleep), and 16 participants to a waitlist control group—and evaluated offline before and after the program completion. Of the 57 participants, there were a total of 45 study completers, 15 participants in each group. The dependent variables were sleep quality scores, measured by the Pittsburgh Sleep Quality Index (PSQI) and health-related quality of life scores, measured using the Short-Form 36 (SF-36), and attentional bias scores from a dot-probe computer task. Results For both the intention-to-treat (N = 57) and study-completers analyses (N = 45, 15 for each group), a significant increase supported by a large effect size was found in the quality of sleep score of the HARUToday Sleep group compared to both the app-based attentional control and the waitlist control group. However, no significant changes were found in the quality of life and attentional bias scores. Conclusion Our results suggest that the HARUToday Sleep app has the potential to serve as an intervention module to enhance the sleep quality of patients with cancer experiencing sleep problems.
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Affiliation(s)
- Kyong-Mee Chung
- Department of Psychology, Yonsei University, Seoul, South Korea
| | - Yung Jae Suh
- Department of Psychology, Yonsei University, Seoul, South Korea
| | - Siyung Chin
- Department of Psychology, Yonsei University, Seoul, South Korea
| | - Daesung Seo
- Department of Psychology, Yonsei University, Seoul, South Korea
| | - Eun-Seung Yu
- Department of Psychiatry and Behavioral Science, National Cancer Center, Goyang, South Korea
| | - Hyun Jeong Lee
- Department of Psychiatry and Behavioral Science, National Cancer Center, Goyang, South Korea.,Division of Cancer Control & Policy, National Cancer Control Institute, National Cancer Center, Goyang, South Korea
| | - Jong-Heun Kim
- Department of Psychiatry and Behavioral Science, National Cancer Center, Goyang, South Korea
| | - Sang Wun Kim
- Department of Obstetrics and Gynecology, Women's Cancer Center, Yonsei University College of Medicine, Seoul, South Korea
| | - Su-Jin Koh
- Department of Hematology and Oncology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, South Korea
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Vicens C, Leiva A, Bejarano F, Sempere-Verdú E, Rodríguez-Rincón RM, Fiol F, Mengual M, Ajenjo-Navarro A, Do Pazo F, Mateu C, Folch S, Alegret S, Coll JM, Martín-Rabadán M, Socias I. Evaluation of a multicomponent intervention consisting of education and feedback to reduce benzodiazepine prescriptions by general practitioners: The BENZORED hybrid type 1 cluster randomized controlled trial. PLoS Med 2022; 19:e1003983. [PMID: 35522626 PMCID: PMC9075619 DOI: 10.1371/journal.pmed.1003983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 04/07/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Current benzodiazepine (BZD) prescription guidelines recommend short-term use to minimize the risk of dependence, cognitive impairment, and falls and fractures. However, many clinicians overprescribe BZDs and chronic use by patients is common. There is limited evidence on the effectiveness of interventions delivered by general practitioners (GPs) on reducing prescriptions and long-term use of BZDs. We aimed to evaluate the effectiveness of a multicomponent intervention for GPs that seeks to reduce BZD prescriptions and the prevalence of long-term users. METHODS AND FINDINGS We conducted a multicenter two-arm, cluster randomized controlled trial in 3 health districts in Spain (primary health centers [PHCs] in Balearic Islands, Catalonia, and Valencian Community) from September 2016 to May 2018. The 81 PHCs were randomly allocated to the intervention group (n = 41; 372 GPs) or the control group (n = 40; 377 GPs). GPs were not blinded to the allocation; however, pharmacists, researchers, and trial statisticians were blinded to the allocation arm. The intervention consisted of a workshop about the appropriate prescribing of BZDs and tapering-off long-term BZD use using a tailored stepped dose reduction with monthly BZD prescription feedback and access to a support web page. The primary outcome, based on 700 GPs (351 in the control group and 349 in the intervention group), compared changes in BZD prescriptions in defined daily doses (DDDs) per 1,000 inhabitants per day after 12 months. The 2 secondary outcomes were the proportion of long-term users (≥6 months) and the proportion of long-term users over age 65 years. Intention-to-treat (ITT) analysis was used to assess all clinical outcomes. Forty-nine GPs (21 intervention group and 28 control group) were lost to follow-up. However, all GPs were included in the ITT analysis. After 12 months, there were a statistically significant decline in total BZD prescription in the intervention group compared to the control group (mean difference: -3.24 DDDs per 1,000 inhabitants per day, 95% confidence interval (CI): -4.96, -1.53, p < 0.001). The intervention group also had a smaller number of long-term users. The adjusted absolute difference overall was -0.36 (95% CI: -0.55, -0.16, p > 0.001), and the adjusted absolute difference in long-term users over age 65 years was -0.87 (95% CI: -1.44, -0.30, p = 0.003). A key limitation of this clustered design clinical trial is the imbalance of some baseline characteristics. The control groups have a higher rate of baseline BZD prescription, and more GPs in the intervention group were women, GPs with a doctorate degree, and trainers of GP residents. CONCLUSIONS A multicomponent intervention that targeted GPs and included educational meeting, feedback about BZD prescriptions, and a support web page led to a statistically significant reduction of BZD prescriptions and fewer long-term users. Although the effect size was small, the high prevalence of BZD use in the general population suggests that large-scale implementation of this intervention could have positive effects on the health of many patients. TRIAL REGISTRATION ISRCTN ISRCTN28272199.
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Affiliation(s)
- Caterina Vicens
- Balearic Health Service IbSalut Son Serra-La Vileta Healthcare Centre, Palma, Illes Balears, Spain
- Research Network on Chronicity, Primary Care, and Health Promotion (RICAPPS)-Balearic Islands Health Research Institute (IdISBa), Mallorca, Spain
| | - Alfonso Leiva
- Research Network on Chronicity, Primary Care, and Health Promotion (RICAPPS)-Balearic Islands Health Research Institute (IdISBa), Mallorca, Spain
- Balearic Health Service IbSalut, Reseach Unit Primary care Mallorca, Palma, Illes Balears, Spain
- * E-mail:
| | - Ferran Bejarano
- Catalan Institute of Health Cat-salut, DAP Camp de Tarragona, Tarragona, Catalunya, Spain
| | - Ermengol Sempere-Verdú
- Conselleria de Sanitat Universal i Salut Pública, Paterna Healthcare Centre, Valencia, Comunitat Valenciana, Spain
| | - Raquel María Rodríguez-Rincón
- Balearic Health Service IbSalut Hospital Universitari Son Espases, Pharmacy Department,Palma de Mallorca, Illes Balears, Spain
| | - Francisca Fiol
- Balearic Health Service IbSalut Son Serra-La Vileta Healthcare Centre, Palma, Illes Balears, Spain
| | - Marta Mengual
- Catalan Institute of Health Cat-salut, DAP Camp de Tarragona, Tarragona, Catalunya, Spain
| | - Asunción Ajenjo-Navarro
- Conselleria de Sanitat Universal i Salut Pública, Paterna Healthcare Centre, Valencia, Comunitat Valenciana, Spain
| | - Fernando Do Pazo
- Balearic Health Service IbSalut Hospital Universitari Son Espases, Pharmacy Department,Palma de Mallorca, Illes Balears, Spain
| | - Catalina Mateu
- Balearic Health Service IbSalut Son Serra-La Vileta Healthcare Centre, Palma, Illes Balears, Spain
| | - Silvia Folch
- Catalan Institute of Health Cat-salut, DAP Camp de Tarragona, Tarragona, Catalunya, Spain
| | - Santiago Alegret
- Balearic Health Service IbSalut Son Serra-La Vileta Healthcare Centre, Palma, Illes Balears, Spain
| | - Jose Maria Coll
- Balearic Health Service IbSalut, Menorca Primary Care Management, Maó, Illes Baleares, Spain
| | - María Martín-Rabadán
- Balearic Health Service IbSalut, Can Misses Healthcare Centre Ibiza, Illes Baleares, Spain
| | - Isabel Socias
- Research Network on Chronicity, Primary Care, and Health Promotion (RICAPPS)-Balearic Islands Health Research Institute (IdISBa), Mallorca, Spain
- Balearic Health Service IbSalut, Manacor Healthcare Centre, Manacor, Illes Baleares, Spain
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Callede N, Masciotti T, Casettari L, Loosveldt N, Goole J. Development and evaluation of a 3D printing protocol to produce zolpidem-containing printlets, as compounding preparation, by the pressurized-assisted microsyringes technique. Int J Pharm 2022; 621:121756. [PMID: 35472510 DOI: 10.1016/j.ijpharm.2022.121756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 04/12/2022] [Accepted: 04/14/2022] [Indexed: 11/20/2022]
Abstract
Insomnia is a chronic disorder with a mean prevalence ranged from 6% to 15% worldwide. The usual pharmacologic treatment for insomnia has been benzodiazepines and barbiturates. More recently, z-drugs were introduced in the therapeutic arsenal to maximize benefits and minimize treatment damage. Zolpidem tartrate, whose primary indication is for sleep initiation problems, is conventionally used at a recommended dose of 5 mg for women as well as elderly patients (<65 years-old) and 10 mg for non-elderly men. However, it was demonstrated that the dose of zolpidem should be adjusted according to the gender, age, condition of the patient and the presence of polypharmacy to decrease the occurrence of adverse events. Faced with the therapeutic limitations inherent to marketed products, magistral preparations offer medical and legal alternatives to mass treatment. The use of a semi-automatic technique, with standardized protocol, such as 3D printing should be advantageously implemented as an alternative to standard compounding procedures. In this work, the pressure-assisted microsyringes method was selected as it allows the tridimensional printing, and so the customization of the dose, by easily extruding a viscous semi-liquid material, called "slurry", through a syringe at room temperature. It has been demonstrated that this methodology allows obtaining printlets that responded to the zolpidem-containing tablets monograph of the US pharmacopoeia Edition 42. The compounding preparations proposed in this work therefore have the same criteria of requirements as a commercial form.
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Affiliation(s)
- Nicolas Callede
- Laboratory of Pharmaceutics and Biopharmaceutics, Université libre de Bruxelles, Campus de la Plaine, CP207, Boulevard du Triomphe, Brussels 1050, Belgium; Lloyds Pharma Group, Avenue Pasteur 2, 1300 Wavre, Belgium
| | - Tommaso Masciotti
- Department of Biomolecular Sciences, School of Pharmacy, University of Urbino Carlo Bo, Piazza el Rinascimento n 06, 61029 Urbino (PU), Italy
| | - Luca Casettari
- Department of Biomolecular Sciences, School of Pharmacy, University of Urbino Carlo Bo, Piazza el Rinascimento n 06, 61029 Urbino (PU), Italy
| | - Nathalie Loosveldt
- McKesson Company, SA Pharma Belgium-Belmedis NV, Avenue Emile Vanderveldelaan 82, 1200 Brussels, Belgium
| | - Jonathan Goole
- Laboratory of Pharmaceutics and Biopharmaceutics, Université libre de Bruxelles, Campus de la Plaine, CP207, Boulevard du Triomphe, Brussels 1050, Belgium.
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Ito H, Tsuneki H, Sasaoka T, Toyooka N, Matsuo M, Yamazaki M. Suvorexant and mirtazapine improve chronic pain-related changes in parameters of sleep and voluntary physical performance in mice with sciatic nerve ligation. PLoS One 2022; 17:e0264386. [PMID: 35213655 PMCID: PMC8880854 DOI: 10.1371/journal.pone.0264386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 02/09/2022] [Indexed: 11/19/2022] Open
Abstract
Both chronic pain and sleep disorders are associated with a reduction in the quality of life. They can be both a cause and a consequence of each other, and should therefore be simultaneously treated. However, optimal treatments for chronic pain-related sleep disorders are not well established. Here, we aimed to investigate the effects of suvorexant, a novel sleep drug, and mirtazapine, a noradrenergic and specific serotonergic antidepressant, on pain-related changes in sleep parameters in a preclinical chronic pain mice model, by partial sciatic nerve ligation. We evaluated the quantity, duration, and depth of sleep by analyzing the electroencephalogram and voluntary activity by counting the number of wheel rotations to determine various symptoms of sleep disorders, including reduced total sleep time, fragmentation, low quality, and impaired activity in the daytime. Suvorexant and mirtazapine normalized the reduction in sleep time and fragmented sleep, further regaining the sleep depth at sleep onset in the chronic pain state in nerve-ligated mice. Mirtazapine also increased the percentage of rapid eye movement sleep in mice. Suvorexant decreased voluntary activity, which was prolonged after administration; however, mirtazapine did not decrease it. Although the effects of suvorexant and mirtazapine on sleep and activity are different, both suvorexant and mirtazapine could be potential therapeutic agents for chronic pain-related sleep disorders.
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Affiliation(s)
- Hisakatsu Ito
- Department of Anesthesiology, University of Toyama, Toyama, Japan
- * E-mail:
| | - Hiroshi Tsuneki
- Department of Clinical Pharmacology, University of Toyama, Toyama, Japan
| | - Toshiyasu Sasaoka
- Department of Clinical Pharmacology, University of Toyama, Toyama, Japan
| | - Naoki Toyooka
- Faculty of Engineering, University of Toyama, Toyama, Japan
| | - Mitsuhiro Matsuo
- Department of Anesthesiology, University of Toyama, Toyama, Japan
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Herhaus B, Kalin A, Gouveris H, Petrowski K. Mobile Heart Rate Variability Biofeedback Improves Autonomic Activation and Subjective Sleep Quality of Healthy Adults – A Pilot Study. Front Physiol 2022; 13:821741. [PMID: 35250623 PMCID: PMC8892186 DOI: 10.3389/fphys.2022.821741] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 01/18/2022] [Indexed: 01/01/2023] Open
Abstract
Objective Restorative sleep is associated with increased autonomous parasympathetic nervous system activity that might be improved by heart rate variability-biofeedback (HRV-BF) training. Hence the aim of this study was to investigate the effect of a four-week mobile HRV-BF intervention on the sleep quality and HRV of healthy adults. Methods In a prospective study, 26 healthy participants (11 females; mean age: 26.04 ± 4.52 years; mean body mass index: 23.76 ± 3.91 kg/m2) performed mobile HRV-BF training with 0.1 Hz breathing over four weeks, while sleep quality, actigraphy and HRV were measured before and after the intervention. Results Mobile HRV-BF training with 0.1 Hz breathing improved the subjective sleep quality in healthy adults [t(24) = 4.9127, p ≤ 0.001, d = 0.99] as measured by the Pittsburgh Sleep Quality Index. In addition, mobile HRV-BF training with 0.1 Hz breathing was associated with an increase in the time and frequency domain parameters SDNN, Total Power and LF after four weeks of intervention. No effect was found on actigraphy metrics. Conclusions Mobile HRV-BF intervention with 0.1 Hz breathing increased the reported subjective sleep quality and may enhance the vagal activity in healthy young adults. HRV-BF training emerges as a promising tool for improving sleep quality and sleep-related symptom severity by means of normalizing an impaired autonomic imbalance during sleep.
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Affiliation(s)
- Benedict Herhaus
- Medical Psychology and Medical Sociology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Adrian Kalin
- Medical Psychology and Medical Sociology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Haralampos Gouveris
- Sleep Medicine Center and Department of Otolaryngology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Katja Petrowski
- Medical Psychology and Medical Sociology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
- Department of Internal Medicine III, University Hospital Carl Gustav Carus Dresden, Technical University Dresden, Dresden, Germany
- *Correspondence: Katja Petrowski,
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Miner B, Stone KL, Zeitzer JM, Han L, Doyle M, Blackwell T, Gill TM, Redeker NS, Hajduk A, Yaggi HK. Self-reported and actigraphic short sleep duration in older adults. J Clin Sleep Med 2022; 18:403-413. [PMID: 34338629 PMCID: PMC8804982 DOI: 10.5664/jcsm.9584] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
STUDY OBJECTIVES Persons > 65 years with short sleep duration (≤ 6 hours) are at risk for adverse outcomes, but the accuracy of self-reported sleep duration may be affected by reduced symptom awareness. We evaluated the performance characteristics of self-reported vs objectively measured sleep duration in this age group. METHODS In 2,980 men from the Osteoporotic Fractures in Men Sleep Study and 2,855 women from the Study of Osteoporotic Fractures we examined the agreement and accuracy of self-reported vs actigraphy-measured short and normal (> 6 but < 9 hours) sleep duration. We evaluated associations of select factors (demographics; medical, physical, and neuropsychiatric conditions; medication and substance use; and sleep-related measures) with risk of false-negative (normal sleep duration by self-report but short sleep duration by actigraphy) and false-positive (short sleep duration by self-report and normal sleep duration by actigraphy) designations, respectively, using logistic regression. RESULTS Average ages were 76.3 ± 5.5 and 83.5 ± 3.7 years in men and women, respectively. There was poor agreement between self-reported and actigraphic sleep duration (kappa ≤ 0.24). False negatives occurred in nearly half and false positives in over a quarter of older persons. In multivariable models in men and women, false negatives were independently associated with obesity, daytime sleepiness, and napping, while false positives were significantly lower with obesity. CONCLUSIONS Under- and overreporting of short sleep is common among older persons. Reliance on self-report may lead to missed opportunities to prevent adverse outcomes or unnecessary interventions. Self-reported sleep duration should be objectively confirmed when evaluating the effect of sleep duration on health outcomes. CITATION Miner B, Stone KL, Zeitzer JM, et al. Self-reported and actigraphic short sleep duration in older adults. J Clin Sleep Med. 2022;18(2):403-413.
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Affiliation(s)
- Brienne Miner
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut,Address correspondence to: Brienne Miner, MD, 333 Cedar Street, New Haven, CT 06520; Tel: (203) 688-9423; Fax (203) 688-4209;
| | - Katie L. Stone
- California Pacific Medical Center Research Institute, San Francisco, California
| | - Jamie M. Zeitzer
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, California
| | - Ling Han
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut,Veterans Affairs Clinical Epidemiology Research Center, West Haven, Connecticut
| | - Margaret Doyle
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Terri Blackwell
- California Pacific Medical Center Research Institute, San Francisco, California
| | - Thomas M. Gill
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Nancy S. Redeker
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut,Yale School of Nursing, West Haven, Connecticut
| | - Alexandra Hajduk
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Henry Klar Yaggi
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut,Veterans Affairs Clinical Epidemiology Research Center, West Haven, Connecticut
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Hwang S, Son H, Kim M, Lee SK, Jung KY. Association of Zolpidem With Increased Mortality in Patients With Brain Cancer: A Retrospective Cohort Study Based on the National Health Insurance Service Database. J Clin Neurol 2022; 18:65-70. [PMID: 35021278 PMCID: PMC8762495 DOI: 10.3988/jcn.2022.18.1.65] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 08/07/2021] [Accepted: 08/09/2021] [Indexed: 11/17/2022] Open
Abstract
Background and Purpose Zolpidem is one of the most common hypnotics prescribed to treat insomnia worldwide. However, there are numerous reports of a positive association between zolpidem and mortality, including an association with increased cancer-specific mortality found in a Taiwanese cohort study. This study aimed to determine the association between zolpidem use and brain-cancer-specific mortality in patients with brain cancer. Methods This population-based, retrospective cohort study analyzed data in the National Health Insurance Service database. All incident cases of brain cancer at an age of ≥18 years at the time of brain cancer diagnosis over a 15-year period (2003–2017) were included. A multivariate Cox regression analysis after adjustment for covariables was performed to evaluate the associations of zolpidem exposure with brain-cancer-specific and all-cause mortality. Results This study identified 38,037 incident cases of brain cancer, among whom 11,823 (31.1%) patients were exposed to zolpidem. In the multivariate Cox regression model, the brain-cancer-specific mortality rate was significantly higher in patients who were prescribed zolpidem than in those with no zolpidem prescription (adjusted hazard ratio [HR]=1.14, 95% confidence interval [CI]=1.08–1.21, p<0.001). Zolpidem exposure was significantly associated with increased brain-cancer-specific mortality after adjustment in younger adults (age 18–64 years; adjusted HR=1.37, 95% CI=1.27–1.49) but not in older adults (age ≥65 years; adjusted HR=0.94, 95% CI=0.86–1.02). Conclusions Zolpidem exposure was significantly associated with increased brain-cancer-specific mortality in patients with brain cancer aged 18–64 years. Further prospective studies are warranted to understand the mechanism underlying the effect of zolpidem on mortality in patients with brain cancer.
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Affiliation(s)
- Sungeun Hwang
- Department of Neurology, Seoul National University Hospital, Seoul, Korea.,Department of Translational Medicine, Seoul National University College of Medicine, Seoul, Korea.,Department of Neurology, Ewha Womans University Mokdong Hospital, Seoul, Korea
| | - Hyoshin Son
- Department of Neurology, Seoul National University Hospital, Seoul, Korea.,Department of Translational Medicine, Seoul National University College of Medicine, Seoul, Korea.,Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea
| | - Manho Kim
- Department of Neurology, Seoul National University Hospital, Seoul, Korea.,Department of Translational Medicine, Seoul National University College of Medicine, Seoul, Korea.,Neuroscience and Protein Metabolism Research Center, Seoul National University College of Medicine, Seoul, Korea
| | - Sang Kun Lee
- Department of Neurology, Seoul National University Hospital, Seoul, Korea.,Department of Translational Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Ki-Young Jung
- Department of Neurology, Seoul National University Hospital, Seoul, Korea.,Department of Translational Medicine, Seoul National University College of Medicine, Seoul, Korea.,Neuroscience Research Institute, Seoul National University College of Medicine, Seoul, Korea.,Sensory Organ Research Institute, Medical Research Center, Seoul National University College of Medicine, Seoul, Korea.
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Association Between Benzodiazepine and Opioid Prescription and Mortality Among Patients in a Large Healthcare System. J Addict Med 2022; 16:65-71. [PMID: 35120065 PMCID: PMC8817063 DOI: 10.1097/adm.0000000000000828] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVE Coprescription of opioids and benzodiazepines (BDZ) is associated with adverse outcomes, including greater healthcare utilization and overdose risk. This study aims to examine opioid and BDZ coprescription, dosing, and mortality among patients with and without opioid use disorder (OUD) in a large healthcare system. METHODS Using data from the California state Prescription Drug Monitoring Program during 2010 to 2014 linked with a large healthcare system electronic health record database and mortality records from the Centers for Disease Control National Death Index, this study examined 5202 patients (1978 with OUD, 3224 controls). Multiple logistic regression analyses were conducted to examine relationships between most recent BDZ and opioid prescription, and their interaction with respect to mortality. RESULTS About 10.5% of the sample died on or before December 31, 2014. About 17.7% were prescribed BDZ during the final month of observation. Individuals with OUD were prescribed higher average BDZ and opioid doses than those without OUD. After adjusting for covariates, increased prescribed doses of BDZ (odds ratio [OR]=1.34, 95%CI: 1.15-1.55 per 10 mg/d increment) and opioids (OR = 1.04, 95%CI: 1.02-1.05 per 10 mg/d increment) were positively associated with mortality. Non-OUD patients who received both BDZ and opioid prescriptions had a higher mortality than those who received only BDZ or opioids (The ratio of odds ratio (ROR) = 3.83, 95%CI: 1.78-8.21). CONCLUSIONS Study findings highlight significant mortality associated with the coprescription of opioids and BDZ in a general healthcare setting. Further research is needed to elucidate factors associated with mortality among non-OUD patients who are co-prescribed opioids and BDZ.
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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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Wang J, Deng T, Sun H, Sun X, You Y, Wang Y, Xun Q, Ma Y. Efficacy and safety of moxibustion for benign prostatic hyperplasia: A protocol of systematic review and meta-analysis. Medicine (Baltimore) 2021; 100:e28437. [PMID: 34941196 PMCID: PMC8702266 DOI: 10.1097/md.0000000000028437] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 12/07/2021] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Benign prostatic hyperplasia (BPH) is a non-malignant enlargement of the prostate gland that is common in older men. The clinical manifestations of BPH are frequent urination, urgency, incomplete dribbling of urine, and urinary retention. Moxibustion, as a convenient, safe and effective method, has been widely applied in the clinical treatment of BPH. The study aim to assess the efficacy and safety of moxibustion for BPH. METHODS The following electronic databases will be searched regardless of language and publication status: Pubmed, MEDLINE, EMBASE, China Biomedical Database, China National Knowledge Infrastructure, VIP Database, and Wanfang Database, to select studies that meet the requirements. The study will consist of a prospective randomised controlled clinical trials (RCTs) of moxibustion in the treatment of BPH, language of publication does not have barrier of blinding or restrictions, adverse events will be assessed and reported for safety assessment. Two reviewers will independently conduct and screen all included studies and the meta-analysis will be performed with RevMan V5.3. RESULTS The study will provide a high-quality convincing assessment of efficacy and safety of moxibustion for BPH. CONCLUSION The conclusion of this study will provide the latest evidence for judging whether moxibustion is effective and safe in the treatment of BPH. TRIAL REGISTRATION NUMBER INPLASY2021120021.
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Affiliation(s)
- Jiaze Wang
- Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
| | - Tingting Deng
- Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
| | - Hao Sun
- Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
| | - Xiaolu Sun
- Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
| | - Yuwei You
- Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
| | - Ying Wang
- Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
| | - Qi Xun
- Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
| | - Yuxia Ma
- Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
- Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
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Analysis of Medical Services for Insomnia in Korea: A Retrospective, Cross-Sectional Study Using the Health Insurance Review and Assessment Claims Data. Healthcare (Basel) 2021; 10:healthcare10010007. [PMID: 35052172 PMCID: PMC8775632 DOI: 10.3390/healthcare10010007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 12/10/2021] [Accepted: 12/17/2021] [Indexed: 12/03/2022] Open
Abstract
This study aimed to analyze current trends in healthcare utilization and medication usage in patients with insomnia. We reviewed the National Patient Sample data from the Health Insurance Review and Assessment Service to determine healthcare utilization in patients diagnosed with insomnia (International Classification of Diseases-10 codes G470, F510) between January 2010 and December 2016. There were 87,470 patients enrolled in this study who utilized healthcare services at least once during the 7-year period. Healthcare utilization trends, Korean and Western medicine (KM and WM, respectively) therapies utilized, comorbidities, and socioeconomic data were analyzed. The number of patients seeking WM or KM care for insomnia increased annually. Adults aged ≥45 years accounted for 73% of the cohort, and there were more female than male patients. KM treatment including acupuncture was the most common in KM (65.29%), while examination was the most common WM treatments (49.31%). In pharmacological therapy, sedatives and hypnotics were the most common (41.08%), followed by antianxiety (19.50%), digestive system and metabolism-related drugs (7.77%). The most common comorbidities were mental health disorders (50.56%) in WM but musculoskeletal disorders in KM (35.67%). Code G470 was used more frequently than code F510, and the difference was more evident in KM than in WM. The findings will provide valuable information for both clinicians and researchers.
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Alhwimani AK, Aljohani RA, Altulaihi BA. The Use of Over-the-Counter Sleep Aid Containing Diphenhydramine Hydrochloride Among Saudis. Cureus 2021; 13:e20622. [PMID: 35106193 PMCID: PMC8786564 DOI: 10.7759/cureus.20622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/22/2021] [Indexed: 11/10/2022] Open
Abstract
Background Diphenhydramine is a first-generation H1 receptor antihistamine that is usually used for the treatment of allergy, insect bites such as mosquitos, bee stings, and some types of skin rashes. However, it possesses antiparkinsonian, antitussive, antiemetic, and most importantly hypnotic properties. This study aimed to assess the prevalence, frequency of use, and dosage of over-the-counter (OTC) sleep aid containing diphenhydramine hydrochloride used among Saudis. Material and Methods The study used a descriptive cross-sectional design conducted among the Saudi population. An online self-administered questionnaire was distributed among the selected Saudi nationality using social media platforms. The subjects included were Saudis aged 15 years or older, literate in using social media. The questionnaire included basic demographic characteristics, previous and current history of medication use that contains diphenhydramine hydrochloride, its side effects, and other related behavior of using, such as frequency of use and dosage. Results A total of 414 respondents were recruited (51% males and 49% females). Previous and current use of medications that contain diphenhydramine hydrochloride constituted 87.2% and 31.9%, respectively. The most common reason for using sleep aid was insomnia (52.1%). Dizziness or imbalance was the most commonly reported side effect. The Chi-square test revealed that the age group of ≤25 years (p = 0.044), female gender (p = 0.040), being a student (p = 0.015), current use of sleeping aid medications (p < 0.001), and the use of other medications (p < 0.001) were significantly associated with increased use of sleep aid medications. Conclusion The excessive use of over-the-counter (OTC) sleep aid medications containing diphenhydramine hydrochloride was widely prevalent among the Saudi population. Younger female students constitute the majority of OTC sleep aid medication users.
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Antza C, Kostopoulos G, Mostafa S, Nirantharakumar K, Tahrani A. The links between sleep duration, obesity and type 2 diabetes mellitus. J Endocrinol 2021; 252:125-141. [PMID: 34779405 PMCID: PMC8679843 DOI: 10.1530/joe-21-0155] [Citation(s) in RCA: 77] [Impact Index Per Article: 25.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 11/12/2021] [Indexed: 11/24/2022]
Abstract
Global rates of obesity and type 2 diabetes mellitus (T2DM) are increasing globally concomitant with a rising prevalence of sleep deprivation and sleep disorders. Understanding the links between sleep, obesity and T2DM might offer an opportunity to develop better prevention and treatment strategies for these epidemics. Experimental studies have shown that sleep restriction is associated with changes in energy homeostasis, insulin resistance and β-cell function. Epidemiological cohort studies established short sleep duration as a risk factor for developing obesity and T2DM. In addition, small studies suggested that short sleep duration was associated with less weight loss following lifestyle interventions or bariatric surgery. In this article, we review the epidemiological evidence linking sleep duration to obesity and T2DM and plausible mechanisms. In addition, we review the impact of changes in sleep duration on obesity and T2DM.
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Affiliation(s)
- Christina Antza
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
- Department of Diabetes and Endocrinology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Georgios Kostopoulos
- Department of Endocrinology, 424 General Military Hospital, Thessaloniki, Greece
| | - Samiul Mostafa
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
- Department of Diabetes and Endocrinology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Krishnarajah Nirantharakumar
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- Centre of Endocrinology Diabetes and Metabolism, Birmingham Health Partners, Birmingham, UK
| | - Abd Tahrani
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
- Department of Diabetes and Endocrinology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- Centre of Endocrinology Diabetes and Metabolism, Birmingham Health Partners, Birmingham, UK
- Correspondence should be addressed to A Tahrani:
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Testing an early online intervention for the treatment of disturbed sleep during the COVID-19 pandemic in self-reported good and poor sleepers (Sleep COVID-19): study protocol for a randomised controlled trial. Trials 2021; 22:913. [PMID: 34895327 PMCID: PMC8665855 DOI: 10.1186/s13063-021-05888-0] [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] [Received: 09/10/2021] [Accepted: 11/26/2021] [Indexed: 11/29/2022] Open
Abstract
Background Theoretical models of insomnia suggest that stressful life events, such as the COVID-19 pandemic, can cause acute insomnia (short-term disruptions to sleep). Early interventions may prevent short-term sleep problems from progressing to insomnia disorder. Although cognitive behavioural therapy for insomnia (CBT-I) is effective in treating insomnia disorder, this can be time and resource-intensive. Further, online interventions can be used to deliver treatment to a large number of individuals. The objective of this study is to investigate if an online behavioural intervention, in the form of a leaflet, which has been successfully used alongside CBT-I for acute insomnia, can reduce symptoms of acute insomnia in poor sleepers. Methods A total of 124 self-reported good and poor sleepers will be enrolled in an online stratified randomised controlled trial. After baseline assessments (T1), participants will complete a 1-week pre-intervention sleep monitoring period (T2) where they will complete daily sleep-diaries. Poor sleepers (n = 62) will be randomly allocated to an invention or wait-list group, where they will receive the intervention (T3), or will do so after a 28-day delay. Good sleepers (n = 62) will be randomly assigned to an intervention or no intervention group. All participants will complete a 1-week post intervention sleep monitoring period using daily sleep diaries (T4). Participants will be followed up at 1 week (T5), 1 month (T6) and 3 months (T7) post intervention. The primary outcome measure will be insomnia severity, measured using the Insomnia Severity Index. Secondary outcome measures will include subjective mood and subjective sleep continuity, measured using sleep diaries. Data will be analysed using an intention-to-treat approach. Discussion It is expected that this online intervention will reduce symptoms of acute insomnia in self-reported short-term poor sleepers, and will also prevent the transition to poor sleep in good sleepers. We expect that this will demonstrate the feasibility of online interventions for the treatment and prevention of acute insomnia. Specific advantages of online approaches include the low cost, ease of administration and increased availability of treatment, relative to face-to-face therapy. Trial registration ISRCTN43900695 (Prospectively registered 8th of April 2020).
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Cromhout PF, Christensen AV, Jørgensen MB, Ekholm O, Juel K, Svendsen JH, Osler M, Rasmussen TB, Borregaard B, Mols RE, Thrysoee L, Thorup CB, Berg SK. Exploring the use of psychotropic medication in cardiac patients with and without anxiety and its association with 1-year mortality. Eur J Cardiovasc Nurs 2021; 21:612-619. [PMID: 35020894 DOI: 10.1093/eurjcn/zvab111] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 05/27/2021] [Accepted: 10/22/2021] [Indexed: 11/13/2022]
Abstract
AIMS Comorbid psychiatric disorders and the use of psychotropic medication are common among cardiac patients and have been found to increase the risk of mortality. The aims of this study were: (i) to describe the use of psychotropic medication among cardiac patients with and without symptoms of anxiety, (ii) to estimate the association between use of psychotropic medication prior to hospital admission and all-cause, 1-year mortality following discharge, and (iii) to estimate the risk of mortality among users and non-users of psychotropic medication with or without self-reported symptoms of anxiety. METHODS AND RESULTS Cardiac patients from the DenHeart survey were included, providing information on self-reported symptoms of anxiety. From national registers, information on the use of psychotropic medication 6 months prior to hospitalization and mortality was obtained. By logistic regression analyses, the association between the use of psychotropic medication, anxiety, and all-cause, 1-year mortality was estimated. The risk of subsequent incident use of psychotropic medication among patients with and without anxiety was furthermore explored. All analyses were fully adjusted. A total of 12 913 patients were included, of whom 18% used psychotropic medication, and 3% died within 1 year. The use of psychotropic medication was found to be associated with increased 1-year all-cause mortality [odds ratio 1.90 (95% confidence interval, 1.46-2.46)]. Patients with symptoms of anxiety were significantly more likely to use psychotropic medication following hospital discharge [2.47 (2.25-2.72)]. CONCLUSION The use of psychotropic medication was associated with 1-year mortality. Thus, the use of psychotropic medication might explain some of the association between anxiety and mortality; however, the association is probably mainly a reflection of the underlying mental illness, rather than the use of psychotropic medication.
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Affiliation(s)
- Pernille Fevejle Cromhout
- Department of Cardiothoracic Anaesthesiology, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Anne Vinggaard Christensen
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Martin Balslev Jørgensen
- Psychiatric Centre Copenhagen, Institute of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen, Denmark
| | - Ola Ekholm
- National Institute of Public Health, University of Southern Denmark, Studiestræde 6, 1455 Copenhagen, Denmark
| | - Knud Juel
- National Institute of Public Health, University of Southern Denmark, Studiestræde 6, 1455 Copenhagen, Denmark
| | - Jesper Hastrup Svendsen
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100 Copenhagen, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen, Denmark
| | - Merete Osler
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospitals, Nordre Fasanvej 57, 2000 Frederiksberg, Denmark
| | - Trine Bernholdt Rasmussen
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen, Denmark.,Department of Cardiology, Herlev and Gentofte University Hospital, Gentofte Hospitalsvej 1, 2900 Hellerup, Denmark
| | - Britt Borregaard
- Department of Cardiothoracic and Vascular Surgery, Odense University Hospital, J.B. Winsløws Vej 4, 5000 Odense, Denmark.,Department of Cardiology, Odense University Hospital, J.B. Winsløws Vej 4, 5000 Odense, Denmark
| | - Rikke Elmose Mols
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Blvd. 161, 8200 Aarhus, Denmark
| | - Lars Thrysoee
- Department of Cardiology, Odense University Hospital, J.B. Winsløws Vej 4, 5000 Odense, Denmark
| | - Charlotte Brun Thorup
- Department of Cardiology, Cardiac Surgery & Clinical Nursing Research Unit, Aalborg University Hospital, Hobrovej 18, 9000 Aalborg, Denmark
| | - Selina Kikkenborg Berg
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100 Copenhagen, Denmark.,National Institute of Public Health, University of Southern Denmark, Studiestræde 6, 1455 Copenhagen, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen, Denmark
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Edinoff AN, Nix CA, Hollier J, Sagrera CE, Delacroix BM, Abubakar T, Cornett EM, Kaye AM, Kaye AD. Benzodiazepines: Uses, Dangers, and Clinical Considerations. Neurol Int 2021; 13:594-607. [PMID: 34842811 PMCID: PMC8629021 DOI: 10.3390/neurolint13040059] [Citation(s) in RCA: 54] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 11/08/2021] [Accepted: 11/08/2021] [Indexed: 11/16/2022] Open
Abstract
Benzodiazepines (BZDs) are among one of the most widely prescribed drug classes in the United States. BZDs are a class of psychoactive drugs known for their depressant effect on the central nervous system (CNS). They quickly diffuse through the blood-brain barrier to affect the inhibitory neurotransmitter GABA and exert sedative effects. Related to their rapid onset and immediate symptom relief, BZDs are used for those struggling with sleep, anxiety, spasticity due to CNS pathology, muscle relaxation, and epilepsy. One of the debilitating side effects of BZDs is their addictive potential. The dependence on BZDs generally leads to withdrawal symptoms, requiring careful tapering of the medication when prescribed. Regular use of BZDs has been shown to cause severe, harmful psychological and physical dependence, leading to withdrawal symptoms similar to that of alcohol withdrawal. Some of these withdrawal symptoms can be life threatening. The current treatment for withdrawal is through tapering with clonazepam. Many drugs have been tested as a treatment for withdrawal, with few proving efficacious in randomized control trials. Future research is warranted for further exploration into alternative methods of treating BZD withdrawal. This call to action proves especially relevant, as those seeking treatment for BZD dependence and withdrawal are on the rise in the United States.
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Affiliation(s)
- Amber N. Edinoff
- Department of Psychiatry and Behavioral Medicine, Louisiana State University Health Shreveport, Shreveport, LA 71103, USA; (C.A.N.); (J.H.)
- Correspondence: ; Tel.: +1-(318)-675-8969
| | - Catherine A. Nix
- Department of Psychiatry and Behavioral Medicine, Louisiana State University Health Shreveport, Shreveport, LA 71103, USA; (C.A.N.); (J.H.)
| | - Janice Hollier
- Department of Psychiatry and Behavioral Medicine, Louisiana State University Health Shreveport, Shreveport, LA 71103, USA; (C.A.N.); (J.H.)
| | - Caroline E. Sagrera
- School of Medicine, Louisiana State University Health Shreveport, Shreveport, LA 71103, USA; (C.E.S.); (B.M.D.); (T.A.)
| | - Blake M. Delacroix
- School of Medicine, Louisiana State University Health Shreveport, Shreveport, LA 71103, USA; (C.E.S.); (B.M.D.); (T.A.)
| | - Tunde Abubakar
- School of Medicine, Louisiana State University Health Shreveport, Shreveport, LA 71103, USA; (C.E.S.); (B.M.D.); (T.A.)
| | - Elyse M. Cornett
- Department of Anesthesiology, Louisiana State University Health Shreveport, Shreveport, LA 71103, USA; (E.M.C.); (A.D.K.)
| | - Adam M. Kaye
- Department of Pharmacy Practice, Thomas J. Long School of Pharmacy and Health Sciences, University of the Pacific, Stockton, CA 95211, USA;
| | - Alan D. Kaye
- Department of Anesthesiology, Louisiana State University Health Shreveport, Shreveport, LA 71103, USA; (E.M.C.); (A.D.K.)
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Collard VEJ, Moore C, Nichols V, Ellard DR, Patel S, Sandhu H, Parsons H, Sharma U, Underwood M, Madan J, Tang NKY. Challenges and visions for managing pain-related insomnia in primary care using the hybrid CBT approach: a small-scale qualitative interview study with GPs, nurses, and practice managers. BMC FAMILY PRACTICE 2021; 22:210. [PMID: 34666682 PMCID: PMC8527665 DOI: 10.1186/s12875-021-01552-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 09/01/2021] [Indexed: 08/30/2023]
Abstract
Background Chronic pain and insomnia have a complex, bidirectional relationship – addressing sleep complaints alongside pain may be key to alleviating patient-reported distress and disability. Healthcare professionals have consistently reported wanting to offer psychologically informed chronic pain management at the primary care level. Research in secondary care has demonstrated good treatment efficacy of hybrid CBT for chronic pain and insomnia. However, primary care is typically the main point of treatment entry, hence may be better situated to offer treatments using a multidisciplinary approach. In this study, primary care service providers’ perception of feasibility for tackling pain-related insomnia in primary care was explored. Methods The data corpus originates from a feasibility trial exploring hybrid CBT for chronic pain and insomnia delivered in primary care. This formed three in-depth group interviews with primary care staff (n = 9) from different primary care centres from the same NHS locale. All interviews were conducted on-site using a semi-structured approach. Verbal data was recorded, transcribed verbatim and analysed using the thematic analysis process. Results Eight themes were identified – 1) Discrepant conceptualisations of the chronic pain-insomnia relationship and clinical application, 2) Mismatch between patients’ needs and available treatment offerings, 3) Awareness of psychological complexities, 4) Identified treatment gap for pain-related insomnia, 5) Lack of funding and existing infrastructure for new service development, 6) General shortage of psychological services for complex health conditions, 7) Multidisciplinary team provision with pain specialist input, and 8) Accessibility through primary care. These mapped onto four domains - Current understanding and practice, Perceived facilitators, Perceived barriers, Ideal scenarios for a new treatment service – which reflected the focus of our investigation. Taken together these provide key context for understanding challenges faced by health care professionals in considering and developing a new clinical service. Conclusions Primary care service providers from one locale advocate better, multidisciplinary treatment provision for chronic pain and insomnia. Findings suggest that situating this in primary care could be a feasible option, but this requires systemic support and specialist input as well as definitive trials for success. Supplementary Information The online version contains supplementary material available at 10.1186/s12875-021-01552-3.
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Affiliation(s)
- V E J Collard
- Department of Psychology, University of Warwick, Gibbet Hill Road, Coventry, CV4 7AL, UK.
| | - C Moore
- Department of Psychology, University of Warwick, Gibbet Hill Road, Coventry, CV4 7AL, UK
| | - V Nichols
- Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK
| | - D R Ellard
- Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK.,University Hospitals Coventry and Warwickshire NHS Trust, Coventry, CV2 2DX, UK
| | - S Patel
- Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK
| | - H Sandhu
- Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK
| | - H Parsons
- Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK.,University Hospitals Coventry and Warwickshire NHS Trust, Coventry, CV2 2DX, UK
| | - U Sharma
- University/User Teaching and Research Action Partnership, University of Warwick, Coventry, CV4 7AL, UK
| | - M Underwood
- Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK.,University Hospitals Coventry and Warwickshire NHS Trust, Coventry, CV2 2DX, UK
| | - J Madan
- Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK
| | - N K Y Tang
- Department of Psychology, University of Warwick, Gibbet Hill Road, Coventry, CV4 7AL, UK
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Mind-Body Therapies for Cancer Patients Living with Depression, Anxiety or Insomnia (MIRACLE): A Systematic Review with Individual Participant Data Network Meta-Analysis. Methods Protoc 2021; 4:mps4040076. [PMID: 34698240 PMCID: PMC8544545 DOI: 10.3390/mps4040076] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 10/13/2021] [Accepted: 10/13/2021] [Indexed: 11/17/2022] Open
Abstract
Depression, anxiety, and insomnia are common in cancer patients. Mind-body therapies (MBTs) are promising forms of treatment for cancer patients living with depression, anxiety, and insomnia. The objective of this study is to assess the effectiveness and acceptability of MBTs in cancer patients living with depression, anxiety, or insomnia. EMBase, PubMed, Cinahl, PsychINFO, IndMED, CSI-NISCAIR, CNKI, Clinicaltrial.gov, ChiCTR, and CTRI will be searched until October 2020 for relevant studies. Randomized controlled studies in which MBTs were tested in a cancer population will be selected. The authors of the selected studies will be contacted to obtain individual participant data. The participants who reached a defined clinical threshold for depression, anxiety, or insomnia will be selected for the three sub-studies on depression, anxiety, and insomnia, respectively. Pairwise and network meta-analyses will be used to assess the changes in depression, anxiety, sleep quality, and completion rate. We will assess the effect of the treatment dose (number and frequency of interventions) on effectiveness. The results of this study will inform clinical decision-making for the treatment of psychological disturbances in cancer patients. If MBTs are found effective, they will potentially be recommended as treatments for cancer patients with psychological symptoms.
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Oh TK, Park HY, Han JY, Song IA. Prior benzodiazepine use and mortality among adult patients with sepsis: A retrospective population-based cohort study in South Korea. Int J Clin Pract 2021; 75:e14517. [PMID: 34133821 DOI: 10.1111/ijcp.14517] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 05/19/2021] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVES This study investigated whether long-term benzodiazepine use is associated with increased 90-day mortality among patients with sepsis. METHODS A retrospective population-based cohort study based on health records obtained from the National Health Insurance Service database in South Korea was conducted. All adult patients (≥18 years) admitted to the hospital with a primary diagnosis of sepsis or septic shock during 2010-2018 were included in the study. Sepsis and septic shock were diagnosed based on the International Classification of Diseases (10th revision: A40, A41 and R65.2). Benzodiazepine users were defined as individuals who were prescribed regular benzodiazepine continuously for over 6 months before admission. RESULTS A total of 251 837 patients with sepsis were included in this study, 16 686 of which (6.6%) were benzodiazepine users, and 235 151 (93.4%) were non-users. After propensity score (PS) matching, 33 370 patients (16 685 in both groups) were ultimately included. Moreover, following PS matching, the 90-day mortality among benzodiazepine users and non-users was 60.9% (10 167) and 41.4% (6916), respectively. Cox regression analysis further revealed the hazard ratio (HR) for 90-day mortality in benzodiazepine users to be 1.75, compared with non-users [95% confidence interval (CI): 1.70-1.81; P < .001]. Sensitivity analyses showed that, compared with non-users, HRs for 90-day mortality in benzodiazepine users without and with other psychiatric illnesses were 1.43 (95% CI: 1.38-1.49; P < .001) and 1.89 (95% CI: 1.84-1.94; P < .001), respectively. CONCLUSION Long-term benzodiazepine use is associated with increased 90-day mortality among adult patients with sepsis compared with non-users. This association was more evident in benzodiazepine users with other psychiatric diseases, such as depression or anxiety disorder.
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Affiliation(s)
- Tak Kyu Oh
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Hye Yoon Park
- Department of Psychiatry, Seoul National University Hospital, Seoul, Republic of Korea
| | - Ji-Yun Han
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - In-Ae Song
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
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Exercise intervention in cancer patients with sleep disturbances scheduled for elective surgery: Systematic review. Int J Surg 2021; 93:106069. [PMID: 34464753 DOI: 10.1016/j.ijsu.2021.106069] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 07/21/2021] [Accepted: 08/24/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND & OBJECTIVES Sleep disturbance is one of the patients' major complaints after major surgery and can impair postoperative recovery. Pre-operative exercise has been shown to increase functional capacity and resilience in cancer patients; scarce knowledge is available on the effects of pre-operative exercise on sleep disturbances. This systematic review aims to determine the impact of pre-operative exercise training alone or as part of multimodal prehabilitation on sleep disturbances and sleep quality in cancer patients. METHODS A systematic search including Biosis, Cochrane Library and CENTRAL, EMBASE, MEDLINE, and clinical trial registries (clinicaltrials.gov, International Clinical Trials Registry Platform) was performed to identify studies involving a pre-operative exercise intervention in cancer patients awaiting surgery. Trials had to contain at least one sleep measure, assessed subjectively and objectively were included in the systematic review. The quality of the included trials was assessed using the Cochrane Risk of Bias Tool for assessing the risk of bias in randomized trials tool and the ROBINS-I tool for evaluating the risk of bias in non-randomized studies. RESULTS Seven studies were included (1 RCT, 2 non-RCTs and 4 single-arm design). Due to substantial heterogeneity in the interventions across studies, a meta-analysis was not conducted. The available empirical evidence on the presurgical effect of exercise on sleep outcomes is scarce and, overall, suggests that it has a limited effect. Besides, non-significant improvement of the pre-operative exercise on sleep was unique to the studies that used subjective measures to assess sleep disturbances changes during cancer treatment. CONCLUSION There are conflicting results and a lack of quality data proving the pre-operative exercise on sleep quality and disturbances. More research is needed in the pre-operative period using clinical sleep disturbances such as insomnia as an inclusion criterion, subjectively and objectively assessed.
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Socias I, Leiva A, Pombo-Ramos H, Bejarano F, Sempere-Verdú E, Rodríguez-Rincón RM, Fiol F, Mengual M, Ajenjo-Navarro A, Do Pazo F, Mateu C, Folch S, Alegret S, Coll JM, Martín-Rabadán M, Vicens C. Evaluating the Implementation of a Multicomponent Intervention Consisting of Education and Feedback on Reducing Benzodiazepine Prescriptions by General Practitioners: BENZORED Hybrid Type I Cluster Randomized Controlled Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:7964. [PMID: 34360267 PMCID: PMC8345522 DOI: 10.3390/ijerph18157964] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 07/15/2021] [Accepted: 07/21/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND General practitioners (GPs) in developed countries widely prescribe benzodiazepines (BZDs) for their anxiolytic, hypnotic, and muscle-relaxant effects. Treatment duration, however, is rarely limited, and this results in a significant number of chronic users. Long-term BZD use is associated with cognitive impairment, falls with hip fractures, traffic accidents, and increased mortality. The BENZORED IV trial was a hybrid type-1 trial conducted to evaluate the effectiveness and implementation of an intervention to reduce BZD prescription in primary care. The purpose of this qualitative study was to analyze the facilitators and barriers regarding the implementation of the intervention in primary care settings. METHODS A qualitative interview study with 40 GPs from three Spanish health districts. Focus group meetings with GPs from the intervention arm of the BENZORED IV trial were held at primary healthcare centers in the three districts. For sampling purposes, the GPs were classified as high or low implementers according to the success of the intervention measured at 12 months. The Consolidated Framework for Implementation Research (CFIR) was used to conduct the meetings and to code, rate, and analyze the data. RESULTS Three of the 41 CFIR constructs strongly distinguished between high and low implementers: the complexity of the intervention, the individual Stage of Change, and the key stakeholder's engagement. Seven constructs weakly discriminated between the two groups: adaptability in the intervention, external policy and incentives, implementation climate, relative priority, self-efficacy, compatibility, and engaging a formally appointed implementation leader. Fourteen constructs did not discriminate between the two groups, six had insufficient data for evaluation, and eleven had no data for evaluation. CONCLUSIONS We identified constructs that could explain differences in the efficacy in implementation of the intervention. This information is relevant for the design of successful strategies for implementation of the intervention.
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Affiliation(s)
- Isabel Socias
- Healthcare Centre Manacor, Balearic Health Service IbSalut, 07500 Manacor, Spain;
- Balearic Islands Health Research Institute (IdISBa), 07120 Palma, Spain
| | - Alfonso Leiva
- Balearic Islands Health Research Institute (IdISBa), 07120 Palma, Spain
- Reseach Unit Mallorca, Balearic Health Service IbSalut, 07003 Palma, Spain
| | - Haizea Pombo-Ramos
- Primary Care Research Unit of Biscaia, Basque HealthCare Service Osakidetza, BioCruces Health Research Institute, 48903 Bizkaia, Spain;
| | - Ferran Bejarano
- Catalunya Health Services-CatSalut, DAP Camp de Tarragona, 43002 Tarragona, Spain; (F.B.); (M.M.); (S.F.)
| | - Ermengol Sempere-Verdú
- Paterna Healthcare Centre, Conselleria de Sanitat Universal i Salut Pública, 46980 Valencia, Spain; (E.S.-V.); (A.A.-N.)
| | - Raquel María Rodríguez-Rincón
- Pharmacy Department, Hospital Universitari Son Espases, Balearic Health Service IbSalut, 07120 Palma, Spain; (R.M.R.-R.); (F.D.P.)
| | - Francisca Fiol
- Balearic Islands Health Research Institute (IdISBa), 07120 Palma, Spain
- Son Serra-La Vileta Healthcare Centre, Balearic Health Service IbSalut, 07013 Palma, Spain; (F.F.); (C.M.); (S.A.); (C.V.)
| | - Marta Mengual
- Catalunya Health Services-CatSalut, DAP Camp de Tarragona, 43002 Tarragona, Spain; (F.B.); (M.M.); (S.F.)
| | - Asunción Ajenjo-Navarro
- Paterna Healthcare Centre, Conselleria de Sanitat Universal i Salut Pública, 46980 Valencia, Spain; (E.S.-V.); (A.A.-N.)
| | - Fernando Do Pazo
- Pharmacy Department, Hospital Universitari Son Espases, Balearic Health Service IbSalut, 07120 Palma, Spain; (R.M.R.-R.); (F.D.P.)
| | - Catalina Mateu
- Son Serra-La Vileta Healthcare Centre, Balearic Health Service IbSalut, 07013 Palma, Spain; (F.F.); (C.M.); (S.A.); (C.V.)
| | - Silvia Folch
- Catalunya Health Services-CatSalut, DAP Camp de Tarragona, 43002 Tarragona, Spain; (F.B.); (M.M.); (S.F.)
| | - Santiago Alegret
- Son Serra-La Vileta Healthcare Centre, Balearic Health Service IbSalut, 07013 Palma, Spain; (F.F.); (C.M.); (S.A.); (C.V.)
| | - Jose Maria Coll
- Menorca Primary Care Management, Balearic Health Service IbSalut, 07701 Maó, Spain;
| | - María Martín-Rabadán
- Can Misses Healthcare Centre Ibiza, Balearic Health Service IbSalut, 07800 Ibiza, Spain;
| | - Caterina Vicens
- Balearic Islands Health Research Institute (IdISBa), 07120 Palma, Spain
- Son Serra-La Vileta Healthcare Centre, Balearic Health Service IbSalut, 07013 Palma, Spain; (F.F.); (C.M.); (S.A.); (C.V.)
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