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Mohammad A, Elham H, Andreas K. A scoping review of the effect of chronic stretch training on sleep quality in people with sleep disorders. Eur J Appl Physiol 2024:10.1007/s00421-024-05541-z. [PMID: 38918221 DOI: 10.1007/s00421-024-05541-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Accepted: 06/14/2024] [Indexed: 06/27/2024]
Abstract
PURPOSE The widespread and health-detrimental sleep disorders have resulted in stretching exercises being investigated as a non-drug solution for enhanced sleep quality. However, a comprehensive understanding of the impact of stretching exercises on individuals with sleep disorders is lacking. METHODS This scoping review systematically maps the existing literature and identifies research gaps on the impact of stretching exercises on sleep quality in individuals with sleep disorders. RESULTS Sixteen eligible studies were included, where the weighted mean changes indicate a positive trend in sleep quality improvement, ranging from trivial to very large magnitudes. However, concerning the individual study results only 5 out of 16 studies reported significant improvements. Notable enhancements include a small 1.22% overall sleep quality improvement, a large 6.51% reduction in insomnia severity, a large 8.88% increase in sleep efficiency, a moderate 4.36% decrease in sleep onset latency, a large 8.27% decrease in wake after sleep onset, and a very large 14.70% improvement in total sleep time. Trivial changes are noted in sleep duration (0.58%), sleep disturbance reduction (0.07%), and daytime dysfunction reduction (0.19%). Likely mechanisms for the improvement of sleep include autonomic nervous system modulation, muscle tension relief, cortisol regulation, enhanced blood circulation, and psychological benefits such as stress reduction and mood enhancement. CONCLUSION There is little evidence that stretching exercises positively impact sleep quality in individuals with sleep disorders. Additionally, further research is vital for designing optimal protocols, understanding of the long-term effects, and clarification of the mechanisms.
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Affiliation(s)
- Alimoradi Mohammad
- Department of Sports Injuries and Corrective Exercises, Faculty of Sports Sciences, University of Shahid Bahonar Kerman, Kerman, Iran
| | - Hosseini Elham
- Department of Sports Injuries and Corrective Exercises, Faculty of Sports Sciences, University of Shahid Bahonar Kerman, Kerman, Iran
| | - Konrad Andreas
- Institute of Human Movement Science, Sport and Health, Graz University, Mozartgasse 14, 8010, Graz, Austria.
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Chodosh J, Cadogan M, Brody AA, Mitchell MN, Hernandez DE, Mangold M, Alessi CA, Song Y, Martin JL. Implementation Outcomes for the SLUMBER Sleep Improvement Program in Long-Term Care. J Am Med Dir Assoc 2024; 25:932-938.e1. [PMID: 38493806 PMCID: PMC11065623 DOI: 10.1016/j.jamda.2024.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 02/07/2024] [Accepted: 02/08/2024] [Indexed: 03/19/2024]
Abstract
OBJECTIVES To describe the implementation of a mentored staff-delivered sleep program in nursing facilities. DESIGN Modified stepped-wedge unit-level intervention. SETTING AND PARTICIPANTS This program was implemented in 2 New York City nursing facilities, with partial implementation (due to COVID-19) in a third facility. METHODS Expert mentors provided staff webinars, in-person workshops, and weekly sleep pearls via text messaging. We used the integrated Promoting Action on Research Implementation in Health Services (i-PARiHS) framework as a post hoc approach to describe key elements of the SLUMBER implementation. We measured staff participation in unit-level procedures and noted their commentary during unit workshops. RESULTS We completed SLUMBER within 5 units across 2 facilities and held 15 leadership meetings before and during program implementation. Sessions on each unit included 3 virtual webinar presentations and 4 in-person workshops for each nursing shift, held over a period of 3 to 4 months. Staff attendance averaged >3 sessions per individual staff member. Approximately 65% of staff present on each unit participated in any given session. Text messaging was useful for engagement, educational reinforcement, and encouraging attendance. We elevated staff as experts in the care of their residents as a strategy for staff engagement and behavior change and solicited challenging cases from staff during workshops to provide strategies to address resident behavior and encourage adoption when successful. CONCLUSIONS AND IMPLICATIONS Engaging staff, leadership, residents, and family of nursing facilities in implementing a multicomponent sleep quality improvement program is feasible for improving nursing facilities' sleep environment. The program required gaining trust at multiple levels through presence and empathy, and reinforcement mechanisms (primarily text messages). To improve scalability, SLUMBER could evolve from an interdisciplinary investigator-based approach to internal coaches in a train-the-trainer model to effectively and sustainably implement this program to improve sleep quality for facility residents.
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Affiliation(s)
- Joshua Chodosh
- Department of Medicine, New York University Grossman School of Medicine, New York City, NY, USA; Medicine Service, VA New York Harbor Healthcare System, New York City, NY, USA.
| | - Mary Cadogan
- School of Nursing, University of California, Los Angeles, CA, USA
| | - Abraham A Brody
- Department of Medicine, New York University Grossman School of Medicine, New York City, NY, USA; Hartford Institute for Geriatric Nursing, Rory Meyers College of Nursing, New York University, New York City, NY, USA
| | - Michael N Mitchell
- Geriatric Research, Education, and Clinical Center, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Diana E Hernandez
- Department of Medicine, New York University Grossman School of Medicine, New York City, NY, USA
| | - Michael Mangold
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai (Beth Israel), New York City, New York, USA
| | - Cathy A Alessi
- Geriatric Research, Education, and Clinical Center, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA; David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Yeonsu Song
- School of Nursing, University of California, Los Angeles, CA, USA; Geriatric Research, Education, and Clinical Center, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA; David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Jennifer L Martin
- Geriatric Research, Education, and Clinical Center, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA; David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
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Piovezan RD, Jadczak AD, Tucker G, Visvanathan R. Daytime Sleepiness Predicts Mortality in Nursing Home Residents: Findings from the Frailty in Residential Aged Care Sector Over Time (FIRST) Study. J Am Med Dir Assoc 2023; 24:1458-1464.e4. [PMID: 37062370 DOI: 10.1016/j.jamda.2023.03.007] [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: 12/20/2022] [Revised: 03/08/2023] [Accepted: 03/10/2023] [Indexed: 04/18/2023]
Abstract
OBJECTIVES Excessive daytime sleepiness is an increasingly frequent condition among older adults with comorbidities and living in nursing homes (NHs). This study investigated associations between participants' characteristics and excessive daytime sleepiness (EDS); the ability of the Epworth Sleepiness Scale (ESS) scores, EDS, and EDS severity levels to predict mortality at 12 months of follow-up; and the optimal cut-off for ESS to predict mortality among NH residents. DESIGN Prospective and cross-sectional analysis in a prospective study. SETTING AND PARTICIPANTS Older adults permanently residing in 12 NHs from South Australia. METHODS Baseline characteristics including the ESS were collected and mortality at 12 months was assessed. Logistic regression analyzed associations between participants' characteristics and EDS (ESS >10). Kaplan-Meier cumulative survival estimates followed by log-rank and adjusted Cox proportional hazards models explored associations of ESS scores, EDS, and EDS severity levels with time-to-incident death. Receiver operator curve analysis assessed the best cut-off for ESS to predict mortality risk. RESULTS A total of 550 participants [mean (SD) age, 87.7 (7.2) years; 968 (50.9%) female]. Malnutrition [adjusted odds ratio (aOR) 2.02, 95% confidence interval (CI) 1.13‒3.61], myocardial infarction (aOR 1.91, 95% CI 1.20‒3.03), heart failure (aOR 2.85, 95% CI 1.68‒4.83), Parkinson's disease (aOR 2.16, 95% CI 1.04‒4.47) and severe dementia (aOR 8.57, 95% CI 5.25‒14.0) were associated with EDS. Kaplan-Meier analyses showed reduced survival among participants with EDS (log-rank test: χ2 = 25.25, P < .001). EDS predicted increased mortality risk (HR 1.63, 95% CI 1.07-2.51, P = .023). ESS score of 10.5 (>10) was the best cut point predicting mortality risk (area under the curve = 0.62). CONCLUSIONS AND IMPLICATIONS EDS predicts mortality risk and is associated with age-related comorbidities in NH residents. Screening for EDS is a simple strategy to identify NH residents at higher risk of adverse outcomes, triggering an assessment for reversibility or conversations about end-of-life care.
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Affiliation(s)
- Ronaldo D Piovezan
- Adelaide Geriatrics Training and Research with Aged Care (GTRAC) Centre, Adelaide Medical School, the Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, Australia; Aged and Extended Care Services, The Queen Elizabeth Hospital, Central Adelaide Local Health Network, Adelaide, Australia.
| | - Agathe D Jadczak
- Adelaide Geriatrics Training and Research with Aged Care (GTRAC) Centre, Adelaide Medical School, the Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, Australia
| | - Graeme Tucker
- Adelaide Geriatrics Training and Research with Aged Care (GTRAC) Centre, Adelaide Medical School, the Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, Australia
| | - Renuka Visvanathan
- Adelaide Geriatrics Training and Research with Aged Care (GTRAC) Centre, Adelaide Medical School, the Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, Australia; Aged and Extended Care Services, The Queen Elizabeth Hospital, Central Adelaide Local Health Network, Adelaide, Australia
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Du L, He X, Fan X, Wei X, Xu L, Liang T, Wang C, Ke Y, Yung WH. Pharmacological interventions targeting α-synuclein aggregation triggered REM sleep behavior disorder and early development of Parkinson's disease. Pharmacol Ther 2023; 249:108498. [PMID: 37499913 DOI: 10.1016/j.pharmthera.2023.108498] [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: 04/28/2023] [Revised: 06/24/2023] [Accepted: 07/18/2023] [Indexed: 07/29/2023]
Abstract
Rapid eye movement (REM) sleep behavior disorder (RBD) is a parasomnia characterized by elevated motor behaviors and dream enactments in REM sleep, often preceding the diagnosis of Parkinson's disease (PD). As RBD could serve as a biomarker for early PD developments, pharmacological interventions targeting α-synuclein aggregation triggered RBD could be applied toward early PD progression. However, robust therapeutic guidelines toward PD-induced RBD are lacking, owing in part to a historical paucity of effective treatments and trials. We reviewed the bidirectional links between α-synuclein neurodegeneration, progressive sleep disorders, and RBD. We highlighted the correlation between RBD development, α-synuclein aggregation, and neuronal apoptosis in key brainstem regions involved in REM sleep atonia maintenance. The current pharmacological intervention strategies targeting RBD and their effects on progressive PD are discussed, as well as current treatments for progressive neurodegeneration and their effects on RBD. We also evaluated emerging and potential pharmacological solutions to sleep disorders and developing synucleinopathies. This review provides insights into the mechanisms and therapeutic targets underlying RBD and PD, and explores bidirectional treatment effects for both diseases, underscoring the need for further research in this area.
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Affiliation(s)
- Lida Du
- Institute of Molecular Medicine & Innovative Pharmaceutics, Qingdao University, Qingdao, China; School of Biomedical Sciences, The Chinese University of Hong Kong, Hong Kong, China.
| | - Xiaoli He
- Institute of Medical Plant Development, Peking Union Medical College, Beijing, China
| | - Xiaonuo Fan
- Department of Biology, Boston University, Boston, USA
| | - Xiaoya Wei
- Harvard T.H. Chan School of Public Health, Boston, USA
| | - Linhao Xu
- School of Biomedical Sciences, The Chinese University of Hong Kong, Hong Kong, China; Department of Cardiology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Tuo Liang
- School of Biomedical Sciences, The Chinese University of Hong Kong, Hong Kong, China; Institute of Neurological and Psychiatric Disorders, Shenzhen Bay Laboratory, Shenzhen, China
| | - Chunbo Wang
- Institute of Molecular Medicine & Innovative Pharmaceutics, Qingdao University, Qingdao, China
| | - Ya Ke
- School of Biomedical Sciences, The Chinese University of Hong Kong, Hong Kong, China
| | - Wing-Ho Yung
- School of Biomedical Sciences, The Chinese University of Hong Kong, Hong Kong, China; Department of Neuroscience, City University of Hong Kong, Hong Kong, China.
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Soyka M, Wild I, Caulet B, Leontiou C, Lugoboni F, Hajak G. Long-term use of benzodiazepines in chronic insomnia: a European perspective. Front Psychiatry 2023; 14:1212028. [PMID: 37599882 PMCID: PMC10433200 DOI: 10.3389/fpsyt.2023.1212028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 07/20/2023] [Indexed: 08/22/2023] Open
Abstract
Chronic insomnia occurs in ~10% of the general population and has numerous negative health effects. The recommended first line treatment of cognitive behavior therapy for insomnia is not widely available for patients in Europe, so pharmacotherapies such as benzodiazepine receptor agonist agents (benzodiazepines and Z-drugs) are commonly used. However, their use is only recommended for ≤4 weeks due to unproven long-term efficacy in treatment of chronic insomnia, and the risk of tolerance, and the potential for dependence and misuse. In Europe, recommendations limiting the use of benzodiazepines (lowest dose and shortest duration) in chronic insomnia are not always followed, likely due to the lack of approved effective alternative therapies. Here we present a recent pilot survey of the pharmacological treatment landscape in chronic insomnia in five European countries (France, Germany, Italy, Spain, and the United Kingdom) and physicians' attitude toward treatment. The results suggest that benzodiazepines and Z-drugs are the most widely used treatments in chronic insomnia and are being used for longer than their recommended duration. Country variations in prescription rates were observed. Due to the known association between long-term benzodiazepine use and potential for developing dependence, further analysis of the literature was performed on the use and misuse of benzodiazepines. The results show that long-term use of benzodiazepines is associated with multiple consequences of treatment, including dependence, but also that previous use of benzodiazepines may increase the risk of opioid use disorder.
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Affiliation(s)
- Michael Soyka
- Department of Psychiatry and Psychotherapy, Ludwig Maximilian University, Munich, Germany
| | - Imane Wild
- Idorsia Pharmaceuticals Ltd., Allschwil, Switzerland
| | | | | | - Fabio Lugoboni
- Department of Internal Medicine, Addiction Unit, Verona University Hospital, Verona, Italy
| | - Göran Hajak
- University of Regensburg, Regensburg, Germany
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, Social Foundation Bamberg, Teaching Hospital of the University of Erlangen, Bamberg, Germany
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Merrill RM, Ashton MK, Angell E. Sleep disorders related to index and comorbid mental disorders and psychotropic drugs. Ann Gen Psychiatry 2023; 22:23. [PMID: 37245028 DOI: 10.1186/s12991-023-00452-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Accepted: 05/13/2023] [Indexed: 05/29/2023] Open
Abstract
PURPOSE Mental disorders positively associate with sleep disorders. This study will explore the moderating influence of comorbid mental disorders and whether selected psychotropic drugs correlate with sleep disorders after adjusting for mental disorders. METHODS A retrospective cohort study design was employed using medical claim data from the Deseret Mutual Benefit Administrators (DMBA). Mental disorders, psychotropic drug use, and demographic data were extracted from claim files for ages 18-64, years 2016-2020. RESULTS Approximately 11.7% filed one or more claims for a sleep disorder [insomnia (2.2%) and sleep apnea (9.7%)]. Rates for selected mental disorders ranged from 0.09% for schizophrenia to 8.4% for anxiety. The rate of insomnia is greater in those with bipolar disorder or schizophrenia than in other mental disorders. The rate of sleep apnea is greater in those with bipolar disorder and depression. There is a significantly positive association between mental disorders and insomnia and sleep apnea, more so for insomnia, especially if they had other comorbid mental disorders. Psychotropic drugs other than CNS stimulants, primarily sedatives (non-barbiturate) and psychostimulants, explain much of the positive association between anxiety, depression, and bipolar disorder with insomnia. Psychotropic drugs with the largest effect on sleep disorders are sedatives (non-barbiturate) and psychostimulants for insomnia and psychostimulants and anticonvulsants for sleep apnea. CONCLUSION Mental disorders positively correlate with insomnia and sleep apnea. The positive association is greater when multiple mental illness exists. Bipolar disorder and schizophrenia are most strongly associated with insomnia, and bipolar disorder and depression are most strongly associated with sleep disorders. Psychotropic drugs other than CNS stimulants, primarily sedatives (non-barbiturate) and psychostimulants for treating anxiety, depression, or bipolar disorder are associated with higher levels of insomnia and sleep apnea.
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Affiliation(s)
- Ray M Merrill
- Department of Public Health, College of Life Sciences, Brigham Young University, Provo, UT, 84602, USA.
| | - McKay K Ashton
- Department of Public Health, College of Life Sciences, Brigham Young University, Provo, UT, 84602, USA
| | - Emily Angell
- Department of Public Health, College of Life Sciences, Brigham Young University, Provo, UT, 84602, USA
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Gonzalez-Chica D, Begum M, Bernardo C, Hoon E, Sweetman A, Stocks N. Trends and patterns of benzodiazepines and Z-drugs prescriptions in Australian general practice: A national study (2011-2018). Drug Alcohol Rev 2023; 42:427-438. [PMID: 36217261 PMCID: PMC10092554 DOI: 10.1111/dar.13561] [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: 01/09/2022] [Revised: 08/22/2022] [Accepted: 09/16/2022] [Indexed: 02/03/2023]
Abstract
INTRODUCTION We aimed to explore trends and sociodemographic patterns in benzodiazepine (BZD) (by half-life) and Z-drugs prescribing in Australian general practice. METHODS This open cohort study used de-identified electronic health records of 1.4 million patients (50,812,413 consultations) from 402 Australian practices (MedicineInsight 2011-2018). Annual prescribing frequency and changes over time were estimated according to sex, age, socioeconomic position and rurality. RESULTS Between 2011 and 2018, the prescribing of very short-acting BZD increased from 0.10 to 0.29 per 1000 consultations (average annual change +17.2% [95% CI 9.6; 25.3]), while it declined for short-intermediate (from 38.5 to 26.6 per 1000 consultations; annual change -5.1% [95% CI -5.6; -4.5]), long-acting BZD (from 24.1 to 21.6 per 1000 consultation; annual change -1.5% [95% CI -2.2; -0.8]) and Z-drugs (from 4.6 to 4.0 per 1000 consultations; annual change -1.9% [95% CI -3.0; -0.7]). Short-intermediate-acting BZD prescribing was three times more frequent among women aged 65+ years than younger women, and long-acting BZD three-to-four times more likely among younger than older men. Z-drugs prescribing was higher among women aged 45-64 years than younger or older females. Short-intermediate- and long-acting BZD were more likely prescribed for patients from more disadvantaged areas, and Z-drugs in more advantaged areas. There were no disparities by rurality. DISCUSSION AND CONCLUSIONS Although most BZD and Z-drugs prescriptions declined over time, short-intermediate BZD prescriptions remained higher among older women and long-acting BZD more frequent among younger men, especially for those living in more disadvantaged areas. Targeted interventions could reduce the prescribing of BZD and Z-drugs in these groups.
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Affiliation(s)
- David Gonzalez-Chica
- Discipline of General Practice, Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Australia
- Adelaide Institute for Sleep Health and Flinders Health and Medical Research Institute, Sleep Health, Flinders University, Australia
| | - Mumtaz Begum
- Discipline of General Practice, Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Australia
| | - Carla Bernardo
- Discipline of General Practice, Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Australia
| | - Elizabeth Hoon
- Discipline of General Practice, Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Australia
| | - Alexander Sweetman
- Adelaide Rural Clinical School, Faculty of Health and Medical Sciences, The University of Adelaide, Australia
| | - Nigel Stocks
- Discipline of General Practice, Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Australia
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de Mendonça FMR, de Mendonça GPRR, Souza LC, Galvão LP, Paiva HS, de Azevedo Marques Périco C, Torales J, Ventriglio A, Castaldelli-Maia JM, Sousa Martins Silva A. Benzodiazepines and Sleep Architecture: A Systematic Review. CNS & NEUROLOGICAL DISORDERS DRUG TARGETS 2023; 22:172-179. [PMID: 34145997 DOI: 10.2174/1871527320666210618103344] [Citation(s) in RCA: 18] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 11/18/2020] [Accepted: 01/20/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND Insomnia, defined as a difficulty in initiating or maintaining sleep, is a relevant medical issue. Benzodiazepines (BZDs) are commonly prescribed to treat insomnia. Two phases characterize human sleep structure: sleep with Non-Rapid Eye Movement (NREM) and sleep with Rapid Eye Movement (REM). Physiological sleep includes NREM and REM phases in a continuous cycle known as "Sleep Architecture." OBJECTIVE This systematic review summarizes the studies that have investigated effects of BZDs on Sleep Architecture. METHODS The articles selection included human clinical trials (in English, Portuguese, or Spanish) only, specifically focused on BZDs effects on sleep architecture. PubMed, BVS, and Google Scholar databases were searched. RESULTS Findings on BZDs effects on sleep architecture confirm an increase in stage 2 of NREM sleep and a decrease in time of stages 3 and 4 of NREM sleep with a reduction in time of REM sleep during the nocturnal sleep. CONCLUSION Variations in NREM and REM sleep may lead to deficits in concentration and working memory and weight gain. The increase in stage 2 of NREM sleep may lead to a subjective improvement of sleep quality with no awakenings. BZDz should be prescribed with zeal and professional judgment. These patients should be closely monitored for possible long-term side effects.
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Affiliation(s)
| | | | - Laura Costa Souza
- Health Secretariat of São Bernardo do Campo, São Bernardo do Campo, SP, Brazil
| | | | | | - Cintia de Azevedo Marques Périco
- Health Secretariat of São Bernardo do Campo, São Bernardo do Campo, SP, Brazil
- Department of Neuroscience, Medical School, ABC Health University Center, Santo Andre, SP, Brazil
| | - Julio Torales
- Department of Psychiatry, School of Medical Sciences, National University of Asuncion, Asuncion, Paraguay
| | - Antonio Ventriglio
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Joao Maurício Castaldelli-Maia
- Health Secretariat of São Bernardo do Campo, São Bernardo do Campo, SP, Brazil
- Otorhinus Clinica Medica, São Paulo, SP, Brazil
- Department of Neuroscience, Medical School, ABC Health University Center, Santo Andre, SP, Brazil
- Department of Psychiatry, Medical School, University of São Paulo, Sao Paulo, SP, Brazil
- Department of Epidemiology, Columbia Mailman School of Public Health, New York, NY, U.S
| | - Anderson Sousa Martins Silva
- Health Secretariat of São Bernardo do Campo, São Bernardo do Campo, SP, Brazil
- Medical School, Universidade Nove de Julho, Sao Paulo, SP, Brazil
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Masse M, Henry H, Cuvelier E, Pinçon C, Pavy M, Beeuwsaert A, Barthélémy C, Cuny D, Gautier S, Kambia N, Lefebvre JM, Mascaut D, Mitoumba F, Puisieux F, Standaert A, Wierre P, Beuscart JB, Roche J, Décaudin B. Sleep Medication in Older Adults: Identifying the Need for Support by a Community Pharmacist. Healthcare (Basel) 2022; 10:healthcare10010147. [PMID: 35052310 PMCID: PMC8775744 DOI: 10.3390/healthcare10010147] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 01/05/2022] [Accepted: 01/07/2022] [Indexed: 11/23/2022] Open
Abstract
Many older adults take benzodiazepines and sedative-hypnotics for the treatment of sleep disorders. With a view to considering the possible discontinuation of hypnotics, the objectives of the present study were to describe bedtime habits and sleep patterns in older adults and to identify the sleep medications taken. An expert group developed a structured interview guide for assessing the patients’ bedtime habits, sleep patterns, and medications. During an internship in a community pharmacy, 103 sixth-year pharmacy students conducted around 10 interviews each with older adults (aged 65 or over) complaining of sleep disorders and taking at least one of the following medications: benzodiazepines, benzodiazepine derivatives (“Z-drugs”), antihistamines, and melatonin. A prospective, observational study was carried out from 4 January to 30 June 2016. The pharmacy students performed 960 interviews (with 330 men and 630 women; mean ± standard deviation age: 75.1 ± 8.8). The most commonly taken hypnotics were the Z-drugs zolpidem (n = 465, 48%) and zopiclone (n = 259, 27%). The vast majority of patients (n = 768, 80%) had only ever taken a single hypnotic medication. The median [interquartile range] prescription duration was 120 (48–180) months. About 75% (n = 696) of the patients had at least 1 poor sleep habit, and over 41% (n = 374) had 2 or more poor sleep habits. A total of 742 of the patients (77%) reported getting up at night—mainly due to nycturia (n = 481, 51%). Further, 330 of the patients (35%) stated that they were keen to discontinue their medication, of which 96 (29%) authorized the pharmacist to contact their family physician and discuss discontinuation. In France, pharmacy students and supervising community pharmacists can identify problems related to sleep disorders by asking simple questions about the patient’s sleep patterns. Together with family physicians, community pharmacists can encourage patients to discuss their hypnotic medications.
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Affiliation(s)
- Morgane Masse
- Univ. Lille, CHU Lille, ULR 7365-GRITA—Groupe de Recherche sur les Formes Injectables et les Technologies Associées, F-59000 Lille, France; (H.H.); (E.C.); (C.B.); (N.K.); (F.M.); (B.D.)
- Correspondence:
| | - Héloïse Henry
- Univ. Lille, CHU Lille, ULR 7365-GRITA—Groupe de Recherche sur les Formes Injectables et les Technologies Associées, F-59000 Lille, France; (H.H.); (E.C.); (C.B.); (N.K.); (F.M.); (B.D.)
| | - Elodie Cuvelier
- Univ. Lille, CHU Lille, ULR 7365-GRITA—Groupe de Recherche sur les Formes Injectables et les Technologies Associées, F-59000 Lille, France; (H.H.); (E.C.); (C.B.); (N.K.); (F.M.); (B.D.)
| | - Claire Pinçon
- Univ. Lille, CHU Lille, ULR2694-METRICS, Evaluation des Technologies de Santé et des Pratiques Médicales, F-59000 Lille, France; (C.P.); (J.-B.B.)
| | - Margot Pavy
- Faculté de Pharmacie, Université de Lille, F-59000 Lille, France; (M.P.); (A.B.)
| | - Audrey Beeuwsaert
- Faculté de Pharmacie, Université de Lille, F-59000 Lille, France; (M.P.); (A.B.)
| | - Christine Barthélémy
- Univ. Lille, CHU Lille, ULR 7365-GRITA—Groupe de Recherche sur les Formes Injectables et les Technologies Associées, F-59000 Lille, France; (H.H.); (E.C.); (C.B.); (N.K.); (F.M.); (B.D.)
| | - Damien Cuny
- Univ. Lille, ULR 4515-LGCgE, Laboratoire de Génie Civil et Géo-Environnement, F-59000 Lille, France;
| | - Sophie Gautier
- Inserm, UMR-S1172, Center for Pharmacovigilance, CHU de Lille, University Lille, F-59037 Lille, France;
| | - Nicolas Kambia
- Univ. Lille, CHU Lille, ULR 7365-GRITA—Groupe de Recherche sur les Formes Injectables et les Technologies Associées, F-59000 Lille, France; (H.H.); (E.C.); (C.B.); (N.K.); (F.M.); (B.D.)
| | - Jean-Marc Lefebvre
- Department of General Practice, University of Lille, F-50045 Lille, France;
| | - Daniel Mascaut
- Association des Conseillers et des Pharmaciens Agréés Maîtres de Stage du Nord—Pas-de-Calais, 21 Rue du Pont-Neuf, F-59000 Lille, France; (D.M.); (P.W.)
| | - Fabrice Mitoumba
- Univ. Lille, CHU Lille, ULR 7365-GRITA—Groupe de Recherche sur les Formes Injectables et les Technologies Associées, F-59000 Lille, France; (H.H.); (E.C.); (C.B.); (N.K.); (F.M.); (B.D.)
| | - François Puisieux
- Hôpital Gériatrique Les Bateliers, Pôle de Gérontologie, CHRU de Lille, F-59000 Lille, France;
| | - Annie Standaert
- Univ. Lille, Inserm, CHU Lille, U1286-INFINITE—Institute for Translational Research in Inflammation, F-59000 Lille, France;
| | - Patrick Wierre
- Association des Conseillers et des Pharmaciens Agréés Maîtres de Stage du Nord—Pas-de-Calais, 21 Rue du Pont-Neuf, F-59000 Lille, France; (D.M.); (P.W.)
| | - Jean-Baptiste Beuscart
- Univ. Lille, CHU Lille, ULR2694-METRICS, Evaluation des Technologies de Santé et des Pratiques Médicales, F-59000 Lille, France; (C.P.); (J.-B.B.)
| | - Jean Roche
- CHU de Lille, Unité de Psychogériatrie, Pôle de Gérontologie, F-59037 Lille, France;
| | - Bertrand Décaudin
- Univ. Lille, CHU Lille, ULR 7365-GRITA—Groupe de Recherche sur les Formes Injectables et les Technologies Associées, F-59000 Lille, France; (H.H.); (E.C.); (C.B.); (N.K.); (F.M.); (B.D.)
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10
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Lin CH, Hsu NW, Chen HC, Chou P. The Concomitant Pattern of Association Between Subjective Global Sleep Quality and Daytime Dysfunction in Hypnotic-Treated Older Adults: The Yilan Study, Taiwan. Nat Sci Sleep 2022; 14:567-579. [PMID: 35418789 PMCID: PMC8995157 DOI: 10.2147/nss.s353141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 03/30/2022] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE The relationship between improvements in subjective sleep quality and restoration of daytime function remains unclear. This study aimed to examine the concomitant pattern between subjective sleep quality and daytime dysfunction in hypnotic-treated older adults. METHODS This was a community-based, cross-sectional study. Participants comprised community-dwelling adults aged ≥ 65 years. Individual items from the Pittsburgh Sleep Quality Index (PSQI) were adopted to evaluate subjective global sleep quality and daytime dysfunction. Daytime dysfunction included composite scores of daytime dysfunction in the PSQI and its two sub-components: "staying awake" and "maintaining enthusiasm." Based on hypnotic use and status in subjective sleep quality, participants were categorized into four groups: "healthy control," "treated with good sleep quality (T+GSQ)," "treated with poor sleep quality (T+PSQ)," and "not treated with poor sleep quality (NT+PSQ)". The associations between these four groups and daytime dysfunction were analyzed using logistic regression. RESULTS In total, 2622 individuals participated in the study. After controlling for covariates, the T+PSQ group was more likely to have daytime dysfunction, including "composite daytime dysfunction" (OR: 6.41; 95% CI: 3.90-10.55), "poor at staying awake" (OR: 3.04; 95% CI: 1.45-6.37), and "poor at maintaining enthusiasm" (OR: 7.42; 95% CI: 4.33-12.70) compared to the T+GSQ group. However, the healthy control group was less likely than the T+GSQ group to present with daytime dysfunction, including "composite daytime dysfunction" (OR: 0.43; 95% CI: 0.26-0.72) and "poor at maintaining enthusiasm" (OR: 0.39; 95% CI: 0.22-0.68). CONCLUSION Subjective sleep quality attributed to hypnotic use did not necessarily indicate restoration of daytime dysfunction.
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Affiliation(s)
- Chia-Heng Lin
- Department of General Psychiatry, Taoyuan Psychiatric Center, Ministry of Health and Welfare, Taoyuan, Taiwan
| | - Nai-Wei Hsu
- Division of Cardiology, Department of Internal Medicine & Community Medicine Center, National Yang Ming ChiaoTung University Hospital, Yilan, Taiwan.,Faculty of Medicine, School of Medicine, National Yang Ming ChiaoTung University, Taipei, Taiwan.,Public Health Bureau, Yilan, Taiwan
| | - Hsi-Chung Chen
- Department of Psychiatry & Center of Sleep Disorders, National Taiwan University Hospital, Taipei, Taiwan
| | - Pesus Chou
- Community Medicine Research Center & Institute of Public Health, National Yang Ming ChiaoTung University, Taipei, Taiwan
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11
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Henwood BF, Rhoades H, Dzubur E, Madden DR, Redline B, Brown RT. Investigating Sleep Disturbance and Its Correlates Among Formerly Homeless Adults in Permanent Supportive Housing. Med Care 2021; 59:S206-S211. [PMID: 33710097 PMCID: PMC7959063 DOI: 10.1097/mlr.0000000000001446] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Adults experiencing homelessness have a high burden of sleep disturbance, which may be reduced by accessing permanent supportive housing. OBJECTIVES To assess sleep disturbances and their correlates, including demographics, activity level, health status, age-related health issues (eg, functionality and cognitive impairment), substance use, and homelessness history in a sample of permanent supportive housing (PSH) tenants. RESEARCH DESIGN Cross-sectional survey design. SUBJECTS A total of 237 formerly homeless adults between 45 and 80 years old. MEASURES The Patient-Reported Outcomes Measurement Information System (PROMIS) Sleep Disturbance short form was used to measure sleep disturbance. RESULTS Twenty-eight percent of our sample had PROMIS scores indicative of a moderate or severe sleep disturbance. Functional impairment, pain, and mental health comorbidities were associated with increased sleep disturbance in multivariable linear regression analyses. The number of years a person experienced homelessness was inversely associated with sleep disturbance. CONCLUSIONS This study supports the need to screen for sleep disturbances among PSH tenants. The findings suggest that supportive services in PSH may need to include integrated physical and behavioral health care, pain management, and interventions designed to address activities of daily livings to improve tenant sleep. They also suggest that improved sleep may help reduce PSH tenant pain, impairment, and mental health symptoms among PSH tenants.
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Affiliation(s)
- Benjamin F. Henwood
- Suzanne Dworak-Peck School of Social Work, University of Southern California
| | - Harmony Rhoades
- Suzanne Dworak-Peck School of Social Work, University of Southern California
| | - Eldin Dzubur
- Suzanne Dworak-Peck School of Social Work, University of Southern California
| | - Danielle R. Madden
- Suzanne Dworak-Peck School of Social Work, University of Southern California
| | - Brian Redline
- Suzanne Dworak-Peck School of Social Work, University of Southern California
| | - Rebecca T. Brown
- Division of Geriatric Medicine, Perelman School of Medicine, University of Pennsylvania
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12
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Jeong AH, Hwang J, Jo K, Kim S, Ahn Y, Suh HJ, Choi HS. Fermented Gamma Aminobutyric Acid Improves Sleep Behaviors in Fruit Flies and Rodent Models. Int J Mol Sci 2021; 22:3537. [PMID: 33805468 PMCID: PMC8036604 DOI: 10.3390/ijms22073537] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 03/20/2021] [Accepted: 03/25/2021] [Indexed: 01/05/2023] Open
Abstract
The aim of this study was to investigate the effect of Lactobacillus brevis-fermented γ-aminobutyric acid (LB-GABA) on sleep behaviors in invertebrate and vertebrate models. In Drosophila melanogaster, LB-GABA-treated group showed an 8-9%-longer sleep duration than normal group did. LB-GABA-treated group also showed a 46.7% lower level of nighttime activity with a longer (11%) sleep duration under caffeine-induced arousal conditions. The LB-GABA-mediated inhibition of activity was confirmed as a reduction of total movement of flies using a video tracking system. In the pentobarbital-induced sleep test in mice, LB-GABA (100 mg/kg) shortened the time of onset of sleep by 32.2% and extended sleeping time by 59%. In addition, mRNA and protein level of GABAergic/Serotonergic neurotransmitters were upregulated following treatment with LB-GABA (2.0%). In particular, intestine- and brain-derived GABAA protein levels were increased by sevenfold and fivefold, respectively. The electroencephalography (EEG) analysis in rats showed that LB-GABA significantly increased non-rapid eye movement (NREM) (53%) with the increase in theta (θ, 59%) and delta (δ, 63%) waves, leading to longer sleep time (35%), under caffeine-induced insomnia conditions. LB-GABA showed a dose-dependent agonist activity on human GABAA receptor with a half-maximal effective concentration (EC50) of 3.44 µg/mL in human embryonic kidney 293 (HEK293) cells.
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Affiliation(s)
- A-Hyun Jeong
- Department of Public Health Science, Korea University, Seoul 02841, Korea; (A.-H.J.); (J.H.); (K.J.); (S.K.); (Y.A.); (H.J.S.)
- Interdisciplinary Program in Precision Public Health, Korea University, Seoul 02841, Korea
| | - Jisu Hwang
- Department of Public Health Science, Korea University, Seoul 02841, Korea; (A.-H.J.); (J.H.); (K.J.); (S.K.); (Y.A.); (H.J.S.)
| | - Kyungae Jo
- Department of Public Health Science, Korea University, Seoul 02841, Korea; (A.-H.J.); (J.H.); (K.J.); (S.K.); (Y.A.); (H.J.S.)
| | - Singeun Kim
- Department of Public Health Science, Korea University, Seoul 02841, Korea; (A.-H.J.); (J.H.); (K.J.); (S.K.); (Y.A.); (H.J.S.)
| | - Yejin Ahn
- Department of Public Health Science, Korea University, Seoul 02841, Korea; (A.-H.J.); (J.H.); (K.J.); (S.K.); (Y.A.); (H.J.S.)
| | - Hyung Joo Suh
- Department of Public Health Science, Korea University, Seoul 02841, Korea; (A.-H.J.); (J.H.); (K.J.); (S.K.); (Y.A.); (H.J.S.)
| | - Hyeon-Son Choi
- Department of Food Nutrition, Sangmyung University, Seoul 03016, Korea
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13
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Murillo-Rodríguez E, Machado S, Imperatori C, Yamamoto T, Budde H. Natural Cannabinoids as Templates for Sleep Disturbances Treatments. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2021; 1297:133-141. [PMID: 33537941 DOI: 10.1007/978-3-030-61663-2_9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
The sleep-wake cycle is a complex composition of specific physiological and behavioral characteristics. In addition, neuroanatomical, neurochemical and molecular systems exerts influences in the modulation of the sleep-wake cycle. Moreover, homeostatic and circadian mechanisms interact to control the waking or sleeping states. As many other behaviors, sleep also develops pathological features that include several signs and symptoms corresponding to medical conditions known as sleep disorders.In addition to the neurobiological mechanisms modulating sleep, external elements also influence the sleep-wake cycle, including the use of Cannabis sativa (C. sativa). In this regard, and over the last decades, the interest of studying the pharmacology of Δ9-tetrahydrocannabinol (Δ9-THC), the principal psychoactive constituent of C. sativa, has been addressed. Moreover, in recent years, the focus of scientific interest has moved on to studying the second plant constituent with non-psychotropic pharmacological properties: Cannabidiol (CBD).The pharmacological and pharmaceutical interest of CBD has been focus of attention due to the accumulating body of evidence regarding the positive outcomes of using CBD for the treatment of several health issues, such as psychiatric and neurodegenerative disorders, epilepsy, etc. Since the most prominent sleep disruptions include excessive daytime sleepiness (EDS), current treatments include the use of drugs such as stimulants of antidepressants. Notwithstanding, side effects are commonly reported among the patients under prescription of these compounds. Thus, the search of novelty therapeutical approaches aimed to treat ESD may consider the use of cannabinoid-derived compounds, such as CBD. In this chapter, we will show experimental evidence regarding the potential role of CBD as a wake-inducing compound aimed to manage EDS.
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Affiliation(s)
- Eric Murillo-Rodríguez
- Laboratorio de Neurociencias Moleculares e Integrativas, Escuela de Medicina División Ciencias de la Salud, Universidad Anáhuac Mayab, Mérida, Yucatán, México. .,Intercontinental Neuroscience Research Group, Mérida, Yucatán, México.
| | - Sérgio Machado
- Intercontinental Neuroscience Research Group, Mérida, Yucatán, México.,Laboratory of Panic and Respiration, Institute of Psychiatry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.,Salgado de Oliveira University, Rio de Janeiro, Brazil.,Physical Activity Neuroscience Laboratory, Physical Activity Sciences Postgraduate Program-Salgado de Oliveira University (UNIVERSO), Rio de Janeiro, Brazil
| | - Claudio Imperatori
- Intercontinental Neuroscience Research Group, Mérida, Yucatán, México.,Cognitive and Clinical Psychology Laboratory, Department of Human Science, European University of Rome, Rome, Italy
| | - Tetsuya Yamamoto
- Intercontinental Neuroscience Research Group, Mérida, Yucatán, México.,Graduate School of Technology, Industrial and Social Sciences, The University of Tokushima, Tokushima, Japan
| | - Henning Budde
- Intercontinental Neuroscience Research Group, Mérida, Yucatán, México.,Faculty of Human Sciences, Medical School Hamburg, Hamburg, Germany
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14
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Imamura S, Tabuchi M, Oizumi H, Ueki T, Omiya Y, Ikarashi Y, Mizoguchi K. Yokukansankachimpihange, a traditional Japanese (Kampo) medicine, enhances the adaptation to circadian rhythm disruption by increasing endogenous melatonin levels. J Pharmacol Sci 2020; 144:129-138. [PMID: 32921394 DOI: 10.1016/j.jphs.2020.08.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 07/17/2020] [Accepted: 08/06/2020] [Indexed: 10/23/2022] Open
Abstract
The traditional Japanese (Kampo) medicines yokukansan (YKS) and yokukansankachimpihange (YKSCH) have similar formulas and the same indications. In animals or cultured cells, the neuropharmacological actions of YKS are sometimes more beneficial than those of YKSCH. Since both drugs are used to treat sleep disorders in Japan, we examined the ameliorative effects of YKS and YKSCH on circadian rhythm disturbance and compared their efficacy using a mouse model of circadian rhythm disruption. Ramelteon was used as the positive control. Ramelteon treatment significantly reversed decreased running wheel activity during the advanced dark phase, indicating facilitation of circadian adaptation. YKS treatment also reversed the activity in the early period of drug treatment; however, it was not statistically significant. YKSCH treatment significantly reversed the decreased activity during the advanced dark phase. Plasma melatonin (MT) levels were significantly increased in the YKSCH but not in the YKS group. The ameliorative effect of YKSCH on rhythm disruption was significantly inhibited by coadministration of the MT2 receptor antagonist. Therefore, the therapeutic effect of YKSCH on circadian rhythm disruption would be attributable, to elevated endogenous MT levels. Taken together, YKS and YKSCH have different pharmacological properties and may be more precisely prescribed depending on patients' psychological symptoms.
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Affiliation(s)
- Sachiko Imamura
- Tsumura Kampo Research Laboratories, Tsumura & Co., 3586 Yoshiwara, Ami-machi, Inashiki-gun, Ibaraki 300-1192, Japan.
| | - Masahiro Tabuchi
- Tsumura Kampo Research Laboratories, Tsumura & Co., 3586 Yoshiwara, Ami-machi, Inashiki-gun, Ibaraki 300-1192, Japan
| | - Hiroaki Oizumi
- Tsumura Kampo Research Laboratories, Tsumura & Co., 3586 Yoshiwara, Ami-machi, Inashiki-gun, Ibaraki 300-1192, Japan
| | - Toshiyuki Ueki
- Tsumura Kampo Research Laboratories, Tsumura & Co., 3586 Yoshiwara, Ami-machi, Inashiki-gun, Ibaraki 300-1192, Japan
| | - Yuji Omiya
- Tsumura Kampo Research Laboratories, Tsumura & Co., 3586 Yoshiwara, Ami-machi, Inashiki-gun, Ibaraki 300-1192, Japan
| | - Yasushi Ikarashi
- Tsumura Kampo Research Laboratories, Tsumura & Co., 3586 Yoshiwara, Ami-machi, Inashiki-gun, Ibaraki 300-1192, Japan
| | - Kazushige Mizoguchi
- Tsumura Kampo Research Laboratories, Tsumura & Co., 3586 Yoshiwara, Ami-machi, Inashiki-gun, Ibaraki 300-1192, Japan
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15
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Zhang Z, Xiao X, Ma W, Li J. Napping in Older Adults: A Review of Current Literature. CURRENT SLEEP MEDICINE REPORTS 2020; 6:129-135. [PMID: 33777656 DOI: 10.1007/s40675-020-00183-x] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Purpose of Review Daytime napping-frequently reported among older populations-has attracted increasing attention in geriatric research due to its association with multiple health conditions. This review aims to integrate the latest knowledge about napping in older adults to provide implications for future research. Recent Findings The prevalence of napping in older adults ranges from 20% to 60% in different studies, but has been consistently reported to be higher than in other age groups. Age-related changes in circadian rhythm and sleep patterns, cultural beliefs, chronic conditions, medications, and lifestyle changes contribute to the high prevalence of napping in older adults. Daytime napping has been associated with multiple health conditions in older adults. Naps of short duration (e.g., 30 minutes) are reported in adults with better health; naps with longer durations (e.g., >90 minutes) have been linked to adverse cardiovascular and diabetes outcomes, declining cognitive function, and increased mortality. Current evidence in the literature, however, is not enough for us to determine the exact role of napping in the health of older adults. Summary Longitudinal and interventional studies are needed to investigate the influence of napping and the critical parameters such as duration, timing, and frequency on health in older adults and the underlying mechanisms. A combination of objective and self-reported measurements of napping are recommended instead of self-reported data only.
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Affiliation(s)
- Zeyu Zhang
- Johns Hopkins University School of Nursing.,Huazhong University of Science and Technology, Tongji Medical College, School of Nursing
| | - Xueling Xiao
- Johns Hopkins University School of Nursing.,Central South University, Xiangya School of Nursing
| | - Weixia Ma
- Johns Hopkins University School of Nursing.,Shandong Provincial Hospital affiliated with Shandong University
| | - Junxin Li
- Johns Hopkins University School of Nursing
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16
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Mahdavikian S, Rezaei M, Modarresi M, Khatony A. Comparing the effect of aromatherapy with peppermint and lavender on the sleep quality of cardiac patients: a randomized controlled trial. SLEEP SCIENCE AND PRACTICE 2020. [DOI: 10.1186/s41606-020-00047-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Abstract
Background
Sleep disorder is a critical problem in cardiac patients. This study aimed to compare the effects of aromatherapy with peppermint and lavender essential oils on the sleep quality of cardiac patients.
Methods
A total of 105 patients were randomly allocated to three groups of peppermint essential oil, lavender essential oil, and control. In each experimental group, the patients inhaled three drops of lavender and peppermint essential oils, whereas the control group received aromatic distilled water. Data were collected using the Pittsburgh Sleep Quality Index (PSQI). The participants completed PSQI before and after the intervention.
Results
There was a significant difference in the mean score of PSQI in each of the experimental groups before and after the intervention; however, the difference was not statistically significant between the experimental groups.
Conclusion
Aromatherapy with lavender and peppermint essential oils can improve the sleep quality of cardiac patients. Therefore, use of this non-pharmacological intervention, as an effective and simple approach, is recommended for cardiac patients.
Trial registration
IRCT, IRCT201601244736N10. Registered 4 November 2016.
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17
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Picton L, Ilomäki J, Keen CS, Lalic S, Adams B, Clinnick LM, Kirkpatrick CM, Ryan-Atwood T, Turner JP, Bell JS. Rates of PRN Medication Administration in Australian Residential Aged Care. J Am Med Dir Assoc 2020; 22:117-123.e1. [PMID: 32611523 DOI: 10.1016/j.jamda.2020.04.033] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2019] [Revised: 04/25/2020] [Accepted: 04/28/2020] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To investigate administration of pro re nata (PRN) medications and nurse-initiated medications (NIMs) in Australian aged care services over a 12-month period. DESIGN Twelve-month longitudinal audit of medication administrations. SETTING AND PARTICIPANTS Three hundred ninety-two residents of 10 aged care services in regional Victoria, Australia. METHODS Records of PRN and NIM administration were extracted from electronic and hard copy medication charts. Descriptive statistics were used to calculate medication administration per person-month. Poisson regression was used to estimate predictors of PRN administration. RESULTS Over a median follow-up of 12 months (interquartile range 10-12 months), 93% of residents were administered a PRN medication and 41% of residents an NIM on 21,147 and 552 occasions, respectively. The mean number of any PRN administration was 5.85 per person-month. The most frequently administered PRN medications per person-month were opioids 1.54, laxatives 0.96, benzodiazepines 0.72, antipsychotics 0.48, paracetamol 0.46, and topical preparations 0.42. Three-quarters of residents prescribed a PRN opioid or PRN benzodiazepine and two-thirds of residents prescribed a PRN antipsychotic had the medication administered on 1 or more occasions over the follow-up. CONCLUSIONS AND IMPLICATIONS Most residents were administered PRN medications. Administration was in line with Australian regulations and institutional protocols. However, the high frequency of PRN analgesic, laxative, and psychotropic medication administration highlights the need for regular clinical review to ensure ongoing safe and appropriate use.
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Affiliation(s)
- Leonie Picton
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Australia
| | - Jenni Ilomäki
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Australia
| | - Claire S Keen
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Australia
| | - Samanta Lalic
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Australia; Pharmacy Department, Monash Health, Melbourne, Australia
| | | | - Lisa M Clinnick
- Ballarat Health Services, Ballarat, Australia; School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Ballarat, Australia
| | - Carl M Kirkpatrick
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Australia
| | - Taliesin Ryan-Atwood
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Australia
| | - Justin P Turner
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Australia; Centre de recherche, Institut universitaire de gériatrie de Montréal, University of Montreal, Montreal, Canada
| | - J Simon Bell
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Australia.
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18
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Torres-Bondia F, de Batlle J, Galván L, Buti M, Barbé F, Piñol-Ripoll G. Trends in the consumption rates of benzodiazepines and benzodiazepine-related drugs in the health region of Lleida from 2002 to 2015. BMC Public Health 2020; 20:818. [PMID: 32487058 PMCID: PMC7268471 DOI: 10.1186/s12889-020-08984-z] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Accepted: 05/24/2020] [Indexed: 12/16/2022] Open
Abstract
Background The high prevalence and long-term use of benzodiazepines (BZDs) treatment are debated topics because of the risk they can cause to the patients. Despite the current information on the risk-benefit balance of these drugs, their consumption remains particularly high. We determined the trend in the consumption prevalence of benzodiazepines (BZDs) and drugs related to BZDs (Z-drugs) in the population of the Health Region of Lleida to explore patterns of use and the associated characteristics associated between 2002 and 2015. Methods An analysis of secular trends was carried out between 2002 and 2015; the databased included all individuals from the Health Region of Lleida, which had 358,157 inhabitants in 2015, that consumed BZDs. The consumption of BZDs was evaluated using prescription billing data from the Public Health System. All types of BZDs and BZD analogues that had been approved by the drug agency were included. Trends by age and sex were investigated. Results Over the whole study period, a total of 161,125 individuals accounted for 338,148 dispensations. Overall, 59% were women, and the mean age was 56 years. The dispensing prevalence of BZDs use in 2015 was 14.2% overall —18.8% in women and 9.6% in men—and was 36% in those over 65 years. According to the half-life of BZDs, the prevalence of short-intermediate BZD use, intermediate-long BZD use, and Z-drugs use was 9.7, 5.5 and 0.8%, respectively. The evolution of the annual prevalence of BZD dispensing showed a progressive decline, from 15.3% in 2002 to 14.2% in 2015, which was attributed to a decrease in the consumption of intermediate-long half-life BZDs (8.0% vs. 5.5%) and Z-drugs (1.4% vs. 0.8%). Conclusion The dispensing prevalence of BZDs and Z-drugs was high, although a small reduction was observed during this time period. The dispensing prevalence was especially high in the population over 65, despite the risk of cognitive decline and falls. Integral actions are required to lower the BZD prescription rate.
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Affiliation(s)
- F Torres-Bondia
- Pharmacy Department, Clinical Neuroscience Research, IRBLleida, Arnau de Vilanova University Hospital, Lleida, Spain
| | - J de Batlle
- Biomedical Research Networking Center in Respiratory Diseases (Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, CIBERES), Madrid, Spain.,Group of Translational Research in Respiratory Medicine, Arnau de Vilanova University Hospital and Santa Maria University Hospital, IRBLleida, Lleida, Spain
| | - L Galván
- Pharmacy Department, Servei Català de la Salut (Catalan Health Services), Lleida, Spain
| | - M Buti
- Unitat d'Avaluació Clínica (Clinical Evaluation Unit), Institut Català de la Salut (Catalan Institute of Health), Lleida, Spain
| | - F Barbé
- Biomedical Research Networking Center in Respiratory Diseases (Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, CIBERES), Madrid, Spain.,Group of Translational Research in Respiratory Medicine, Arnau de Vilanova University Hospital and Santa Maria University Hospital, IRBLleida, Lleida, Spain
| | - G Piñol-Ripoll
- Unitat Trastorns Cognitius (Cognitive Disorders Unit), Clinical Neuroscience Research, IRBLleida, Santa Maria University Hospital, Rovira Roure n° 44, 25198, Lleida, Spain.
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19
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Hmwe NTT, Browne G, Mollart L, Allanson V, Chan SWC. Acupressure to improve sleep quality of older people in residential aged care: a randomised controlled trial protocol. Trials 2020; 21:360. [PMID: 32334620 PMCID: PMC7183710 DOI: 10.1186/s13063-020-04286-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Accepted: 03/26/2020] [Indexed: 12/16/2022] Open
Abstract
Background Sleep disturbance in older people is an important health issue that is associated with many other health problems. Effective interventions are required to address sleep problems in this group. Acupressure has been suggested as a potential therapeutic technique to improve sleep. The aim of this study is to evaluate the effects of an acupressure intervention on sleep quality, anxiety, depression, and quality of life among older persons in residential aged care facilities within an Australian context. Methods/design This is a randomised controlled trial with two parallel groups in a pre- and post-test study. Study participants will be older people living in residential aged care facilities. They will be assigned to intervention and control groups using computer-generated random numbers. The intervention group will receive 12-min acupressure three times per week for four consecutive weeks, applied on three acupoints: HT7, PC6, and SP6. The control group will receive only routine care. The primary outcome measure is sleep quality, and secondary outcomes include anxiety, depression, and quality of life. Data will be collected before the intervention, immediately after the end of the intervention, and 2 weeks after the intervention. Discussion This study targets a poorly met healthcare need of older people who are experiencing sleep disturbance and its negative consequences. To the researchers’ knowledge, this is the first study evaluating acupressure in an Australian aged care context, using specific acupoints and a standardised acupressure protocol. If the results show positive outcomes, acupressure could be used to manage sleep disturbances for older people in the Australian context as well as in the global ageing population. This will contribute to reducing negative consequences of sleep disturbance and use of sleep medications. Trial registration Australian New Zealand Clinical Trials Registry: ACTRN12619000262101. Registered on 20 February 2019.
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Affiliation(s)
- Nant Thin Thin Hmwe
- School of Nursing and Midwifery, The University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia.
| | - Graeme Browne
- School of Nursing and Midwifery, The University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia
| | - Lyndall Mollart
- School of Nursing and Midwifery, The University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia
| | - Viv Allanson
- Maroba Caring Communities, Waratah, NSW, Australia
| | - Sally Wai-Chi Chan
- UON Singapore, International and Advancement Division, The University of Newcastle, Callaghan, NSW, Australia
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20
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Jee HJ, Shin W, Jung HJ, Kim B, Lee BK, Jung YS. Impact of Sleep Disorder as a Risk Factor for Dementia in Men and Women. Biomol Ther (Seoul) 2020; 28:58-73. [PMID: 31838834 PMCID: PMC6939686 DOI: 10.4062/biomolther.2019.192] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 11/22/2019] [Accepted: 11/26/2019] [Indexed: 12/30/2022] Open
Abstract
Sleep is an essential physiological process, especially for proper brain function through the formation of new pathways and processing information and cognition. Therefore, when sleep is insufficient, this can result in pathophysiologic conditions. Sleep deficiency is a risk factor for various conditions, including dementia, diabetes, and obesity. Recent studies have shown that there are differences in the prevalence of sleep disorders between genders. Insomnia, the most common type of sleep disorder, has been reported to have a higher incidence in females than in males. However, sex/gender differences in other sleep disorder subtypes are not thoroughly understood. Currently, increasing evidence suggests that gender issues should be considered important when prescribing medicine. Therefore, an investigation of the gender-dependent differences in sleep disorders is required. In this review, we first describe sex/gender differences not only in the prevalence of sleep disorders by category but in the efficacy of sleep medications. In addition, we summarize sex/gender differences in the impact of sleep disorders on incident dementia. This may help understand gender-dependent pathogenesis of sleep disorders and develop therapeutic strategies in men and women.
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Affiliation(s)
- Hye Jin Jee
- College of Pharmacy, Ajou University, Suwon 16499, Republic of Korea.,Research Institute of Pharmaceutical Sciences and Technology, Ajou University, Suwon 16499, Republic of Korea
| | - Wonseok Shin
- College of Pharmacy, Ajou University, Suwon 16499, Republic of Korea
| | - Ho Joong Jung
- College of Pharmacy, Ajou University, Suwon 16499, Republic of Korea
| | - Baekgyu Kim
- Graduate School of Global Pharmaceutical Industry and Clinical Pharmacy, Ajou University, Suwon 16499, Republic of Korea
| | - Bo Kyung Lee
- College of Pharmacy, Ajou University, Suwon 16499, Republic of Korea
| | - Yi-Sook Jung
- College of Pharmacy, Ajou University, Suwon 16499, Republic of Korea.,Research Institute of Pharmaceutical Sciences and Technology, Ajou University, Suwon 16499, Republic of Korea.,Graduate School of Global Pharmaceutical Industry and Clinical Pharmacy, Ajou University, Suwon 16499, Republic of Korea
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21
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Marron L, Segurado R, Kenny RA, McNicholas T. The association between benzodiazepine use and falls, and the impact of sleep quality on this association: data from the TILDA study. QJM 2020; 113:31-36. [PMID: 31424520 DOI: 10.1093/qjmed/hcz217] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Revised: 08/10/2019] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Benzodiazepines (BZD) are associated with adverse effects, particularly in older adults. AIM This study assesses the association between BZD use and falls, and the impact of sleep quality on this association, in community dwelling adults aged over 50. DESIGN Cross-sectional analysis of data from wave 1 of The Irish Longitudinal Study on Ageing. METHODS Participants were classed as BZD users or non-users and asked if they had fallen in the last year, and whether any falls were unexplained. Sleep quality was assessed via self-reported trouble falling asleep, daytime somnolence and early-rising. Logistic regression assessed for an association between BZD use and falls, and the impact of sleep quality on this association was assessed by categorizing based on BZD use and sleep quality variables. RESULTS Of 8175 individuals, 302 (3.69%) reported taking BZDs. BZD use was associated with falls, controlling for confounders [Odds Ratio (OR) 1.40; 1.08, 1.82; P-value 0.012]. There was no significant association between BZDs and unexplained falls, controlling for confounders [OR 1.41; 95% Confidence Interval (CI) 0.95, 2.10; P-value 0.09]. Participants who use BZDs and report daytime somnolence (OR 1.93; 95% CI 1.12, 3.31; P-value 0.017), early-rising (OR 1.93; 95% CI 1.20, 3.11; P-value 0.007) or trouble falling asleep (OR 1.83; 95% CI 1.12, 2.97; P-value 0.015), have an increased odds of unexplained falls. CONCLUSION BZD use is associated with falls, with larger effect size in those reporting poor sleep quality in community dwelling older adults. Appropriate prescription of medications such as BZDs is an important public health issue.
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Affiliation(s)
- L Marron
- UCD School of Public Health, Physiotherapy and Sports Science, Woodview House University College Dublin Belfield, Dublin 4, D04 V1W8, Ireland
- Department of Public Health, Health Service Executive, Dr. Steevens' Hospital, Dublin 8, D08 W2AB, Ireland
| | - R Segurado
- UCD School of Public Health, Physiotherapy and Sports Science, Woodview House University College Dublin Belfield, Dublin 4, D04 V1W8, Ireland
| | - R A Kenny
- The Irish Longitudinal Study on Ageing (TILDA), Lincoln Gate, Trinity College, Dublin 2, D02 PN40, Ireland
- Department of Medical Gerontology, Trinity College, Dublin 2, D02 PN40, Ireland
- Mercer's Institute for Successful Ageing, St James's Hospital, James's St, Dublin 8, D08 RT2X, Ireland
| | - T McNicholas
- The Irish Longitudinal Study on Ageing (TILDA), Lincoln Gate, Trinity College, Dublin 2, D02 PN40, Ireland
- Department of Medical Gerontology, Trinity College, Dublin 2, D02 PN40, Ireland
- Mercer's Institute for Successful Ageing, St James's Hospital, James's St, Dublin 8, D08 RT2X, Ireland
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22
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Salas-Crisóstomo M, Torterolo P, Veras AB, Rocha NB, Machado S, Murillo-Rodríguez E. Therapeutic Approaches for the Management of Sleep Disorders in Geriatric Population. Curr Med Chem 2019; 26:4775-4785. [PMID: 30182852 DOI: 10.2174/0929867325666180904113115] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Revised: 09/25/2017] [Accepted: 08/16/2018] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Aging is a natural biological phenomenon that occurs in human beings. With increasing of age, there is an appearance of deleterious changes related to progression onto pathological conditions, including hypertension, heart disease, diabetes, hearing and vision impairments, as well as sleep disorders. It is important to recognize that some sleep disturbances reported by aged subjects include insomnia, obstructive sleep apnea, restless legs syndrome, among others. Moreover, accumulating evidence indicates that coexistence of medical issues with sleep disorders constitutes clinical challenges for treatment of comorbidities in elderly. Here, we have attempted to review and summarize the available literature that assesses the sleep disturbances in aging. In addition, we highlight the management of sleep disorders associated with aging. Due to the particular health condition of aged adults, the development of effective pharmacological interventions for sleep disorders treatment in aging is warranted. METHODS Review of studies retrieved from the PubMed. RESULTS The sleep-wake cycle includes abnormalities classified as sleep disorders. Comorbidity between sleep disturbances and aging-related health issues will represent a public health challenge to be addressed in the near future. Moreover, this scenario will suggest an area that requires further drug investigation and design of new pharmacological and pharmaceutical strategies to treat sleep disorders in the elderly population. CONCLUSION The review highlights the sleep disturbances in aging. We focus on current knowledge in medicinal chemistry and further design of new treatments tools for managing sleep disturbances in the aged population.
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Affiliation(s)
- Mireille Salas-Crisóstomo
- Laboratorio de Neurociencias Moleculares e Integrativas. Escuela de Medicina División Ciencias de la Salud. Universidad Anáhuac Mayab, Mérida, Yucatán, México.,Grupo de Investigacion en Envejecimiento. Division Ciencias de la Salud, Universidad Anahuac Mayab. Merida, Yucatan, Mexico.,Intercontinental Neuroscience Research Group, Montevideo, Uruguay
| | - Pablo Torterolo
- Intercontinental Neuroscience Research Group, Montevideo, Uruguay.,Laboratorio de Neurobiologia del Sueno. Depto. de Fisiologia, Facultad de Medicina, Universidad de la Republica, Montevideo, Uruguay
| | - André Barciela Veras
- Intercontinental Neuroscience Research Group, Montevideo, Uruguay.,Institute of Psychiatry. Federal University of Rio de Janeiro. Rio de Janeiro, Brazil.,Dom Bosco Catholic University. Campo Grande, Mato Grosso del Sur, Brazil
| | - Nuno Barbosa Rocha
- Intercontinental Neuroscience Research Group, Montevideo, Uruguay.,Health School Sciences, Polytechnic Institute of Porto, Porto, Portugal
| | - Sérgio Machado
- Intercontinental Neuroscience Research Group, Montevideo, Uruguay.,Laboratory of Panic and Respiration, Institute of Psychiatry of Federal University of Rio de Janeiro, Rio de Janeiro. Brazil.,Physical Activity Neuroscience Laboratory, Physical Activity Sciences Postgraduate Program of Salgado de Oliveira University. Niterói, Brazil
| | - Eric Murillo-Rodríguez
- Laboratorio de Neurociencias Moleculares e Integrativas. Escuela de Medicina División Ciencias de la Salud. Universidad Anáhuac Mayab, Mérida, Yucatán, México.,Grupo de Investigacion en Envejecimiento. Division Ciencias de la Salud, Universidad Anahuac Mayab. Merida, Yucatan, Mexico.,Intercontinental Neuroscience Research Group, Montevideo, Uruguay
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Gerlach LB, Strominger J, Kim HM, Maust DT. Discontinuation of Chronic Benzodiazepine Use Among Adults in the United States. J Gen Intern Med 2019; 34:1833-1840. [PMID: 31240606 PMCID: PMC6712149 DOI: 10.1007/s11606-019-05098-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Revised: 04/11/2019] [Accepted: 05/09/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Guidelines recommend most benzodiazepine (BZD) treatment be short-term, though chronic BZD use is increasing. OBJECTIVE Determine the rate of BZD discontinuation among chronic users and identify patient- and provider-level factors associated with discontinuation. DESIGN, SETTING, AND PARTICIPANTS A retrospective cohort study using nationwide insurance claims data from 2014 to 2016 of US adults ≥ 18 years old with chronic BZD use (i.e., > 120 days) during the baseline year. MAIN OUTCOMES AND MEASURES The primary outcome was BZD discontinuation among chronic users after 1 year of follow-up. A series of multilevel logistic regression models examined the association of BZD discontinuation with patient and provider characteristics. Covariates included patient sociodemographics, medical and psychiatric comorbidity, co-prescribed opioids and other psychotropics, and characteristics of the prescribed BZD. KEY RESULTS Of 141,008 chronic BZD users, 13.4% discontinued use after 1 year. Females had lower odds of discontinuation (AOR 0.83, 99% CI 0.79-0.87), while African-American patients had higher odds (AOR 1.12, 99% CI 1.03-1.22). Those prescribed a high-potency BZD had lower odds of discontinuation (AOR 0.51, 99% CI 0.47-0.54), as did those prescribed an opioid (AOR 0.94, 99% CI 0.89-0.99). After adjusting for patient- and provider-level factors, differences between providers accounted for 5.8% of variation in BZD discontinuation (p < 0.001). The median odds ratio for provider was 1.54, an association with discontinuation larger than almost all patient-level clinical variables. CONCLUSIONS A small minority of patients prescribed chronic BZD in a given year are no longer prescribed BZDs 1 year later. There is significant variation in the likelihood of discontinuation accounted for by non-clinical factors such as race, geography, and a patient's provider, which had a stronger association with the odds of discontinuation than almost every other patient-level variable. Provider-facing elements of interventions to reduce BZD prescribing may be critical.
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Affiliation(s)
- Lauren B Gerlach
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, USA. .,Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA.
| | - Julie Strominger
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, USA.,Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - Hyungjin Myra Kim
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA.,Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA.,Center for Statistical Consultation and Research, University of Michigan, Ann Arbor, MI, USA
| | - Donovan T Maust
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, USA.,Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA.,Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
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24
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Sheehy O, Zhao JP, Bérard A. Association Between Incident Exposure to Benzodiazepines in Early Pregnancy and Risk of Spontaneous Abortion. JAMA Psychiatry 2019; 76:948-957. [PMID: 31090881 PMCID: PMC6537838 DOI: 10.1001/jamapsychiatry.2019.0963] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
IMPORTANCE Benzodiazepine use in early pregnancy is associated with spontaneous abortion (SA). However, to date, the association between specific benzodiazepine agent exposure and the risk of SA has not been examined. OBJECTIVE To quantify the risk of SA associated with gestational benzodiazepine incident use by drug class, duration of action, and specific benzodiazepine agent. DESIGN, SETTING, AND PARTICIPANTS This nested case-control study within the Quebec Pregnancy Cohort, Montreal, Quebec, Canada, includes all pregnancies covered by the Quebec Prescription Drug Insurance Plan from January 1, 1998, through December 31, 2015. Each case was randomly matched with up to 5 controls. Statistical analysis was performed from January 1, 1998, through December 31, 2015. EXPOSURES Benzodiazepine exposure was defined as 1 or more filled prescriptions between the first day of the last menstrual period and the index date (the calendar date of the SA diagnosis). Benzodiazepine exposure was categorized by overall use, long- or short-acting benzodiazepine, and specific benzodiazepine agents. MAIN OUTCOMES AND MEASURES Spontaneous abortion defined as a pregnancy loss between the beginning of the sixth week of gestation and the 19th completed week of gestation. Conditional logistic regression models were used to calculate odds ratios (OR) and 95% CIs. RESULTS Of the 442 066 pregnancies included in the Quebec Pregnancy Cohort, 27 149 (6.1%) ended with SA, with a mean (SD) maternal age of 24.2 (6.5) years. Among pregnancies ending with SA, 375 (1.4%) were among women exposed to benzodiazepines in early pregnancy compared with 788 (0.6%) of the 134 305 matched control pregnancies (crude OR, 2.39; 95% CI, 2.10-2.73). Adjusting for potential confounders, including maternal mood and anxiety disorders before pregnancy, and compared with nonuse, benzodiazepine exposure in early pregnancy was associated with an increased risk of SA (adjusted OR, 1.85; 95% CI, 1.61-2.12). The risk was similar among pregnancies exposed to short-acting (284 exposed cases; adjusted OR, 1.81; 95% CI, 1.55-2.12) and long-acting (98 exposed cases; adjusted OR, 1.73; 95% CI, 1.31-2.28) benzodiazepines during early pregnancy. All benzodiazepine agents were independently associated with an increased risk of SA (range of adjusted ORs, 1.13-3.43). CONCLUSIONS AND RELEVANCE An increased risk of SA was observed among early pregnancies with incident exposure to short- and long-acting benzodiazepines and all specific benzodiazepine agents during early pregnancy. Insomnia, anxiety, and mood disorders are prevalent during pregnancy; clinicians should carefully evaluate the risk-benefit ratio of prescribing benzodiazepines in early pregnancy since alternative nonpharmacologic treatments exist.
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Affiliation(s)
- Odile Sheehy
- Research Center, Centre Hospitalier Universitaire Sainte-Justine, Montreal, Quebec, Canada
| | - Jin-Ping Zhao
- Research Center, Centre Hospitalier Universitaire Sainte-Justine, Montreal, Quebec, Canada
| | - Anick Bérard
- Research Center, Centre Hospitalier Universitaire Sainte-Justine, Montreal, Quebec, Canada,Faculty of Pharmacy, University of Montreal, Montreal, Quebec, Canada
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25
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He B, Zhang L, Zhuang JH, Xu J, Li P, Peng H. The effects of different meditation exercises on sleep quality in older people: a network meta-analysis. Eur Geriatr Med 2019; 10:543-552. [PMID: 34652740 DOI: 10.1007/s41999-019-00212-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Accepted: 06/01/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Chronic sleep loss or sleep disorders is a public health problem affecting older people and cause many health problems. We aim to estimate the effects of different meditation exercises on relieving and improvement of sleep disorders in older people using the pairwise and network meta-analyses. METHODS Randomized controlled trials, which were published in English and reported on meditation exercises for sleep disorders in the older people, were retrieved from PubMed and EMBASE up to May 2018. Publication bias of the included studies were assessed by the Cochrane Collaboration recommendations. Network meta-analysis was performed by ADDIS, and all test models used random-effects model. Pooled effect sizes were presented with weighted mean differences (WMDs) and 95% confidence interval (CI). RESULTS A total of ten studies were included in our research. Pairwise comparisons indicated that Qigong could significantly improve the quality of sleep in older people with sleep disorders compared with Activities (WMD = - 4.28, 95% CI - 5.75 to - 2.81). In addition, there were significant differences in Education vs. Usual care (WMD = 2.60, 95% CI 1.03-4.17) and Tai Chi vs. Activities (WMD = - 1.05, 95% CI - 1.73 to - 0.38). With great consistence and convergence, network meta-analysis showed that there was a significant difference in Qigong vs. Activities (WMD = - 4.23, 95% CI - 8.31 to - 0.21). Moreover, Qigong showed a best outcome in relieving sleep disorders, followed by Yoga. CONCLUSIONS Qigong, Yoga, and Tai Chi improved sleep disorders in the older people, and Qigong intervention had the best effect followed by Yoga. A long-term clinical verification should be needed in the future.
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Affiliation(s)
- Bin He
- Department of Neurology, Changzheng Hospital, Second Military Medical University, 415 Fengyang Road, Shanghai, 200003, People's Republic of China
| | - Lin Zhang
- Department of Neurology, Changzheng Hospital, Second Military Medical University, 415 Fengyang Road, Shanghai, 200003, People's Republic of China
| | - Jian-Hua Zhuang
- Department of Neurology, Changzheng Hospital, Second Military Medical University, 415 Fengyang Road, Shanghai, 200003, People's Republic of China
| | - Jin Xu
- Department of Neurology, Changzheng Hospital, Second Military Medical University, 415 Fengyang Road, Shanghai, 200003, People's Republic of China
| | - Peng Li
- Department of Neurology, Changzheng Hospital, Second Military Medical University, 415 Fengyang Road, Shanghai, 200003, People's Republic of China
| | - Hua Peng
- Department of Neurology, Changzheng Hospital, Second Military Medical University, 415 Fengyang Road, Shanghai, 200003, People's Republic of China.
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26
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The association between physical and mental chronic conditions and napping. Sci Rep 2019; 9:1795. [PMID: 30741949 PMCID: PMC6370873 DOI: 10.1038/s41598-018-37355-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Accepted: 11/16/2018] [Indexed: 12/17/2022] Open
Abstract
The objectives of this study were to assess the associations among various physical and mental chronic conditions and napping. A cross-sectional epidemiological survey was proposed within the NutriNet-Santé population-based e-cohort launched in France in 2009. Participants were 43,060 French volunteers aged 18 y and over with Internet access. A self-report questionnaire assessing sleep characteristics was administered in 2014. The main outcome (dependent) variable was weekday or weekend napping (yes/no). The main exposure (independent) variables were overweight/obesity, hypertension, diabetes, anxiety and depressive disorders, incident major cardiovascular diseases (myocardial infarction, stroke, unstable angina), and incident cancer (breast and prostate). The associations of interest were investigated with multivariable logistic regression analysis. No significant associations were found between major cardiovascular diseases or breast or prostate cancer and napping. Instead, we found that napping was more common among males (46.1%) than among females 36.9% (p < 0.0001). Individuals who were overweight or obese or had hypertension, diabetes, depression or anxiety disorders had an increased likelihood of napping compared with their healthy peers. The adjusted ORs ranged from 1.14 to 1.28″. In conclusion, most chronic conditions were independently associated with napping. Future longitudinal analyses are needed to elucidate causality.
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27
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Westbury J, Gee P, Ling T, Kitsos A, Peterson G. More action needed: Psychotropic prescribing in Australian residential aged care. Aust N Z J Psychiatry 2019; 53:136-147. [PMID: 29488403 DOI: 10.1177/0004867418758919] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE For at least two decades, concerns have been raised about inappropriate psychotropic prescribing in Australian residential aged care facilities, due to their modest therapeutic benefit and increased risk of falls and mortality. To date, the majority of prevalence data has been collected in Sydney exclusively and it is not known if recent initiatives to promote appropriate psychotropic prescribing have impacted utilisation. Thus, we aimed to comprehensively analyse psychotropic use in a large national sample of residential aged care facility residents. METHOD A cross-sectional, retrospective cohort study of residents from 150 residential aged care facilities distributed nationally during April 2014-October 2015. Antipsychotic, anxiolytic/hypnotic and antidepressant utilisation was assessed, along with anticonvulsant and anti-dementia drug use. Negative binomial regression analysis was used to examine variation in psychotropic use. RESULTS Full psychotropic prescribing data was available from 11,368 residents. Nearly two-thirds (61%) were taking psychotropic agents regularly, with over 41% prescribed antidepressants, 22% antipsychotics and 22% of residents taking benzodiazepines. Over 30% and 11% were charted for 'prn' (as required) benzodiazepines and antipsychotics, respectively. More than 16% of the residents were taking sedating antidepressants, predominantly mirtazapine. South Australian residents were more likely to be taking benzodiazepines ( p < 0.05) and residents from New South Wales/Australian Capital Territory less likely to be taking them ( p < 0.01), after adjustment for rurality and size of residential aged care facility. Residents located in New South Wales/Australian Capital Territory were also significantly less likely to take antidepressants ( p < 0.01), as were residents from outer regional residential aged care facilities ( p < 0.01). Antipsychotic use was not associated with State, rurality or residential aged care facility size. CONCLUSION Regular antipsychotic use appears to have decreased in residential aged care facilities but benzodiazepine prevalence is higher, particularly in South Australian residential aged care facilities. Sedating antidepressant and 'prn' psychotropic prescribing is widespread. Effective interventions to reduce the continued reliance on psychotropic management, in conjunction with active promotion of non-pharmacological strategies, are urgently required.
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Affiliation(s)
- Juanita Westbury
- 1 Wicking Dementia Research and Education Centre, College of Health and Medicine, University of Tasmania, Hobart, TAS, Australia
| | - Peter Gee
- 2 Pharmacy, School of Medicine, College of Health and Medicine, University of Tasmania, Hobart, TAS, Australia
| | - Tristan Ling
- 2 Pharmacy, School of Medicine, College of Health and Medicine, University of Tasmania, Hobart, TAS, Australia
| | - Alex Kitsos
- 3 Health Services Innovation Tasmania, School of Medicine, College of Health and Medicine, University of Tasmania, Hobart, TAS, Australia
| | - Gregory Peterson
- 3 Health Services Innovation Tasmania, School of Medicine, College of Health and Medicine, University of Tasmania, Hobart, TAS, Australia
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Deprescribing Benzodiazepines in Older Patients: Impact of Interventions Targeting Physicians, Pharmacists, and Patients. Drugs Aging 2018; 35:493-521. [PMID: 29705831 DOI: 10.1007/s40266-018-0544-4] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Benzodiazepines (BZDs; including the related Z-drugs) are frequently targets for deprescribing; long-term use in older people is harmful and often not beneficial. BZDs can result in significant harms, including falls, fractures, cognitive impairment, car crashes and a significant financial and legal burden to society. Deprescribing BZDs is problematic due to a complex interaction of drug, patient, physician and systematic barriers, including concern about a potentially distressing but rarely fatal withdrawal syndrome. Multiple studies have trialled interventions to deprescribe BZDs in older people and are discussed in this narrative review. Reported success rates of deprescribing BZD interventions range between 27 and 80%, and this variability can be attributed to heterogeneity of methodological approaches and limited generalisability to cognitively impaired patients. Interventions targeting the patient and/or carer include raising awareness (direct-to-consumer education, minimal interventions, and 'one-off' geriatrician counselling) and resourcing the patient (gradual dose reduction [GDR] with or without cognitive behavioural therapy, teaching relaxation techniques, and sleep hygiene). These are effective if the patient is motivated to cease and is not significantly cognitively impaired. Interventions targeted to physicians include prescribing interventions by audit, algorithm or medication review, and providing supervised GDR in combination with medication substitution. Pharmacists have less frequently been the targets for studies, but have key roles in several multifaceted interventions. Interventions are evaluated according to the Behaviour Change Wheel. Research supports trialling a stepwise approach in the cognitively intact older person, but having a low threshold to use less-consultative methods in patients with dementia. Several resources are available to support deprescribing of BZDs in clinical practice, including online protocols.
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29
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Reinstatler KM, Woolf B. Treatment of Sleep Disturbances in Nursing Home Patients: Practical Management Strategies. Psychiatr Ann 2018. [DOI: 10.3928/00485713-20180514-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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30
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Clinical and Economic Outcomes of Interventions to Reduce Antipsychotic and Benzodiazepine Use Within Nursing Homes: A Systematic Review. Drugs Aging 2018; 35:123-134. [DOI: 10.1007/s40266-018-0518-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Abstract
OBJECTIVES Despite evidence for many potential risks, use of benzodiazepines (BZDs) among older adults is common. The authors evaluated the available evidence for BZD effectiveness and tolerability for use in older adults in three psychiatric conditions for which BZDs are commonly prescribed: insomnia, anxiety disorders, and behavioral and psychological symptoms of dementia. DESIGN Electronic databases, including PubMed/MEDLINE, were searched to identify articles that (1) included patients ≥50 years of age, (2) focused on patients diagnosed with insomnia, anxiety disorders, or behavioral and psychological symptoms of dementia, and (3) were either a randomized, placebo-controlled trial or a randomized trial comparing a BZD with either another psychotropic medication or psychotherapy. RESULTS Thirty-one studies met the inclusion criteria. Of the three clinical indications evaluated, treatment of insomnia had the greatest available evidence for use of BZDs among older adults, with 21 of 25 trials demonstrating improved sleep outcomes with use of BZDs. Only one trial was found to meet eligibility criteria for BZD use in anxiety disorders, demonstrating benefit over placebo. Five studies for use in behavioral disturbances in dementia were included, of which only one demonstrated improvement over placebo. CONCLUSION This systematic review suggests that BZD prescribing to older adults is significantly in excess of what the available evidence suggests is appropriate. Future trials should focus on efforts to reduce both acute and chronic BZD use among older adults while improving access to effective non-pharmacologic treatment alternatives.
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