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Luo X, Zhang A, Li H, Li Y, Ying F, Wang X, Yang Q, Zhang Z, Huang G. The role of arts therapies in mitigating Sleep Initiation and Maintenance Disorders: a systematic review. Front Psychiatry 2024; 15:1386529. [PMID: 38818021 PMCID: PMC11137235 DOI: 10.3389/fpsyt.2024.1386529] [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: 02/15/2024] [Accepted: 05/01/2024] [Indexed: 06/01/2024] Open
Abstract
Introduction Arts therapies offer effective non-pharmacological intervention for Sleep Initiation and Maintenance Disorders (SIMDs), encompassing both passive and active modalities. This review assesses their effectiveness and ethical considerations, focusing on music therapy, meditation, and Tai Chi. Methods Following PRISMA guidelines, a detailed search across PubMed, the Cochrane Library, Web of Science, and CNKI identified 17 relevant RCTs. Utilizing the Joanna Briggs Institute (JBI) quality criteria and the PICO(S) framework for data extraction ensured methodological integrity. Results Analysis shows arts therapies significantly improve sleep quality. Music therapy and meditation yield immediate benefits, while Tai Chi and Qigong require longer commitment for significant outcomes. Discussion The link between SIMDs and mental health issues like anxiety, stress, and depression suggests arts therapies not only enhance sleep quality but also address underlying mental health conditions. The evidence supports a wider adoption of arts therapies in treating SIMDs due to their dual benefits. Systematic review registration PROSPERO, ID: CRD42024506393.
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Affiliation(s)
- Xuexing Luo
- Faculty of Humanities and Arts, Macau University of Science and Technology, Macao, Macao SAR, China
| | - Aijia Zhang
- Faculty of Humanities and Arts, Macau University of Science and Technology, Macao, Macao SAR, China
| | - Hong Li
- Faculty of Humanities and Arts, Macau University of Science and Technology, Macao, Macao SAR, China
| | - Yu Li
- State Key Laboratory of Quality Research in Chinese Medicines, Macau University of Science and Technology, Macao, Macao SAR, China
- Faculty of Chinese Medicine, Macau University of Science and Technology, Macao, Macao SAR, China
| | - Fangtian Ying
- Faculty of Humanities and Arts, Macau University of Science and Technology, Macao, Macao SAR, China
- College of Computer Science and Technology Zhejiang University, Hangzhou, Zhejiang, China
- Operation Management Centre, Guangzhou Wanqu Cooperative Institute of Design, Guangzhou, Guangdong, China
| | - Xiaoli Wang
- Qinghai Province Cardiovascular and Cerebrovascdular Disease Specialist Hospital, Xining, Qinghai, China
| | - Qianxu Yang
- Centre for Epidemiology and Evidence-Based Practice, Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Zheyu Zhang
- Faculty of Humanities and Arts, Macau University of Science and Technology, Macao, Macao SAR, China
| | - Guanghui Huang
- Faculty of Humanities and Arts, Macau University of Science and Technology, Macao, Macao SAR, China
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Zhang JY, Wang YT, Sun L, Wang SQ, Chen ZS. Synthesis and clinical application of new drugs approved by FDA in 2022. MOLECULAR BIOMEDICINE 2023; 4:26. [PMID: 37661221 PMCID: PMC10475455 DOI: 10.1186/s43556-023-00138-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Accepted: 07/24/2023] [Indexed: 09/05/2023] Open
Abstract
The pharmaceutical industry had a glorious year in 2022, with a total of 37 new drugs including 20 new chemical entities (NCEs) and 17 new biological entities (NBEs) approved by the Food and Drug Administration (FDA). These drugs are mainly concentrated in oncology, central nervous system, antiinfection, hematology, cardiomyopathy, dermatology, digestive system, ophthalmology, MRI enhancer and other therapeutic fields. Of the 37 drugs, 25 (68%) were approved through an expedited review pathway, and 19 (51%) were approved to treat rare diseases. These newly listed drugs have unique structures and new mechanisms of action, which can serve as lead compounds for designing new drugs with similar biological targets and enhancing therapeutic efficacy. This review aims to outline the clinical applications and synthetic methods of 19 NCEs newly approved by the FDA in 2022, but excludes contrast agent (Xenon Xe-129). We believe that an in-depth understanding of the synthetic methods of drug molecules will provide innovative and practical inspiration for the development of new, more effective, and practical synthetic techniques. According to the therapeutic areas of these 2022 FDA-approved drugs, we have classified these 19 NCEs into seven categories and will introduce them in the order of their approval for marketing.
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Affiliation(s)
- Jing-Yi Zhang
- College of Chemistry and Chemical Engineering, Zhengzhou Normal University, Zhengzhou, 450044, China
| | - Ya-Tao Wang
- First People's Hospital of Shangqiu, Henan Province, Shangqiu, 476100, China
- Henan Engineering Research Center of Precision Therapy of Gastrointestinal Cancer, Zhengzhou Key Laboratory for Precision Therapy of Gastrointestinal Cancer, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, 450008, China
| | - Lu Sun
- Henan Engineering Research Center of Precision Therapy of Gastrointestinal Cancer, Zhengzhou Key Laboratory for Precision Therapy of Gastrointestinal Cancer, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, 450008, China.
- Zhongshan Hospital Affiliated to Dalian University, Dalian, 116001, China.
| | - Sai-Qi Wang
- Henan Engineering Research Center of Precision Therapy of Gastrointestinal Cancer, Zhengzhou Key Laboratory for Precision Therapy of Gastrointestinal Cancer, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, 450008, China.
| | - Zhe-Sheng Chen
- College of Pharmacy and Health Sciences, St. John's University, Queens, NY, 11439, USA.
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Zhu J, Chen C, Wu J, He M, Li S, Fang Y, Zhou Y, Xu H, Sadigh-Eteghad S, Manyande A, Zheng F, Chen T, Xu F, Ma D, Wang J, Zhang Z. Effects of propofol and sevoflurane on social and anxiety-related behaviours in sleep-deprived rats. Br J Anaesth 2023; 131:531-541. [PMID: 37543435 DOI: 10.1016/j.bja.2023.05.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 05/15/2023] [Accepted: 05/16/2023] [Indexed: 08/07/2023] Open
Abstract
BACKGROUND Sleep disorders can profoundly affect neurological function. We investigated changes in social and anxiety-related brain functional connectivity induced by sleep deprivation, and the potential therapeutic effects of the general anaesthetics propofol and sevoflurane in rats. METHODS Twelve-week-old male Sprague-Dawley rats were subjected to sleep deprivation for 20 h per day (from 14:00 to 10:00 the next day) for 4 consecutive weeks. They were free from sleep deprivation for the remaining 4 h during which they received propofol (40 mg kg-1 i.p.) or sevoflurane (2% for 2 h) per day or no treatment. These cohorts were instrumented for EEG/EMG recordings on days 2, 14, and 28. Different cohorts were used for open field and three-chambered social behavioural tests, functional MRI, nuclear magnetic resonance spectroscopy, and positron emission tomography imaging 48 h after 4 weeks of sleep deprivation. RESULTS Propofol protected against sleep deprivation-induced anxiety behaviours with more time (44.7 [8.9] s vs 24.2 [4.1] s for the sleep-deprivation controls; P<0.001) spent in the central area of the open field test and improved social preference index by 30% (all P<0.01). Compared with the sleep-deprived rats, propofol treatment enhanced overall functional connectivity by 74% (P<0.05) and overall glucose metabolism by 30% (P<0.01), and improved glutamate kinetics by 20% (P<0.05). In contrast, these effects were not found after sevoflurane treatment. CONCLUSIONS Unlike sevoflurane, propofol reduced sleep deprivation-induced social and anxiety-related behaviours. Propofol might be superior to sevoflurane for patients with sleep disorders who receive anaesthesia, which should be studied in clinical studies.
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Affiliation(s)
- Jinpiao Zhu
- Department of Anesthesiology, Zhongnan Hospital, Wuhan University, Wuhan, China
| | - Chang Chen
- Department of Anesthesiology, Zhongnan Hospital, Wuhan University, Wuhan, China
| | - Jinfeng Wu
- Key Laboratory of Magnetic Resonance in Biological Systems, State Key Laboratory of Magnetic Resonance and Atomic and Molecular Physics, National Center for Magnetic Resonance in Wuhan, Wuhan Institute of Physics and Mathematics, Innovation Academy for Precision Measurement Science and Technology, Chinese Academy of Sciences-Wuhan National Laboratory for Optoelectronics, Wuhan, China; University of Chinese Academy of Sciences, Beijing, China
| | - Mengying He
- Department of Anesthesiology, Zhongnan Hospital, Wuhan University, Wuhan, China; Key Laboratory of Magnetic Resonance in Biological Systems, State Key Laboratory of Magnetic Resonance and Atomic and Molecular Physics, National Center for Magnetic Resonance in Wuhan, Wuhan Institute of Physics and Mathematics, Innovation Academy for Precision Measurement Science and Technology, Chinese Academy of Sciences-Wuhan National Laboratory for Optoelectronics, Wuhan, China
| | - Shuang Li
- Key Laboratory of Magnetic Resonance in Biological Systems, State Key Laboratory of Magnetic Resonance and Atomic and Molecular Physics, National Center for Magnetic Resonance in Wuhan, Wuhan Institute of Physics and Mathematics, Innovation Academy for Precision Measurement Science and Technology, Chinese Academy of Sciences-Wuhan National Laboratory for Optoelectronics, Wuhan, China
| | - Yuanyuan Fang
- Department of Anesthesiology, Zhongnan Hospital, Wuhan University, Wuhan, China; Key Laboratory of Magnetic Resonance in Biological Systems, State Key Laboratory of Magnetic Resonance and Atomic and Molecular Physics, National Center for Magnetic Resonance in Wuhan, Wuhan Institute of Physics and Mathematics, Innovation Academy for Precision Measurement Science and Technology, Chinese Academy of Sciences-Wuhan National Laboratory for Optoelectronics, Wuhan, China
| | - Yan Zhou
- Frontier Science Center for Immunology and Metabolism, and Medical Research Institute at School of Medicine, Wuhan University, Wuhan, China
| | - Haibo Xu
- Department of Radiology, Zhongnan Hospital, Wuhan University, Wuhan, China
| | - Saeed Sadigh-Eteghad
- Neurosciences Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Anne Manyande
- School of Human and Social Sciences, University of West London, London, UK
| | - Feng Zheng
- Department of Anesthesiology, Zhongnan Hospital, Wuhan University, Wuhan, China
| | - Ting Chen
- Department of Anesthesiology, Zhongnan Hospital, Wuhan University, Wuhan, China
| | - Fuqiang Xu
- Key Laboratory of Magnetic Resonance in Biological Systems, State Key Laboratory of Magnetic Resonance and Atomic and Molecular Physics, National Center for Magnetic Resonance in Wuhan, Wuhan Institute of Physics and Mathematics, Innovation Academy for Precision Measurement Science and Technology, Chinese Academy of Sciences-Wuhan National Laboratory for Optoelectronics, Wuhan, China; University of Chinese Academy of Sciences, Beijing, China
| | - Daqing Ma
- Division of Anaesthetics, Pain Medicine and Intensive Care, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, Chelsea and Westminster Hospital, London, UK; Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Jie Wang
- Key Laboratory of Magnetic Resonance in Biological Systems, State Key Laboratory of Magnetic Resonance and Atomic and Molecular Physics, National Center for Magnetic Resonance in Wuhan, Wuhan Institute of Physics and Mathematics, Innovation Academy for Precision Measurement Science and Technology, Chinese Academy of Sciences-Wuhan National Laboratory for Optoelectronics, Wuhan, China; University of Chinese Academy of Sciences, Beijing, China.
| | - Zongze Zhang
- Department of Anesthesiology, Zhongnan Hospital, Wuhan University, Wuhan, China.
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Butler M, D'Angelo S, Perrin A, Rodillas J, Miller D, Arader L, Chandereng T, Cheung YK, Shechter A, Davidson KW. A Series of Remote Melatonin Supplement Interventions for Poor Sleep: Protocol for a Feasibility Pilot Study for a Series of Personalized (N-of-1) Trials. JMIR Res Protoc 2023; 12:e45313. [PMID: 37535419 PMCID: PMC10436115 DOI: 10.2196/45313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 03/27/2023] [Accepted: 03/27/2023] [Indexed: 03/30/2023] Open
Abstract
BACKGROUND Poor sleep, defined as short-duration or poor-quality sleep, is a frequently reported condition with many deleterious effects including poorer cognitive functioning, increased accidents, and poorer health. Melatonin has been shown to be an efficacious treatment to manage symptoms of poor sleep. However, the treatment effects of melatonin on sleep can vary greatly between participants. Personalized, or N-of-1, trial designs represent a method for identifying the best treatment for individual participants. Although using N-of-1 trials of melatonin to treat poor sleep is possible, the feasibility, acceptability, and effectiveness of N-of-1 trials using melatonin are unknown. Using the National Institutes of Health Stage Model for Behavioral Intervention Development, a stage IB (intervention refinement, modification, and adaptation and pilot testing) design appeared to be needed to address these feasibility questions. OBJECTIVE This trial series evaluates the feasibility, acceptability, and effectiveness of a series of personalized interventions for remote delivery of melatonin dose (3 and 0.5 mg) versus placebo supplements for self-reported poor sleep among 60 participants. The goal of this study is to provide valuable information about implementing remote N-of-1 randomized controlled trials to improve poor sleep. METHODS Participants will complete a 2-week baseline followed by six 2-week alternating intervention periods of 3 mg of melatonin, 0.5 mg of melatonin, and placebo. Participants will be randomly assigned to 2 intervention orders. The feasibility and acceptability of the personalized trial approach will be determined with participants' ratings of usability and satisfaction with the remote, personalized intervention delivery system. The effectiveness of the intervention will be measured using participants' self-reported sleep quality and duration and Fitbit tracker-measured sleep duration and efficiency. Additional measures will include ecological momentary assessment measures of fatigue, stress, pain, mood, concentration, and confidence as well as measures of participant adherence to the intervention, use of the Fitbit tracker, and survey data collection. RESULTS As of the submission of this protocol, recruitment for this National Institutes of Health stage IB personalized trial series is approximately 78.3% complete (47/60). We expect recruitment and data collection to be finalized by June 2023. CONCLUSIONS Evaluating the feasibility, acceptability, and effectiveness of a series of personalized interventions of melatonin will address the longer term aim of this program of research-is integrating N-of-1 trials useful patient care? The personalized trial series results will be published in a peer-reviewed journal and will follow the CONSORT (Consolidated Standards of Reporting Trials) extension for N-of-1 trials (CENT 2015) reporting guidelines. This trial series was approved by the Northwell Health institutional review board. TRIAL REGISTRATION ClinicalTrials.gov NCT05349188; https://www.clinicaltrials.gov/study/NCT05349188. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/45313.
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Affiliation(s)
- Mark Butler
- Institute of Health System Science, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, United States
| | - Stefani D'Angelo
- Institute of Health System Science, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, United States
| | - Alexandra Perrin
- Institute of Health System Science, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, United States
| | - Jordyn Rodillas
- Institute of Health System Science, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, United States
| | - Danielle Miller
- Institute of Health System Science, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, United States
| | - Lindsay Arader
- Institute of Health System Science, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, United States
- St John's University, New York, NY, United States
| | - Thevaa Chandereng
- Institute of Health System Science, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, United States
| | - Ying Kuen Cheung
- Mailman School of Public Health, Columbia University, New York, NY, United States
| | - Ari Shechter
- Columbia University Irving Medical Center, New York, NY, United States
| | - Karina W Davidson
- Institute of Health System Science, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, United States
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell Health, Hempstead, NY, United States
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5
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Burgazli CR, Rana KB, Brown JN, Tillman F. Efficacy and safety of hydroxyzine for sleep in adults: Systematic review. Hum Psychopharmacol 2023; 38:e2864. [PMID: 36843057 DOI: 10.1002/hup.2864] [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: 06/29/2022] [Revised: 12/16/2022] [Accepted: 02/06/2023] [Indexed: 02/28/2023]
Abstract
OBJECTIVE The purpose of this systematic review is to assess the efficacy and safety of hydroxyzine for insomnia in adults. METHODS A comprehensive literature search of PubMed, Embase, and CENTRAL databases was conducted to identify relevant published studies through October 2022 using the search terms: hydroxyzine and sleep, insomnia, sleep disorder or sleep initiation and maintenance disorders. Studies identified for review included prospective, interventional designs or cohort trials that reported impact of hydroxyzine on sleep in adults. Animal studies, case reports, non-English articles, letters to the editor, case studies, and conference abstracts were excluded. Data were extracted using a standardized systematic process. RESULTS Five articles were identified for inclusion, including 1 open-label and 4 randomized controlled trials, evaluating a total of 207 patients receiving hydroxyzine 25 mg, 50 mg, or 100 mg at bedtime. Mixed efficacy was demonstrated in the sleep measures of sleep onset, sleep maintenance, and sleep quality. The most common adverse drug effect was dry mouth, although 4 of the 5 studies did not report safety outcomes. CONCLUSIONS The studies in this review suggest hydroxyzine could be considered as a short-term treatment option for adults with insomnia for whom previous therapy was ineffective, not tolerated, or contraindicated. Additional long-term studies with an active comparator are needed to further establish its role in insomnia treatment.
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Affiliation(s)
- Courtney R Burgazli
- Geriatric Research Education and Clinical Center, Durham VA Health Care System, Durham, North Carolina, USA
| | - Krishna B Rana
- Geriatric Research Education and Clinical Center, Durham VA Health Care System, Durham, North Carolina, USA
| | - Jamie N Brown
- Pharmacy Service, Durham VA Health Care System, Durham, North Carolina, USA.,Department of Pharmacy Practice, Campbell University College of Pharmacy and Health Sciences, Buies Creek, North Carolina, USA
| | - Frank Tillman
- Pharmacy Service, Durham VA Health Care System, Durham, North Carolina, USA
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White B, Snyder HS, Patel MVB. Evaluation of Medications Used for Hospitalized Patients With Sleep Disturbances: A Frequency Analysis and Literature Review. J Pharm Pract 2023; 36:126-138. [PMID: 34096384 DOI: 10.1177/08971900211017857] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
PURPOSE Poor sleep during hospitalization is common and implicated in worse patient outcomes. Despite implementation of non-pharmacologic techniques, medications are still frequently required. The study objective is to assess the frequency of new medications administered for sleep in hospitalized patients and to review literature evaluating these drug therapies in the inpatient setting. METHODS This retrospective study included adult inpatients if they received a new medication for sleep during a 5-day period. Patients were excluded if the medication was continued from home or if sleep was not the documented indication. For the literature review, a MEDLINE search was conducted to identify studies pertaining to pharmacotherapy for sleep in hospitalized patients. RESULTS Of 1,968 patient-days reviewed, a medication for sleep was given for 166 patient-days (8.4%) in 78 patients. Melatonin was most commonly received (70.5%), followed by benzodiazepines (9.6%). A review of antihistamines, benzodiazepines, melatonin, quetiapine, trazodone, and Z-drugs (non-benzodiazepine hypnotics) was conducted and 23 studies were included. CONCLUSIONS Despite widespread use of pharmacotherapy for sleep, there is a paucity of data evaluating use in the inpatient setting. Although there is significant heterogeneity among studies, melatonin has the strongest evidence for use and is an attractive option given its lack of adverse reactions and drug interactions. Benzodiazepines and Z-drugs were also frequently utilized; however, their reduced clearance in the elderly and potential for compounded sedative effects should be weighed heavily against potential sleep benefits. Antipsychotic agents cannot be recommended for routine use due to limited data and the potential for significant adverse effects.
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Affiliation(s)
- Brittany White
- Department of Pharmacy, Erlanger Health-System, Chattanooga, TN, USA.,Department of Internal Medicine, The University of Tennessee Health Science Center College of Medicine-Chattanooga, TN, USA
| | - Heather S Snyder
- Department of Pharmacy, Emory University Hospital, Atlanta, GA, USA
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Bouayyadi A, Aliani AE, Kasmi Y, Moussaif A, Abbadi NE, Mesfioui A, Essassi EM, Mzibri ME. Molecular docking analysis of α2-containing GABAA receptors with benzimidazoles derivatives. Bioinformation 2020; 16:611-619. [PMID: 33214749 PMCID: PMC7649024 DOI: 10.6026/97320630016611] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Accepted: 07/10/2020] [Indexed: 11/23/2022] Open
Abstract
It is of interest to study the binding capacity of "3-[2-(2-Amino-1H-benzo[d]imidazol-1-yl)ethyl]-1,3-oxazolidin-2-one" (OXB2) with the active site of gamma-aminobutyric acid (GABA) located in the GABA type A receptor (GABAAR) in comparison with different GABAA subtypes. Optimal binding features were observed with the α2β2γ2 isoform (-8 kcal/mol). This is similar (-7.3 and -7.2 kcal/mol, respectively) for subtypes (α3β2γ2 and α1β2γ2). This implies that OXB2 binds preferentially to subtypes associated with anxiety (α2- and/or α3-containing receptors) linked molecules than with the subtype associated with sedation (α1-containing receptors). It is further noted that molecular dynamics simulation data of the complex (OXB2-GABAAR) shows adequate structural stability in aqueous environment. Moreover, relevant ADMET data is found adequate for further consideration.
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Affiliation(s)
- Abdellatif Bouayyadi
- Division of Life Sciences, National Centre for Energy, Nuclear Sciences and Techniques (CNESTEN), Morocco
| | - Aissam El Aliani
- Division of Life Sciences, National Centre for Energy, Nuclear Sciences and Techniques (CNESTEN), Morocco
| | - Yassine Kasmi
- Division of Life Sciences, National Centre for Energy, Nuclear Sciences and Techniques (CNESTEN), Morocco
| | - Ahmed Moussaif
- Division of Life Sciences, National Centre for Energy, Nuclear Sciences and Techniques (CNESTEN), Morocco
| | - Najia El Abbadi
- Division of Life Sciences, National Centre for Energy, Nuclear Sciences and Techniques (CNESTEN), Morocco
| | - Abdelhalim Mesfioui
- Laboratory of Genetic, Endocrinology and Biotechnology–Faculty of Sciences, Ibn Tofaïl University, Morocco
| | - El Mokhtar Essassi
- Moroccan Foundation for Advanced Sciences, Innovation and Research. Morocco
| | - Mohammed El Mzibri
- Division of Life Sciences, National Centre for Energy, Nuclear Sciences and Techniques (CNESTEN), Morocco
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Barton DL, Atherton PJ, Satele DV, Qin R, Dakhil S, Pipe T, Hobday T, Fee-Schroeder K, Loprinzi CL. A randomized phase II trial evaluating two non-pharmacologic interventions in cancer survivors for the treatment of sleep-wake disturbances: NCCTG N07C4 (Alliance). Support Care Cancer 2020; 28:6085-6094. [PMID: 32307658 DOI: 10.1007/s00520-020-05461-6] [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: 12/12/2019] [Accepted: 04/04/2020] [Indexed: 11/24/2022]
Abstract
PURPOSE Sleep disturbance is a prevalent problem for cancer survivors and effective behavioral treatments are not widely used for this population. This study evaluated home-based sleep interventions based on cognitive behavioral therapy for insomnia (CBT-I). METHODS This phase II randomized controlled trial evaluated two manualized interventions over 7 weeks. The intervention group received sleep hygiene information, stimulus control, sleep restriction, and a bedtime imagery audio recording. The control group was similar, but without sleep restriction and used audio recordings of bedtime short stories instead of imagery. Eligibility included adult cancer survivors who had trouble falling asleep or falling back to sleep on 3 of 7 days. Patients with diagnoses of sleep or mental health disorders were excluded. The primary endpoint was change in time to fall asleep or falling back to sleep after awakening, from baseline to week 7. Two-sample T tests evaluated differences between arms for this endpoint. RESULTS Ninety-three of 168 planned participants were enrolled from 20 institutions. The study closed early for poor accrual. Baseline time to sleep was 45 min and 52 min for the intervention and control group, respectively. At 7 weeks, both groups improved, the intervention group to 26 min and control group to 30 min, a non-significant difference between groups (p = 0.85). Secondary outcomes improved in both groups with no significant differences between arms. CONCLUSIONS Improvement in sleep outcomes in both arms was consistent with other CBT-I interventions delivered through alternative approaches to provider-delivered therapy. More research on optimal scalable delivery of CBT-I is needed. CLINICAL RELEVANCE This study supports the effectiveness of CBT-I based behavioral interventions for sleep but also the need for better delivery methods to improve uptake and effect size. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT00993928.
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Affiliation(s)
- Debra L Barton
- University of Michigan School of Nursing, 400 N. Ingalls, Room 4320, Ann Arbor, MI, 48109-5482, USA.
| | - Pamela J Atherton
- Alliance Statistics and Data Center, Mayo Clinic, Rochester, MN, USA
| | - Daniel V Satele
- Alliance Statistics and Data Center, Mayo Clinic, Rochester, MN, USA
| | - Rui Qin
- Janssen Pharmaceuticals, Raritan, NJ, Belgium
| | | | - Teri Pipe
- Arizona State University, Tempe, AZ, USA
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9
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Fox RS, Baik SH, McGinty H, Garcia SF, Reid KJ, Bovbjerg K, Fajardo P, Wu LM, Shahabi S, Ong JC, Zee PC, Penedo FJ. Feasibility and Preliminary Efficacy of a Bright Light Intervention in Ovarian and Endometrial Cancer Survivors. Int J Behav Med 2020; 28:83-95. [PMID: 32080797 DOI: 10.1007/s12529-020-09861-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Cancer-related sleep disturbance is common and can adversely affect physical and mental health. Bright light (BL) therapy is a novel intervention that targets sleep by promoting circadian regulation. Emerging evidence suggests BL can improve sleep disturbance, symptom burden, and health-related quality of life in cancer and other populations; however, this research is limited. The present two-phase pilot study assessed the feasibility and preliminary intended effects of BL therapy on sleep in ovarian and endometrial cancer survivors, and explored biologic and chronobiologic factors that may underlie intervention effects. METHODS In phase I, focus groups were conducted with 12 survivors and 9 gynecologic oncology clinicians to evaluate and gather feedback about the proposed study. In phase II, a pilot randomized controlled trial was conducted with 18 ovarian or endometrial cancer survivors who were randomized 1:1 to receive 45 min of BL or dim light (DL) for 4 weeks. Participants wore wrist actigraphs; completed sleep diaries and self-report questionnaires; and provided blood, saliva, and urine samples at baseline (T1), post-intervention (T2), and 3-month follow-up (T3). RESULTS Study procedures were modified according to focus group results. Enrollment, retention, and adherence were all ≥ 80%. Mixed-model ANOVAs demonstrated that the number of nighttime awakenings per actigraphy, and sleep quality and depression per self-report, trended toward improvements in the BL condition compared to the DL condition. These variables improved from T1 to T2 before returning to baseline at T3. Effect sizes were generally medium to large. CONCLUSIONS Study findings suggest that BL therapy is feasible among ovarian and endometrial cancer survivors. It may be an effective, non-pharmacological approach to reduce sleep disturbance and symptom burden in this population.
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Affiliation(s)
- Rina S Fox
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Sharon H Baik
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Heather McGinty
- Department of Psychiatry and Behavioral Health, Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Sofia F Garcia
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Kathryn J Reid
- Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Katrin Bovbjerg
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Precilla Fajardo
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Lisa M Wu
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,Aarhus Institute of Advanced Studies, Aarhus University, Aarhus, Denmark
| | - Shohreh Shahabi
- Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Jason C Ong
- Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Phyllis C Zee
- Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Frank J Penedo
- Department of Psychology, University of Miami, 5665 Ponce de Leon Boulevard, Flipse Building, 5th Floor, Coral Gables, FL, 33146, USA.
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van der Sluiszen NN, Vermeeren A, Verster JC, van de Loo AJ, van Dijken JH, Veldstra JL, Brookhuis KA, de Waard D, Ramaekers JG. Driving performance and neurocognitive skills of long-term users of benzodiazepine anxiolytics and hypnotics. Hum Psychopharmacol 2019; 34:e2715. [PMID: 31837049 PMCID: PMC7003498 DOI: 10.1002/hup.2715] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2019] [Revised: 09/03/2019] [Accepted: 10/17/2019] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The aim of this study is to compare actual driving performance and skills related to driving of patients using benzodiazepine anxiolytics or hypnotics for at least 6 months to that of healthy controls. METHODS Participants were 44 long-term users of benzodiazepine and benzodiazepine-related anxiolytics (n = 12) and hypnotics (n = 32) and 65 matched healthy controls. Performance was assessed using an on-the-road driving test measuring standard deviation of lateral position (SDLP, in cm) and a battery of neurocognitive tasks. Performance differences between groups were compared with a blood alcohol concentration of 0.5 mg/ml to determine clinical relevance. RESULTS Compared with controls, SDLP was significantly increased in hypnotic users (+1.70 cm) but not in anxiolytic users (+1.48 cm). Anxiolytic and hypnotic users showed significant and clinically relevant impairment on neurocognitive task measuring executive functioning, vigilance, and reaction time. For patients using hypnotics for at least 3 years, no significant driving impairment was observed. CONCLUSION Impairing effects of benzodiazepine hypnotics on driving performance may mitigate over time following longer term use (i.e. 3 years or more) although neurocognitive impairments may remain.
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Affiliation(s)
- Nick N.J.J.M. van der Sluiszen
- Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and NeuroscienceMaastricht UniversityMaastrichtThe Netherlands
| | - Annemiek Vermeeren
- Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and NeuroscienceMaastricht UniversityMaastrichtThe Netherlands
| | - Joris C. Verster
- Division PharmacologyUtrecht UniversityUtrechtThe Netherlands,Institute for Risk Assessment SciencesUtrecht UniversityUtrechtThe Netherlands,Centre for Human PsychopharmacologySwinburne UniversityMelbourneVictoriaAustralia
| | - Aurora J.A.E. van de Loo
- Division PharmacologyUtrecht UniversityUtrechtThe Netherlands,Institute for Risk Assessment SciencesUtrecht UniversityUtrechtThe Netherlands
| | - Joke H. van Dijken
- Department of Clinical and Developmental NeuropsychologyUniversity of GroningenGroningenThe Netherlands
| | - Janet L. Veldstra
- Department of Clinical and Developmental NeuropsychologyUniversity of GroningenGroningenThe Netherlands
| | - Karel A. Brookhuis
- Department of Clinical and Developmental NeuropsychologyUniversity of GroningenGroningenThe Netherlands
| | - Dick de Waard
- Department of Clinical and Developmental NeuropsychologyUniversity of GroningenGroningenThe Netherlands
| | - Johannes G. Ramaekers
- Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and NeuroscienceMaastricht UniversityMaastrichtThe Netherlands
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11
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Warth J, Puth MT, Tillmann J, Porz J, Zier U, Weckbecker K, Münster E. Over-indebtedness and its association with sleep and sleep medication use. BMC Public Health 2019; 19:957. [PMID: 31315596 PMCID: PMC6637586 DOI: 10.1186/s12889-019-7231-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Accepted: 06/24/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Over-indebtedness is currently rising in high-income countries. Millions of citizens are confronted with the persistent situation when household income and assets are insufficient to cover payment obligations and living expenses. Previous research shows that over-indebtedness increases the risk of various adverse health effects. However, its association with sleep problems has not yet been examined. The objective of this study was to investigate the association between over-indebtedness and sleep problems and sleep medication use. METHODS A cross-sectional study on over-indebtedness (OID survey) was conducted in 70 debt advisory centres in Germany in 2017 that included 699 over-indebted respondents. The survey data were combined with the nationally representative German Health Interview and Examination Survey for Adults (DEGS1; n = 7987). We limited analyses to participants with complete data on all sleep variables (OID: n = 538, DEGS1: n = 7447). Descriptive analyses and logistic regression analyses were used to examine the association between over-indebtedness and difficulty initiating and maintaining sleep, and sleep medication use. RESULTS A higher prevalence of sleep problems and sleep medication use was observed among over-indebted individuals compared to the general population. After adjustment for socio-economic and health factors (age, sex, education, marital status, employment status, subjective health status and mental illness), over-indebtedness significantly increased the risk of difficulties with sleep onset (adjusted odds ratio (aOR) 1.79, 95%-confidence interval (CI) 1.45-2.21), sleep maintenance (aOR 1.45, 95%-CI 1.17-1.80) and sleep medication use (aOR 3.94, 95%-CI 2.96-5.24). CONCLUSIONS Evidence suggests a strong association between over-indebtedness and poor sleep and sleep medication use independent of conventional socioeconomic measures. Considering over-indebtedness in both research and health care practice will help to advance the understanding of sleep disparities, and facilitate interventions for those at risk. TRIAL REGISTRATION German Clinical Trials Register: DRKS00013100 (OID survey, ArSemü); Date of registration: 23.10.2017; Date of enrolment of the first participant: 18.07.2017, retrospectively registered.
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Affiliation(s)
- Jacqueline Warth
- Institute of General Practice and Family Medicine, University of Bonn, Universitätsklinikum Bonn AöR, Sigmund-Freud-Str. 25, 53127, Bonn, Germany.
| | - Marie-Therese Puth
- Institute of General Practice and Family Medicine, University of Bonn, Universitätsklinikum Bonn AöR, Sigmund-Freud-Str. 25, 53127, Bonn, Germany.,Institute for Medical Biometry, Informatics and Epidemiology (IMBIE), University of Bonn, Universitätsklinikum Bonn AöR, Sigmund-Freud-Str. 25, 53127, Bonn, Germany
| | - Judith Tillmann
- Institute of General Practice and Family Medicine, University of Bonn, Universitätsklinikum Bonn AöR, Sigmund-Freud-Str. 25, 53127, Bonn, Germany
| | - Johannes Porz
- Institute of General Practice and Family Medicine, University of Bonn, Universitätsklinikum Bonn AöR, Sigmund-Freud-Str. 25, 53127, Bonn, Germany
| | - Ulrike Zier
- Institute of General Practice and Family Medicine, University of Bonn, Universitätsklinikum Bonn AöR, Sigmund-Freud-Str. 25, 53127, Bonn, Germany
| | - Klaus Weckbecker
- Institute of General Practice and Family Medicine, University of Bonn, Universitätsklinikum Bonn AöR, Sigmund-Freud-Str. 25, 53127, Bonn, Germany
| | - Eva Münster
- Institute of General Practice and Family Medicine, University of Bonn, Universitätsklinikum Bonn AöR, Sigmund-Freud-Str. 25, 53127, Bonn, Germany
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12
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Burke SL, Hu T, Spadola CE, Li T, Naseh M, Burgess A, Cadet T. Mild cognitive impairment: associations with sleep disturbance, apolipoprotein e4, and sleep medications. Sleep Med 2018; 52:168-176. [PMID: 30359892 PMCID: PMC6800075 DOI: 10.1016/j.sleep.2018.09.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 08/22/2018] [Accepted: 09/04/2018] [Indexed: 01/03/2023]
Abstract
OBJECTIVE Mild cognitive impairment (MCI) is associated with increased memory problems although the ability to complete daily life activities remains relatively intact. This study examined: (1) if sleep disturbance increased the hazard of MCI; (2) if APOE e4 carriers with sleep disturbance experience an increased risk of MCI; and, (3) if prescription sleep medications provide a protective effect against MCI. We hypothesized that sleep disturbance increases the hazard of MCI, this relationship is stronger among APOE e4 carriers reporting a sleep disturbance. Furthermore, we hypothesized that sleep medications decrease the hazard of MCI. METHODS To determine whether sleep medication mediates the risk of developing MCI for individuals with sleep disturbance and/or APOE e4, we analyzed the National Alzheimer's Coordinating Center Uniform Data Set. We selected participants with normal cognition at baseline (n = 6798), and conduced survival analyses. RESULTS Our main findings indicated that the hazard of MCI was significantly associated with sleep disturbance. The hazard remained among those who did not use sleep medication. Trazodone and zolpidem users did not have a significant hazard of MCI, but the significant hazard remained for those who did not use these medications. APOE e4 carriers had a significantly higher hazard of MCI. Among e4 carriers who used trazodone or zolpidem, there was not a statistically significant risk of MCI. CONCLUSION This study demonstrated the potential utilization of trazodone and zolpidem in the treatment of sleep disturbance while potentially mitigating the risk of MCI. While trazodone and zolpidem have been shown to positively impact sleep disturbance in individuals with normal cognition, further research should explore these findings given that these medications are potentially inappropriate for older adults.
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Affiliation(s)
- Shanna L Burke
- Florida International University, Robert Stempel College of Public Health and Social Work, School of Social Work, 11200 S.W. 8th Street, AHC5 585, Miami, FL, 33199, USA.
| | - Tianyan Hu
- Florida International University, Robert Stempel College of Public Health and Social Work, Department of Health Policy and Management, 11200 S.W. 8th Street, AHC5 452, Miami, FL, 33199, USA.
| | - Christine E Spadola
- Florida Atlantic University, Phyllis and Harvey Sandler School of Social Work, 777 Glades Road SO303 Boca Raton, FL, 33431-0991, USA.
| | - Tan Li
- Florida International University, Robert Stempel College of Public Health and Social Work, Department of Biostatistics, 11200 S.W. 8th Street, AHC5464 Miami, FL, 33199, USA.
| | - Mitra Naseh
- Florida International University, Robert Stempel College of Public Health & Social Work, School of Social Work, Miami, FL, 33199, USA.
| | - Aaron Burgess
- Florida International University, Robert Stempel College of Public Health & Social Work, School of Social Work, 11200 S.W. 8th Street, Miami, FL, 33199, USA.
| | - Tamara Cadet
- Simmons University, School of Social Work, Harvard School of Dental Medicine, Oral Health Policy and Epidemiology, Boston, MA 02115 USA.
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Poor Sleep Quality Is Associated with Higher Hemoglobin A1c in Pregnant Women: A Pilot Observational Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15102287. [PMID: 30340366 PMCID: PMC6210387 DOI: 10.3390/ijerph15102287] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 10/12/2018] [Accepted: 10/14/2018] [Indexed: 02/07/2023]
Abstract
We hypothesized that poor sleep quality exacerbates glucose intolerance manifested as elevated glycosylated hemoglobin (HbA1c), which increases the risk for gestational diabetes. To test this, 38 pregnant and 22 non-pregnant (age, 18–35 years; body-mass index, 20–35 kg/m2) otherwise healthy women were enrolled in the study. Sleep quality was assessed during gestational week 24 (pregnant), or outside of the menstrual period (non-pregnant), using qualitative (Pittsburgh Sleep Quality Index) and objective (actigraphic wrist-watch) measures. Blood glucose, total cortisol, and depression status were evaluated. Eight pregnant and one non-pregnant women were lost to follow-up, or withdrew from the study. There was a higher incidence of poor sleep quality in pregnant (73%) relative to non-pregnant women (43%). Although actigraphic data revealed no differences in actual sleep hours between pregnant and non-pregnant women, the number of wake episodes and sleep fragmentation were higher in pregnant women. Poor sleep quality was positively correlated with higher HbA1c in both pregnant (r = 0.46, n = 26, p = 0.0151) and non-pregnant women (r = 0.50, n = 19, p = 0.0217), reflecting higher average blood glucose concentrations. In contrast, poor sleep was negatively correlated with cortisol responses in pregnant women (r = −0.46, n = 25, p = 0.0167). Three pregnant women had elevated one-hour oral glucose tolerance test results (>153 mg/dL glucose). These same pregnant women exhibited poor sleep quality. These results support the suggestion that poor sleep quality is an important risk factor that is associated with glucose intolerance and attendant health complications in pregnancy.
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Kawada K, Ohta T, Tanaka K, Miyamura M, Tanaka S. Addition of Suvorexant to Ramelteon Therapy for Improved Sleep Quality with Reduced Delirium Risk in Acute Stroke Patients. J Stroke Cerebrovasc Dis 2018; 28:142-148. [PMID: 30322756 DOI: 10.1016/j.jstrokecerebrovasdis.2018.09.024] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 08/28/2018] [Accepted: 09/14/2018] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND AND PURPOSE Delirium in acute stroke is associated with poor clinical outcome. The purpose of this study was to examine the effect of sleep medications on sleep quality and delirium in acute stroke. METHODS In this retrospective cohort study, sleep disturbances, and delirium were investigated in acute stroke patients treated in April 2013-March 2017 who were prescribed ramelteon plus either an alpha-aminobutyric acid receptor (GABAR) agonist or a selective dual orexin receptor antagonist (suvorexant). RESULTS Of the patients included, 104 received a GABAR agonist and 128 received suvorexant in addition to ramelteon. Patient characteristics did not differ significantly between the groups, except for a higher proportion of cerebral infarction in suvorexant group (P = .033). Subjective sleep quality was significantly improved in suvorexant group compared to GABAR agonist group (difficulty staying asleep: 6.3% versus 34%, P < .001; daytime sleepiness: 33% versus 63%, P < .001). Delirium was significantly less frequent in suvorexant group than GABAR agonist group (7.0% versus 31%, P < .001). The length of hospital stay was significantly shorter in suvorexant group than in GABAR agonist group (in days, 21 [15-29] versus 25 [18-33]; P = .019). Multivariable logistic regression analysis revealed that the addition of suvorexant was significantly associated with a reduced occurrence of delirium (odds ratios .19, 95% confidence interval .085-.43, P < .001). CONCLUSIONS Addition of suvorexant to ramelteon therapy, rather than a GABA receptor agonist, can improve subjective sleep quality without inducing delirium in acute stroke patients.
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Affiliation(s)
- Kei Kawada
- Pharmaceutical Department, Kochi Health Sciences Center, Kochi, Japan
| | - Tsuyoshi Ohta
- Department of Neurosurgery, Kochi Health Sciences Center, Kochi, Japan.
| | - Koudai Tanaka
- Pharmaceutical Department, Kochi Health Sciences Center, Kochi, Japan
| | | | - Satoshi Tanaka
- Pharmaceutical Department, Kochi Health Sciences Center, Kochi, Japan
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15
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Thomas R, Ramos-Rivas E. Benzodiazepine Risks in Older People with Insomnia. Psychiatr Ann 2018. [DOI: 10.3928/00485713-20180513-01] [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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Wong KKL, Tang LCY, Zhou J, Ho V. Analysis of spatiotemporal pattern and quantification of gastrointestinal slow waves caused by anticholinergic drugs. Organogenesis 2017; 13:39-62. [PMID: 28277890 DOI: 10.1080/15476278.2017.1295904] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Anticholinergic drugs are well-known to cause adverse effects, such as constipation, but their effects on baseline contractile activity in the gut driven by slow waves is not well established. In a video-based gastrointestinal motility monitoring (GIMM) system, a mouse's small intestine was placed in Krebs solution and recorded using a high definition camera. Untreated controls were recorded for each specimen, then treated with a therapeutic concentration of the drug, and finally, treated with a supratherapeutic dose of the drug. Next, the video clips showing gastrointestinal motility were processed, giving us the segmentation motions of the intestine, which were then converted via Fast Fourier Transform (FFT) into their respective frequency spectrums. These contraction quantifications were analyzed from the video recordings under standardised conditions to evaluate the effect of drugs. Six experimental trials were included with benztropine and promethazine treatments. Only the supratherapeutic dose of benztropine was shown to significantly decrease the amplitude of contractions; at therapeutic doses of both drugs, neither frequency nor amplitude was significantly affected. We have demonstrated that intestinal slow waves can be analyzed based on the colonic frequency or amplitude at a supratherapeutic dose of the anticholinergic medications. More research is required on the effects of anticholinergic drugs on these slow waves to ascertain the true role of ICC in neurologic control of gastrointestinal motility.
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Affiliation(s)
- Kelvin K L Wong
- a School of Medicine, Western Sydney University , Campbelltown , NSW , Australia
| | - Lauren C Y Tang
- a School of Medicine, Western Sydney University , Campbelltown , NSW , Australia
| | - Jerry Zhou
- a School of Medicine, Western Sydney University , Campbelltown , NSW , Australia
| | - Vincent Ho
- a School of Medicine, Western Sydney University , Campbelltown , NSW , Australia
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Narita Z, Takano H, Sumiyoshi T. Successful treatment for psychomotor agitation in neuromyelitis optica spectrum disorder with trazodone-risperidone combination: a case report. Neuropsychiatr Dis Treat 2017; 13:775-777. [PMID: 28331329 PMCID: PMC5356923 DOI: 10.2147/ndt.s132516] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Neuromyelitis optica (NMO) is a relapsing disease that typically affects the spinal cord and optic nerves. So far, a few studies have reported pharmacologic treatment for psychiatric symptoms in patients with NMO spectrum disorder (NMOSD). However, no literature has described psychomotor agitation associated with the disease and its treatment. We report an 84-year-old woman with NMOSD whose psychomotor agitation was effectively treated with a combination of trazodone and risperidone. Our observation suggests the ability of augmentation of antipsychotic drugs with antidepressants to ameliorate psychotic symptoms associated with NMOSD.
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Affiliation(s)
- Zui Narita
- Department of Psychiatry, National Center Hospital
| | | | - Tomiki Sumiyoshi
- Department of Clinical Epidemiology, Translational Medical Center, National Center of Neurology and Psychiatry, Tokyo, Japan
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18
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Veauthier C, Hasselmann H, Gold SM, Paul F. The Berlin Treatment Algorithm: recommendations for tailored innovative therapeutic strategies for multiple sclerosis-related fatigue. EPMA J 2016; 7:25. [PMID: 27904656 PMCID: PMC5121967 DOI: 10.1186/s13167-016-0073-3] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2016] [Accepted: 10/21/2016] [Indexed: 12/11/2022]
Abstract
More than 80% of multiple sclerosis (MS) patients suffer from fatigue. Despite this, there are few therapeutic options and evidence-based pharmacological treatments are lacking. The associated societal burden is substantial (MS fatigue is a major reason for part-time employment or early retirement), and at least one out of four MS patients view fatigue as the most burdensome symptom of their disease. The mechanisms underlying MS-related fatigue are poorly understood, and objective criteria for distinguishing and evaluating levels of fatigue and tiredness have not yet been developed. A further complication is that both symptoms may also be unspecific indicators of many other diseases (including depression, sleep disorders, anemia, renal failure, liver diseases, chronic obstructive pulmonary disease, drug side effects, recent MS relapses, infections, nocturia, cancer, thyroid hypofunction, lack of physical exercise). This paper reviews current treatment options of MS-related fatigue in order to establish an individualized therapeutic strategy that factors in existing comorbid disorders. To ensure that such a strategy can also be easily and widely implemented, a comprehensive approach is needed, which ideally takes into account all other possible causes and which is moreover cost efficient. Using a diagnostic interview, depressive disorders, sleep disorders and side effects of the medication should be identified and addressed. All MS patients suffering from fatigue should fill out the Modified Fatigue Impact Scale, Epworth Sleepiness Scale, the Beck Depression Inventory (or a similar depression scale), and the Pittsburgh Sleep Quality Index (or the Insomnia Severity Index). In some patients, polygraphic or polysomnographic investigations should be performed. The treatment of underlying sleep disorders, drug therapy with alfacalcidol or fampridine, exercise therapy, and cognitive behavioral therapy-based interventions may be effective against MS-related fatigue. The objectives of this article are to identify the reasons for fatigue in patients suffering from multiple sclerosis and to introduce individually tailored treatment approaches. Moreover, this paper focuses on current knowledge about MS-related fatigue in relation to brain atrophy and lesions, cognition, disease course, and other findings in an attempt to identify future research directions.
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Affiliation(s)
- Christian Veauthier
- Interdisciplinary Center for Sleep Medicine, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany ; NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Helge Hasselmann
- NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany ; Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Hindenburgdamm 30, 12203 Berlin, Germany
| | - Stefan M Gold
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Hindenburgdamm 30, 12203 Berlin, Germany ; Institute of Neuroimmunology and Multiple Sclerosis (INIMS), Center for Molecular Neurobiology (ZMNH), University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany
| | - Friedemann Paul
- NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany ; Clinical and Experimental Multiple Sclerosis Research Center, Department of Neurology, Charité - Universitätsmedizin Berlin, 10117 Berlin, Germany ; Experimental and Clinical Research Center, Max Delbrück Center for Molecular Medicine and Charité - Universitätsmedizin Berlin, Berlin, Germany
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Schroeck JL, Ford J, Conway EL, Kurtzhalts KE, Gee ME, Vollmer KA, Mergenhagen KA. Review of Safety and Efficacy of Sleep Medicines in Older Adults. Clin Ther 2016; 38:2340-2372. [DOI: 10.1016/j.clinthera.2016.09.010] [Citation(s) in RCA: 143] [Impact Index Per Article: 17.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Revised: 09/09/2016] [Accepted: 09/23/2016] [Indexed: 01/25/2023]
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Sadeghniiat-Haghighi K, Bahrami H, Aminian O, Meysami A, Khajeh-Mehrizi A. Melatonin therapy in shift workers with difficulty falling asleep: A randomized, double-blind, placebo-controlled crossover field study. Work 2016; 55:225-230. [DOI: 10.3233/wor-162376] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Khosro Sadeghniiat-Haghighi
- Occupational Sleep Research Center, Tehran University of Medical Sciences, Tehran, Iran
- Center for Research on Occupational Diseases, Tehran University of Medical Sciences, Tehran, Iran
| | - Hamid Bahrami
- Occupational Sleep Research Center, Tehran University of Medical Sciences, Tehran, Iran
- Center for Research on Occupational Diseases, Tehran University of Medical Sciences, Tehran, Iran
| | - Omid Aminian
- Occupational Sleep Research Center, Tehran University of Medical Sciences, Tehran, Iran
- Center for Research on Occupational Diseases, Tehran University of Medical Sciences, Tehran, Iran
| | - Alipasha Meysami
- Department of Community Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Ahmad Khajeh-Mehrizi
- Occupational Sleep Research Center, Tehran University of Medical Sciences, Tehran, Iran
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Kolanowski A, Mogle J, Fick DM, Campbell N, Hill N, Mulhall P, Behrens L, Colancecco E, Boustani M, Clare L. Anticholinergic Exposure During Rehabilitation: Cognitive and Physical Function Outcomes in Patients with Delirium Superimposed on Dementia. Am J Geriatr Psychiatry 2015; 23:1250-1258. [PMID: 26419732 PMCID: PMC4691545 DOI: 10.1016/j.jagp.2015.07.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Revised: 07/09/2015] [Accepted: 07/09/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVES We examined the association between anticholinergic medication exposure and subsequent cognitive and physical function in patients with delirium superimposed on dementia during rehabilitation. We also examined length of stay and discharge disposition by anticholinergic medication exposure. DESIGN In this secondary analysis we used control group data from an ongoing randomized clinical trial. SETTING/PARTICIPANTS Participants with delirium and dementia were enrolled at admission to post-acute care. These 99 participants had a mean age of 86.11 (±6.83) years; 67.6% were women; 98% were Caucasian; and 33% were positive for at least one APOE e4 allele. MEASURES We obtained daily measures of cognitive and physical function using: Digit Span; memory, orientation and attention items from the Montreal Cognitive Assessment; CLOX; the Confusion Assessment Method; and the Barthel Index. Anticholinergic medication exposure was measured weekly using the Anticholinergic Cognitive Burden Scale. RESULTS Using multilevel models for time we found that greater use of clinically relevant anticholinergic medications in the previous week reduced cognitive and physical function, as measured by Digit Span Backwards and the Barthel index, in the current week. There was no effect of anticholinergic medication use on delirium severity, and APOE status did not moderate any outcomes. Greater use of clinically relevant anticholinergic medications was related to longer length of stay but not discharge disposition. CONCLUSIONS For vulnerable older adults, anticholinergic exposure represents a potentially modifiable risk factor for poor attention, working memory, physical function, and greater length of stay during rehabilitation.
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Affiliation(s)
- Ann Kolanowski
- College of Nursing, Penn State, University Park, PA, USA.
| | | | | | - Noll Campbell
- Purdue University College of Pharmacy, West Lafayette, Indiana; Department of Pharmacy Practice
| | - Nikki Hill
- College of Nursing, Penn State, University Park, PA
| | | | - Liza Behrens
- College of Nursing, Penn State, University Park, PA
| | | | - Malaz Boustani
- Regenstrief Institute, Indianapolis, Indiana,Department of Medicine, Indiana University School of Medicine, Indianapolis, IN
| | - Linda Clare
- REACH: The Centre for Research in Ageing and Cognitive Health, College of Life and Environmental Sciences - Psychology, Washington Singer Laboratories, Exeter EX4 4QG, United Kingdom
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Vaidya V, Gabriel MH, Gangan N, Borse M. Characteristics of prescription and nonprescription sleep medication users in the United States. Popul Health Manag 2015; 17:345-50. [PMID: 25075610 DOI: 10.1089/pop.2013.0124] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Sleep deprivation and disturbances can result in lowered productivity and increased errors/accidents. Little is known about population characteristics associated with the use of sleep medications. The objective of this study was to investigate the association of sociodemographic factors with the use of sleep medications in the US population. This was a retrospective, cross-sectional study using data from the 2010 Medical Expenditure Panel Survey, which contains nationally representative data from the US population. The study population included all respondents older than 18 years of age. A multiple logistic regression model was built to analyze the odds of reporting use of prescription or nonprescription sleep medication. In 2010, an estimated 19 million survey respondents (10%) used some type of medication to fall asleep. The odds of reporting use of sleep medication were significantly lower among males (odds ratio [OR]=0.695, 95% confidence interval [CI]=0.599-0.808), and the uninsured (OR=0.613, 95% CI=0.439-0.855). The odds of sleep medication use were significantly higher among age groups 24-44 years and 44-64 years as compared with 18-24 years (OR=1.868, 95% CI=1.254-2.781 and OR=1.936, 95% CI=1.309-2.865, respectively), whites (OR=2.003, 95% CI=1.597-2.512) compared with African Americans, or non-Hispanics (OR=1.609, 95% CI=1.316-1.967), the unemployed (OR=1.773, 95% CI=1.496-2.101), and respondents with depression (OR=2.077, 95% CI=1.463-2.951) or anxiety (OR=6.855, 95% CI=4.998-9.403). Differences in sleep medication use were seen among specific subpopulations. Further research into why such differences exist is necessary. The factors identified in this study should be investigated further to identify vulnerable populations to determine the underlying causes of sleep disorders.
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Affiliation(s)
- Varun Vaidya
- 1 University of Toledo College of Pharmacy , Toledo, Ohio
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Kostyun RO, Hafeez I. Protracted recovery from a concussion: a focus on gender and treatment interventions in an adolescent population. Sports Health 2015; 7:52-7. [PMID: 25553213 PMCID: PMC4272696 DOI: 10.1177/1941738114555075] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background: Several studies have demonstrated that age and sex may influence concussion recovery time frames, with female athletes and adolescents being potentially more susceptible to a protracted recovery course. Currently, limited work has examined the influence sex may have on concussion management strategies and treatment interventions, especially for younger individuals suffering persistent concussion symptoms and cognitive dysfunctions. Hypothesis: Female athletes are prescribed more treatment interventions than male athletes during a protracted recovery from a concussion. Study Design: Descriptive epidemiology study. Level of Evidence: Level 4. Methods: Data were retrospectively collected for adolescent athletes presenting to a sports medicine concussion clinic between September 2010 and September 2011. Results: A total of 266 adolescent athletes were evaluated and treated for concussion. Female athletes had a longer recovery course (P = 0.002) and required more treatment interventions (P < 0.001) for their symptoms and dysfunction. Female athletes were more likely to require academic accommodations (P < 0.001), vestibular therapy (P < 0.001), or medication (P < 0.001). Conclusion: Medical providers should be aware that during the recovery course, adolescent female athletes may require a management plan that will most likely include additional treatment interventions beyond the standard cognitive and physical rest. Clinical Relevance: Treatment interventions are more commonly prescribed for adolescent female athletes than for adolescent male athletes during a protracted recovery from a concussion. This highlights the need for identifying evidence-based clinical management guidelines that focus on sex, especially when dealing with persistent concussion symptoms and cognitive dysfunctions.
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Affiliation(s)
- Regina O Kostyun
- Elite Sports Medicine, Connecticut Children's Medical Center, Farmington, Connecticut
| | - Imran Hafeez
- Elite Sports Medicine, Connecticut Children's Medical Center, Farmington, Connecticut
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Rojas-Fernandez CH, Chen Y. Use of ultra-low-dose (≤6 mg) doxepin for treatment of insomnia in older people. Can Pharm J (Ott) 2014; 147:281-9. [PMID: 25364337 DOI: 10.1177/1715163514543856] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Insomnia is one of the most frequent complaints encountered in primary care practice, one that results in significant clinical consequences and cost burden to the public health system. It is more common in elderly adults (≥65 years of age), with frequent complaints regarding sleep maintenance and early morning wakening. Current treatment options have limitations. This review was conducted to evaluate the evidence behind ultra-low-dose doxepin in insomnia and to discuss its potential advantages, its place in therapy and its implications in practice in the treatment of older patients. METHODS A systematic literature search was conducted of MEDLINE via Ovid, PubMed and EMBASE using the MeSH and key terms "doxepin," "sleep initiation and maintenance disorders," "insomnia," and "low dose." Only randomized controlled trials comparing 3 mg and/or 6 mg of doxepin to placebo and involving participants diagnosed with primary insomnia were included. Primary outcomes for this review were objective sleep study parameters. RESULTS Five studies were identified, 3 of which (n = 571) were conducted in older adults. Doxepin 3 mg and 6 mg significantly reduced waking after sleep onset and increased total sleep time. There was no significant difference between the 2 doses of doxepin. Latency to persistent sleep did not differ significantly compared with placebo for any doses of doxepin. The most frequent adverse events reported were somnolence and headache. Adverse events did not appear to be dose-related, and studies reported the incidence of adverse effects to be comparable to placebo. CONCLUSION Doxepin 3 mg and 6 mg significantly improved and sustained sleep maintenance and sleep duration into the last third of the night but did not significantly affect sleep onset. Sleep benefits were achieved without next-day residual or discontinuation effects. Doxepin appears to be well suited for managing insomnia in older people.
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Affiliation(s)
| | - Yannan Chen
- Schlegel-UW Research Institute for Aging (Rojas-Fernandez), University of Waterloo, Waterloo
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Abstract
PURPOSE OF REVIEW Multiple lines of evidence support the conceptualization of bipolar disorder as a disorder of circadian rhythms. Considering bipolar disorder in the framework of circadian disturbances also helps understand the clinical phenomenology pointing toward a multisystemic involvement. RECENT FINDINGS Patients with bipolar disorder show altered rhythmicity in body temperature and melatonin rhythms, high day-to-day variability in activity and sleep timing, persistent disturbances of sleep or wake cycles, including disturbances of sleep continuity. The internal clocks are, indeed, responsible for regulating a variety of physiologic functions, including appetitive behaviors, cognitive functions and metabolism. SUMMARY An underlying circadian pathology in bipolar disorder is a unifying explicatory model for the high psychiatric and medical comorbidity observed during the long-term course of the disorder. This model also provides a rationale for therapeutic interventions aimed at re-entraining the internal clock.
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Vandrey R, Babson KA, Herrmann ES, Bonn-Miller MO. Interactions between disordered sleep, post-traumatic stress disorder, and substance use disorders. Int Rev Psychiatry 2014; 26:237-47. [PMID: 24892898 PMCID: PMC4052373 DOI: 10.3109/09540261.2014.901300] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Disordered sleep is associated with a number of adverse health consequences and is an integral component of many psychiatric disorders. Rates of substance use disorders (SUDs) are markedly higher among individuals with post-traumatic stress disorder (PTSD), and this relationship may be partly mediated by disturbed sleep. Sleep disturbances (e.g. insomnia, daytime sleepiness, vivid nightmares) are hallmark features of PTSD and there is evidence that individuals with PTSD engage in substance use as a means of coping with these symptoms. However, prolonged substance use can lead to more severe sleep disturbances due to the development of tolerance and withdrawal. Behavioural or pharmacological treatment of disordered sleep is associated with improved daytime symptoms and psychosocial functioning among individuals who have developed PTSD. Initial research also suggests that improving sleep could be similarly beneficial in reducing coping oriented substance use and preventing relapse among those seeking treatment for SUDs. Together, these findings suggest that ameliorating sleep disturbance among at-risk individuals would be a viable target for the prevention and treatment of PTSD and associated SUDs, but prospective research is needed to examine this hypothesis. Enhanced understanding of the interrelation between sleep, PTSD, and SUDs may yield novel prevention and intervention approaches for these costly, prevalent and frequently co-occurring disorders.
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Affiliation(s)
- Ryan Vandrey
- Johns Hopkins University School of Medicine, University of Pennsylvania
| | - Kimberly A. Babson
- Center for Innovation to Implementation, VA Palo Alto Health Care System, University of Pennsylvania
- Department of Psychiatry and Behavioral Sciences, Stanford School of Medicine, University of Pennsylvania
| | - Evan S. Herrmann
- Johns Hopkins University School of Medicine, University of Pennsylvania
| | - Marcel O. Bonn-Miller
- Center for Innovation to Implementation, VA Palo Alto Health Care System, University of Pennsylvania
- Center of Excellence in Substance Abuse Treatment and Education, Philadelphia VAMC; Department of Psychiatry, University of Pennsylvania
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Pergolizzi JV, Taylor R, Raffa RB, Nalamachu S, Chopra M. Fast-Acting Sublingual Zolpidem for Middle-of-the-Night Wakefulness. SLEEP DISORDERS 2014; 2014:527109. [PMID: 24649369 PMCID: PMC3932650 DOI: 10.1155/2014/527109] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/18/2013] [Revised: 11/02/2013] [Accepted: 11/02/2013] [Indexed: 01/20/2023]
Abstract
Sleep disorders (somnipathies) are conditions characterized by disruptions of sleep quality or of sleep pattern. They can involve difficulty falling asleep (prolonged sleep onset latency), difficulty staying asleep (disturbance of sleep maintenance), sleep of poor quality (unrefreshing), or combinations of these and can lead to poor health and quality of life problems. A subtype of sleep-maintenance insomnia is middle-of-the-night wakefulness, a relatively common occurrence. Zolpidem, a nonbenzodiazepine benzodiazepine receptor agonist, allosterically modulates an ion channel and increases the influx of Cl(-), thereby dampening the effect of excitatory (sleep disrupting) input. Recently, product label changes to some zolpidem containing products have been implemented by the FDA in order to reduce the risk associated with their morning after residual side effects. A new formulation of zolpidem tartrate (Intermezzo) sublingual tablet, an approved product indicated exclusively for the treatment of middle-of-the-night wakefulness and difficulty returning to sleep, did not have its label changed. We present a short summary of its basic science and clinical attributes in light of the recent regulatory changes for zolpidem products.
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Affiliation(s)
- Joseph V. Pergolizzi
- Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD 21205, USA
- Department of Anesthesiology, Georgetown University School of Medicine, Washington, DC 20057, USA
- Department of Pharmacology, School of Medicine in Philadelphia, Temple University, PA 19140, USA
| | | | - Robert B. Raffa
- School of Pharmacy, Temple University, Philadelphia, PA 19140, USA
| | - Srinivas Nalamachu
- Kansas University Medical Center, Kansas City, KS 66160, USA
- International Clinical Research, Leawood, KS 66211, USA
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Leufkens TRM, Ramaekers JG, de Weerd AW, Riedel WJ, Vermeeren A. On-the-road driving performance and driving-related skills in older untreated insomnia patients and chronic users of hypnotics. Psychopharmacology (Berl) 2014; 231:2851-65. [PMID: 24488406 PMCID: PMC4072063 DOI: 10.1007/s00213-014-3455-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2013] [Accepted: 01/13/2014] [Indexed: 12/04/2022]
Abstract
RATIONALE Many older adults report sleep problems and use of hypnotics. Several studies have shown that hypnotics can have acute adverse effects on driving the next morning. It is unclear however whether driving of chronic hypnotic users is impaired. Therapeutic effects on insomnia and development of tolerance may reduce the residual effects on driving. OBJECTIVES The present study aimed to compare actual driving performance and driving-related skills of chronic hypnotic users to good sleepers. To determine whether insomnia itself affects driving performance, driving and driving-related skills were compared between insomnia patients who do not or infrequently use hypnotics and good sleepers. METHODS Twenty-two frequent users of hypnotics (using hypnotics ≥ 4 nights per week for more than 3 months), 20 infrequent users (using hypnotics ≤ 3 nights per week), and 21 healthy, age-matched controls participated in this study. On the night before testing, all subjects were hospitalized for an 8-h sleep recorded by polysomnography. Frequent hypnotic users used their regular medication at bedtime (2330 hours), while infrequent users and controls received no medication. Cognitive performance (word learning, digit span, tracking, divided attention, vigilance, and inhibitory control) was assessed 8.5 h and driving performance between 10 and 11 h after bedtime and dosing. RESULTS Polysomnographic recordings did not significantly differ between the groups, but the insomnia patients, treated or untreated, still reported subjective sleep complaints. Results show no differences in driving performance and driving-related skills between both groups of insomnia patients and controls. CONCLUSIONS Driving performance in chronic users of hypnotics and untreated insomnia patients is not impaired. For chronic users, this may be due to prescription of relatively safe drugs and low doses. For untreated insomniacs, this corroborates previous findings showing an absence of neuropsychological deficits in this group of patients.
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Affiliation(s)
- T. R. M. Leufkens
- Philips Group Innovation–Research, Division Information and Cognition, Department of Brain, Body and Behavior, High Tech Campus 34, 5656 AE Eindhoven, The Netherlands
| | - J. G. Ramaekers
- Experimental Psychopharmacology Unit, Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - A. W. de Weerd
- Department of Clinical Neurophysiology and Sleep Centre SEIN, Zwolle, The Netherlands
| | - W. J. Riedel
- Experimental Psychopharmacology Unit, Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - A. Vermeeren
- Experimental Psychopharmacology Unit, Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands
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Roussin A, Bouyssi A, Pouché L, Pourcel L, Lapeyre-Mestre M. Misuse and dependence on non-prescription codeine analgesics or sedative H1 antihistamines by adults: a cross-sectional investigation in France. PLoS One 2013; 8:e76499. [PMID: 24098516 PMCID: PMC3789666 DOI: 10.1371/journal.pone.0076499] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2013] [Accepted: 08/28/2013] [Indexed: 11/22/2022] Open
Abstract
Background Given the growing worldwide market of non-prescription drugs, monitoring their misuse in the context of self-medication represents a particular challenge in Public Health. The aim of this study was to investigate the prevalence of misuse, abuse, and dependence on non-prescription psychoactive drugs. Method During one month, in randomly solicited community pharmacies, an anonymous questionnaire was offered to adults requesting paracetamol (control group), codeine combined with paracetamol in analgesics, or sedative H1 antihistamines. Responses about misuse (drug use not in agreement with the Patient Information Leaflet) abuse (excessive drug use having detrimental consequences), and dependence (established according to questions adapted from the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition criteria) on psychoactive drugs were compared to those of the paracetamol control group. Results 295 patients (mean age 48.5 years, 68.5% of women) having used one of the studied drugs during the previous month were included. Misuse and dependence to codeine analgesics concerned 6.8% and 17.8% of the patients exposed to these drugs, respectively, (n = 118), which was significantly higher than for paracetamol. 19.5% had used codeine analgesics daily for more than six months. Headache was the most frequent reason for persistent daily use. A high prevalence of persistent daily users of sedative H1 antihistamines was also observed. Whereas these drugs are recommended only for short treatment courses of occasional insomnia, 72.2% of the participants having taken doxylamine (n = 36) were daily users, predominantly for more than six months. Conclusions Results on misuse and dependence on non-prescription codeine analgesics suggest that chronic pain, in particular chronic cephalalgia, requires better medical care. In addition, as for hypnotics on prescription, persistent use of doxylamine for self-medication is not justified until an acceptable benefit-risk ratio for chronic sleep disturbance is shown by clinical data.
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Affiliation(s)
- Anne Roussin
- Equipe de Pharmacoépidémiologie, UMR1027 INSERM- Université de Toulouse III, Toulouse, France ; Centre d'Evaluation et d'Information sur la Pharmacodépendance (Addictovigilance Centre), Service de Pharmacologie Clinique, Hôpitaux de Toulouse, Toulouse, France
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Andrea CS. Insomnio: generalidades y alternativas terapéuticas de última generación. REVISTA MÉDICA CLÍNICA LAS CONDES 2013. [DOI: 10.1016/s0716-8640(13)70179-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Abstract
Melatonin is a methoxyindole synthesized within the pineal gland. The hormone is secreted during the night and appears to play multiple roles within the human organism. The hormone contributes to the regulation of biological rhythms, may induce sleep, has strong antioxidant action and appears to contribute to the protection of the organism from carcinogenesis and neurodegenerative disorders. At a therapeutic level as well as in prevention, melatonin is used for the management of sleep disorders and jet lag, for the resynchronization of circadian rhythms in situations such as blindness and shift work, for its preventive action in the development of cancer, as additive therapy in cancer and as therapy for preventing the progression of Alzheimer's disease and other neurodegenerative disorders.
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Affiliation(s)
- Ifigenia Kostoglou-Athanassiou
- Ifigenia Kostoglou-Athanassiou, MSc, MD, PhD Department of Endocrinology, Red Cross Hospital, 7 Korinthias Street, Athens, GR115 26, Greece
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Thorpy MJ, Roth T. Toward a classification of medications for sleep and circadian rhythm disorders. Nat Sci Sleep 2013; 5:143-5. [PMID: 24363563 PMCID: PMC3862774 DOI: 10.2147/nss.s55679] [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] [Indexed: 11/23/2022] Open
Abstract
While some systems classify medications according to therapeutic class, others are based on the mechanism of action of the drugs. The two main classifications of medications used to treat patients in the United States are those of the United States Pharmacopeia and US Food and Drug Administration, and they vary in their organization of the medication categories. Here we propose a taxonomy for medications used to treat sleep and circadian rhythm disorders based on symptoms and disorders.
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Affiliation(s)
- Michael J Thorpy
- Sleep-Wake Disorders Center, Montefiore Medical Center, Albert Einstein College of Medicine of Yeshiva University, Bronx, New York, NY, USA
| | - Thomas Roth
- University of Michigan School of Medicine, Ann Arbor, Michigan, USA ; Sleep Disorders and Research Center, Henry Ford Hospital, Detroit, Michigan, USA
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Homsey M, O’Connell K. Use and success of pharmacologic and nonpharmacologic strategies for sleep problems. ACTA ACUST UNITED AC 2012; 24:612-23. [DOI: 10.1111/j.1745-7599.2012.00745.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Eichhorn T, Greten HJ, Efferth T. Self-medication with nutritional supplements and herbal over-thecounter products. NATURAL PRODUCTS AND BIOPROSPECTING 2011; 1:62-70. [PMCID: PMC4131654 DOI: 10.1007/s13659-011-0029-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/22/2011] [Accepted: 11/07/2011] [Indexed: 06/08/2023]
Abstract
In recent years, the popularity increased for nutritional supplements and herbal products. Prescription drugs, but not herbal therapies are paid by health insurances. They are sold over-the-counter (OTC) on the patients’ own expense. However, there are potential risks of self-medication, e.g. incorrect self-diagnosis, severe adverse reactions, dangerous drug interactions, risk of addiction etc. They are often used by patients at their own discretion without knowledge of and control by their physicians. Certain users are at risk of intoxication. Multiple medications taken by older patients increase the risk for adverse drug reactions, drug-drug interactions, and compliance problems for this age group (polypharmacy). Herbals should be discontinued prior to operations to avoid interactions with anesthetics or anticoagulants. Herbal preparations may also be carcinogenic or interfere with cancer treatments. Pregnant women use various OTC preparations. However, in many cases, it is unclear whether their use is safe for mother or baby. Self-medication with herbals is also largely distributed among anxious and depressive patients, and patients with other conditions and symptoms. The popularity of herbal products has also brought concerns on quality, efficacy and safety. Cases of botanical misidentification, contaminations with heavy metals, pesticides, radioactivity, organic solvents, microbials as well as adulteration with chemical drugs necessitate the establishment of international quality control standards. Hepatotoxic effects have been reported for more than 300 plant species, and some commonly used herbs have been demonstrated to interact with Western medication. Health care professionals have a critical responsibility assessing the self-care ability of their patients. Databases are available for pharmacists with information on action, side effects and toxicities as well as herb-drug interactions. There is a need for established guidelines regarding the correct use of nutritional supplements and herbal OTC preparations (phytovigilance). Physicians, pharmacists, and other health care professionals have to counsel patients and the general public on the benefits and risks associated with herbal drugs. Information centers for consumers and general practitioners are needed, and convincing evidence on safety and efficacy of herbal products has to be demonstrated in placebo-controlled, double blind and randomized clinical trials.
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Affiliation(s)
- Tolga Eichhorn
- Department of Pharmaceutical Biology, Institute of Pharmacy and Biochemistry, Johannes Gutenberg University, Staudinger Weg 5, 55128 Mainz, Germany
| | - Henry Johannes Greten
- Heidelberg School of Chinese Medicine, Karlsruher Straße 12, 69126 Heidelberg, Germany
- Biomedical Sciences Institute Abel Salazar, University of Porto, Porto, Portugal
| | - Thomas Efferth
- Department of Pharmaceutical Biology, Institute of Pharmacy and Biochemistry, Johannes Gutenberg University, Staudinger Weg 5, 55128 Mainz, Germany
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Postconcussion Syndrome: A Physiatrist's Approach. PM R 2011; 3:S396-405. [DOI: 10.1016/j.pmrj.2011.07.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2011] [Accepted: 07/29/2011] [Indexed: 01/11/2023]
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Barton DL, Atherton PJ, Bauer BA, Moore DF, Mattar BI, Lavasseur BI, Rowland KM, Zon RT, Lelindqwister NA, Nagargoje GG, Morgenthaler TI, Sloan JA, Loprinzi CL. The use of Valeriana officinalis (Valerian) in improving sleep in patients who are undergoing treatment for cancer: a phase III randomized, placebo-controlled, double-blind study (NCCTG Trial, N01C5). ACTA ACUST UNITED AC 2011; 9:24-31. [PMID: 21399726 DOI: 10.1016/j.suponc.2010.12.008] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Sleep disorders are a substantial problem for cancer survivors, with prevalence estimates ranging from 23% to 61%. Although numerous prescription hypnotics are available, few are approved for long-term use or have demonstrated benefit in this circumstance. Hypnotics may have unwanted side effects and are costly, and cancer survivors often wish to avoid prescription drugs. New options with limited side effects are needed. The purpose of this trial was to evaluate the efficacy of a Valerian officinalis supplement for sleep in people with cancer who were undergoing cancer treatment. Participants were randomized to receive 450 mg of valerian-or placebo orally 1 hour before bedtime for 8 weeks. The primary end point was area under the curve (AUC) of the overall Pittsburgh Sleep Quality Index (PSQI). Secondary outcomes included the Functional Outcomes of Sleep Questionnaire, the Brief Fatigue Inventory (BFI), and the Profile of Mood States (POMS). Toxicity was evaluated with both self-reported numeric analogue scale questions and the Common Terminology Criteria for Adverse Events (CTCAE), version 3.0. Questionnaires were completed at baseline and at 4 and 8 weeks. A total of 227 patients were randomized into this study between March 19, 2004, and March 9, 2007, with 119 being evaluable for the primary end point. The AUC over the 8 weeks for valerian was 51.4 (SD = 16), while that for placebo was 49.7 (SD = 15), with a P value of 0.6957. A supplemental, exploratory analysis revealed that several fatigue end points, as measured by the BFI and POMS, were significantly better for those taking valerian over placebo. Participants also reported less trouble with sleep and less drowsiness on valerian than placebo. There were no significant differences in toxicities as measured by self-report or the CTCAE except for mild alkaline phosphatase increases, which were slightly more common in the placebo group. This study failed to provide data to support the hypothesis that valerian, 450 mg, at bedtime could improve sleep as measured by the PSQI. However, exploratory analyses revealed improvement in some secondary outcomes, such as fatigue. Further research with valerian exploring physiologic effects in oncology symptom management may be warranted.
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Chhangani B, Greydanus DE, Patel DR, Feucht C. Pharmacology of sleep disorders in children and adolescents. Pediatr Clin North Am 2011; 58:273-91, xiii. [PMID: 21281861 DOI: 10.1016/j.pcl.2010.11.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
There is a high prevalence of sleep disorders in children and an apparent increasing need for pharmacologic management. However, because of the paucity of data available with regards to dosing, efficacy, tolerability, and safety profiles of medications as well as a lack of adequate well-designed clinical trials, medications are currently not approved for the pediatric population by the US Food and Drug Administration. There are no pharmacologic guidelines for the specific sleep disorders or the different pediatric age ranges. Additional research is needed for evidence-based pediatric sleep pharmacotherapy. This article reviews pediatric sleep disorders and the pharmacologic therapeutic options.
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Affiliation(s)
- Bantu Chhangani
- Sleep Medicine, Saint Mary's Neuroscience Program, Saint Mary's Neuroscience Institute, Kalamazoo, MI 49503, USA.
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Abstract
The aim of this research was to determine the quality of sleep, reasons for sleep disturbances, and nonpharmacological strategies versus sleep disturbances of cancer patients' family caregivers. A descriptive, cross-sectional study design was used. Ninety family caregivers were included. Data were collected using the Pittsburgh Sleep Quality Index (PSQI), demographic data form, and open-ended questions about reasons for sleep disturbances and nonpharmacological strategies used by family caregivers. Descriptive statistics, Kruskal-Wallis variance analysis, and Bonferoni-corrected Mann-Whitney U test were performed using SPSS program. The PSQI score of 72.22% of the caregivers was above 5, which indicated poor sleep quality. The most commonly determined reasons for sleep disturbances were "emotional distress because of the patient's illness" (83.33%), "financial problems" (36.66%), and "inadequate support system" (34.44%); 76.92% of caregivers used at least 1 nonpharmacological strategy, which included mostly "lifestyle practices" (54.28%) and "behavioral practices" (25.71%). The total PSQI scores of caregivers having an illness were significantly higher than those of caregivers having no illness (Z = 3.230; P = .001). Total PSQI scores did not differ by sex, age, education, marital status, or duration of caregiving (P > .05). This study implies that caregivers are in need of support by healthcare professionals to provide a positive environment during the care process.
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Garaulet M, Madrid JA. Chronobiological aspects of nutrition, metabolic syndrome and obesity. Adv Drug Deliv Rev 2010; 62:967-78. [PMID: 20580916 DOI: 10.1016/j.addr.2010.05.005] [Citation(s) in RCA: 108] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2009] [Revised: 05/05/2010] [Accepted: 05/19/2010] [Indexed: 10/19/2022]
Abstract
The present review starts from the classical physiological and nutritional studies related with food intake control, digestion, transport and absorption of nutrients. It continues with studies related with the metabolism of adipose tissue, and finish with modern experiments in genetics and molecular biology - all from a fresh, chronobiological point of view. Obesity will be explained as a fault in the circadian system, as pathology associated with "chronodisruption". The main gaps in chronobiological research related to obesity will be also identified and chronobiological-based therapies will be proposed in order to allow the resetting of the circadian rhythm among obese subjects.
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Molina-Martínez FJ, Jiménez-Martínez MC, Vives-Pastor B. Some questions provoked by a chronic headache (with mixed migraine and cluster headache features) in a woman with a pineal cyst. Answers from a literature review. Cephalalgia 2010; 30:1031-40. [DOI: 10.1177/0333102409359467] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
The main known function of the pineal gland in humans is the production of melatonin. Benign cysts of the gland have been related to headache, although the mechanism of production of this assumed clinical manifestation has not been clearly determined, due to the lack of large prospective studies. The question is complicated by the fact that pineal cysts are frequently found on brain magnetic resonance imaging. Much has been published about the possible role of benign pineal cysts in the pathophisiology of headaches and the potential of melatonin in headache therapy, as well as in other disorders. The aim of this article is to review the current state of the suject. We have tried to place accurately the relation between headache and pineal cysts based on the available evidence, as well as the actual role of melatonin in physiology and pharmacology, more specifically in headache therapy. We include a clinical case to illustrate the subject.
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Taylor SR, Weiss JS. Review of insomnia pharmacotherapy options for the elderly: implications for managed care. Popul Health Manag 2010; 12:317-23. [PMID: 20038257 DOI: 10.1089/pop.2008.0047] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
The prevalence of insomnia in the elderly is significant. If left untreated or inappropriately treated, insomnia may contribute to increased health care resource use. Therefore, better identification and management of insomnia is required for this patient population. The etiology and magnitude of insomnia due to changes in circadian rhythms, comorbid conditions, and pharmaceutical agents are not well documented, and the utilization of over-the-counter and non-Food and Drug Administration (FDA)-approved agents to induce sleep (including antihistamines and ethyl alcohol) have not been studied in a natural setting. Evaluating the actual type of insomnia remains much more art than science for the majority of patients and providers. Another issue to consider in this population involves the relationship between patient and physician and the traditional passive patient role. Nonpharmacologic approaches (ie, cognitive behavioral therapy) for insomnia management are effective and usually are first-line therapy. However, the challenges to implementing these approaches may limit their use, thus necessitating pharmacologic therapy. There are currently 3 FDA-approved drug classes for the treatment of insomnia: benzodiazepines, benzodiazepine receptor agonists, and melatonin receptor agonists. Although all agents in these classes are efficacious, benzodiazepines and benzodiazepine receptor agonists are associated with adverse events that must be considered when treating insomnia in the elderly. Melatonin agonists have a mechanism of action that regulates normal sleep-wake cycles and readjusts circadian rhythms, which may confer a better safety profile than traditional sedative-hypnotics that target gamma-aminobutyric acid receptors. Because the 3 currently approved drug classes for insomnia have similar efficacy, safety considerations should be of paramount importance for the elderly patient; however, additional data are needed to appropriately assess the risk-benefit ratios of each.
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Affiliation(s)
- Scott R Taylor
- Geisinger Health System, Henry Hood Center, Geisinger Center for Health Research, Danville, Pennsylvania 17822, USA.
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Abstract
Aging is associated with substantial changes in sleep patterns, which are almost always negative in nature. Typical findings in the elderly include a reduction in the deeper stages of sleep and a profound increase in the fragmentation of nighttime sleep by periods of wakefulness. The prevalence of specific sleep disorders increases with age, such as a phase advance in the normal circadian sleep cycle, restless legs syndrome, and obstructive sleep apnea, which is increasingly seen among older individuals and is significantly associated with cardio- and cerebrovascular disease as well as cognitive impairment. Elderly patients with sleep disturbances are often considered difficult to treat; yet, they are among the groups with the greatest need of treatment. Management of sleep disturbances begins with recognition and adequate assessment. Hypnotic drugs have clearly been shown to improve subjective and objective sleep measures in short-term situations, but their role in chronic insomnia still remains to be further defined by research evidence. Non-pharmacological treatments, particularly stimulus control and sleep restriction, are effective for conditioned aspects of insomnia and are associated with a stable, long-term improvement in sleep. This review delineates the common causes of disordered sleep in older individuals, and effective diagnostic approaches and treatments for these conditions.
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Affiliation(s)
- Arne Fetveit
- Department of General Practice and Community Medicine, University of Oslo, Oslo, Norway.
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Berger AM, Kuhn BR, Farr LA, Von Essen SG, Chamberlain J, Lynch JC, Agrawal S. One-year outcomes of a behavioral therapy intervention trial on sleep quality and cancer-related fatigue. J Clin Oncol 2009; 27:6033-40. [PMID: 19884558 DOI: 10.1200/jco.2008.20.8306] [Citation(s) in RCA: 94] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To determine 1-year outcomes of a four-component behavioral therapy (BT) sleep intervention (Individualized Sleep Promotion Plan [ISPP]) versus a healthy eating control (HEC) on cancer-related fatigue in women receiving breast cancer adjuvant chemotherapy treatment (CTX). PATIENTS AND METHODS A total of 219 participants from 12 oncology clinics were randomly assigned in a clinical trial. Before CTX, research nurses coached intervention participants to develop a BT plan including stimulus control, modified sleep restriction, relaxation therapy, and sleep hygiene. BT plans were revised before each CTX and 30, 60, and 90 days after the last CTX and reinforced 7 to 9 days later. HEC participants received nutritional information and equal attention. Pittsburgh Sleep Quality Index (PSQI), Daily Diary, Wrist Actigraph, and Piper Fatigue Scale measures and Repeated Linear Mixed Model analysis following the Intent to Treat paradigm were used. RESULTS Sleep quality differed over 1 years time (F [4,162] = 7.7, P < .001; by group, F [1,173] = 4.8, P = .029; and over time by group, F [4,162] = 3.3, P = .013). Pairwise comparisons revealed significant differences between groups at 90 days (P = .002) but not at 1 year (P = .052). Seven days of diary and actigraphy data did not corroborate with monthly reflections (PSQI). The night awakenings (Actigraph) pattern was significantly different by group over time (P = .046), with no differences between groups at 90 days or at 1 year. Fatigue was lower at 1 year than before CTX; no group effects were found. CONCLUSION The BT group, on average, experienced significant improvement on global sleep quality compared with the HEC group, but not on objective sleep or fatigue outcomes.
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Affiliation(s)
- Ann M Berger
- University of Nebraska Medical Center, Omaha, NE 68198-5330, USA.
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Lemon MD, Strain JD, Hegg AM, Farver DK. Indiplon in the management of insomnia. DRUG DESIGN DEVELOPMENT AND THERAPY 2009; 3:131-42. [PMID: 19920929 PMCID: PMC2769245 DOI: 10.2147/dddt.s3207] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Indiplon is a novel pyrazolopyrimidine, nonbenzodiazepine γ-aminobutyric acid (GABA) agonist studied for the treatment of insomnia. This article reviews the chemistry, pharmacology, clinical pharmacokinetics, drug interactions, clinical trials, safety, tolerability, contraindications, use in special populations, and dosing of indiplon. OVID, International Pharmaceutical Abstracts (IPA), and PubMed databases were searched (1966 to February 2009) for the keywords indiplon, NBI-34060, and insomnia. References of key articles were also reviewed to identify additional publications. Only English language articles were selected for review. Indiplon has been shown to have high affinity and selectivity for the GABAα1 receptor subunit associated with sedation. In clinical studies, indiplon has demonstrated efficacy in improving latency to sleep onset, latency to persistent sleep, total sleep time, wake time after sleep onset, number of awakenings after sleep onset, and overall sleep quality when compared to placebo. Indiplon has a favorable safety profile with limited rebound insomnia and no tolerance. Neurocrine Biosciences, Incorporated received an Approvable Letter from the United States Food and Drug Administration in December 2007 for the indiplon IR 5 mg and 10 mg capsules based on meeting three additional requirements. At the time of this writing, indiplon remains unapproved.
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Affiliation(s)
- Michael D Lemon
- Department of Pharmacy Practice, South Dakota State University College of Pharmacy, VA Black Hills Health Care System, 13 Comanche Road, Fort Meade, SD 57741, USA.
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Aton SJ, Seibt J, Dumoulin MC, Coleman T, Shiraishi M, Frank MG. The sedating antidepressant trazodone impairs sleep-dependent cortical plasticity. PLoS One 2009; 4:e6078. [PMID: 19568418 PMCID: PMC2699540 DOI: 10.1371/journal.pone.0006078] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2009] [Accepted: 06/02/2009] [Indexed: 01/06/2023] Open
Abstract
Background Recent findings indicate that certain classes of hypnotics that target GABAA receptors impair sleep-dependent brain plasticity. However, the effects of hypnotics acting at monoamine receptors (e.g., the antidepressant trazodone) on this process are unknown. We therefore assessed the effects of commonly-prescribed medications for the treatment of insomnia (trazodone and the non-benzodiazepine GABAA receptor agonists zaleplon and eszopiclone) in a canonical model of sleep-dependent, in vivo synaptic plasticity in the primary visual cortex (V1) known as ocular dominance plasticity. Methodology/Principal Findings After a 6-h baseline period of sleep/wake polysomnographic recording, cats underwent 6 h of continuous waking combined with monocular deprivation (MD) to trigger synaptic remodeling. Cats subsequently received an i.p. injection of either vehicle, trazodone (10 mg/kg), zaleplon (10 mg/kg), or eszopiclone (1–10 mg/kg), and were allowed an 8-h period of post-MD sleep before ocular dominance plasticity was assessed. We found that while zaleplon and eszopiclone had profound effects on sleeping cortical electroencephalographic (EEG) activity, only trazodone (which did not alter EEG activity) significantly impaired sleep-dependent consolidation of ocular dominance plasticity. This was associated with deficits in both the normal depression of V1 neuronal responses to deprived-eye stimulation, and potentiation of responses to non-deprived eye stimulation, which accompany ocular dominance plasticity. Conclusions/Significance Taken together, our data suggest that the monoamine receptors targeted by trazodone play an important role in sleep-dependent consolidation of synaptic plasticity. They also demonstrate that changes in sleep architecture are not necessarily reliable predictors of how hypnotics affect sleep-dependent neural functions.
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Affiliation(s)
- Sara J. Aton
- Department of Neuroscience, School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Julie Seibt
- Department of Neuroscience, School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Michelle C. Dumoulin
- Department of Neuroscience, School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Tammi Coleman
- Department of Neuroscience, School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Mia Shiraishi
- Department of Neuroscience, School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Marcos G. Frank
- Department of Neuroscience, School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
- * E-mail:
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Abstract
INTRODUCTION Insomnia is a common and underdiagnosed condition that can result in significant economic and clinical consequences. Despite numerous behavioral and pharmacotherapeutic treatment options available for insomnia, few receive adequate treatment, and sleep maintenance (staying asleep) remains a significant problem. To date, available sedative-hypnotic agents have limitations that have lead to inadequate treatment of insomnia. This review provides an overview of eszopiclone and its role in the treatment of insomnia. METHODS Electronic databases (MEDLINE, EMBASE, International Pharmaceutical Abstracts) were searched for applicable primary literature and review articles. RESULTS Mechanisms of action at the gamma-amino butyric acid (GABA) receptor sites and pharmacologic and pharmacokinetic characteristics are presented. Eszopiclone, a nonbenzodiazepine S-enantiomer of racemic zopiclone, is highlighted as the first sedative-hypnotic agent to be approved by the United States Food and Drug Administration for the treatment of sleep onset latency and sleep maintenance insomnia with no short-term restrictions. Recently, the European Medicines Agency recommended marketing authorization of eszopiclone. CONCLUSION Eszopiclone has been shown to be an efficacious and cost-effective option for the treatment of transient and chronic insomnia in adults.
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Affiliation(s)
- Anna K Morin
- Massachusetts College of Pharmacy and Health Sciences, Department of Pharmacy Practice, 19 Foster Street, Worcester, Massachusetts 01608, USA.
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Landolt HP, Wehrle R. Antagonism of serotonergic 5-HT2A/2C receptors: mutual improvement of sleep, cognition and mood? Eur J Neurosci 2009; 29:1795-809. [PMID: 19473234 DOI: 10.1111/j.1460-9568.2009.06718.x] [Citation(s) in RCA: 79] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Serotonin [5-hydroxytryptamine (5-HT)] and 5-HT receptors are involved in sleep and in waking functions such as cognition and mood. Animal and human studies support a particular role for the 5-HT(2A) receptor in sleep, which has led to renewed interest in this receptor subtype as a target for the development of novel pharmacological agents to treat insomnia. Focusing primarily on findings in healthy human volunteers, a review of the available data suggests that antagonistic interaction with 5-HT(2A) receptors (and possibly also 5-HT(2C) receptors) prolongs the duration of slow wave sleep and enhances low-frequency (< 7 Hz) activity in the sleep electroencephalogram (EEG), a widely accepted marker of sleep intensity. Despite certain differences, the changes in sleep and the sleep EEG appear to be remarkably similar to those of physiologically more intense sleep after sleep deprivation. It is currently unclear whether these changes in sleep are associated with improved vigilance, cognition and mood during wakefulness. While drug-induced interaction with sleep must be interpreted cautiously, too few studies are available to provide a clear answer to this question. Moreover, functional relationships between sleep and waking functions may differ between healthy controls and patients with sleep disorders. A multimodal approach investigating subjective and objective aspects of sleep and wakefulness provides a promising research avenue for shedding light on the complex relationships among 5-HT(2A/2C) receptor-mediated effects on sleep, the sleep EEG, cognition and mood in health and various diseases associated with disturbed sleep and waking functions.
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Affiliation(s)
- H-P Landolt
- Institute of Pharmacology and Toxicology, University of Zürich, Zürich, Switzerland.
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