Sleep Medication in Older Adults: Identifying the Need for Support by a Community Pharmacist

Systematic literature review of the impact of psychiatric pharmacists

Introduction

Pharmacists focusing on psychotropic medication management and practicing across a wide variety of healthcare settings have significantly improved patient-level outcomes. The Systematic Literature Review Committee of the American Association of Psychiatric Pharmacists was tasked with compiling a comprehensive database of primary literature highlighting the impact of psychiatric pharmacists on patient-level outcomes.

Methods

A systematic search of literature published from January 1, 1961, to December 31, 2022, was conducted using PubMed and search terms based on a prior American Association of Psychiatric Pharmacists literature review. Publications describing patient-level outcome results associated with pharmacist provision of care in psychiatric/neurologic settings and/or in relation to psychotropic medications were included. The search excluded articles for which there was no pharmacist intervention, no psychiatric disorder treatment, no clinical outcomes, no original research, no access to full text, and/or no English-language version.

Results

A total of 4270 articles were reviewed via PubMed, with 4072 articles excluded based on title, abstract, and/or full text in the initial pass and 208 articles selected for inclusion. A secondary full-text review excluded 11 additional articles, and 5 excluded articles were ultimately included based on a secondary review, for a final total of 202 articles meeting the inclusion criteria. A comprehensive database of these articles was compiled, including details on their study designs and outcomes.

Discussion

The articles included in the final database had a wide range of heterogeneity. While the overall impact of psychiatric pharmacists was positive, the study variability highlights the need for future publications to have more consistent, standardized outcomes with stronger study designs.

Subjective Symptoms Linked to Sleep Duration: An Analysis from Japanese National Statistics

BACKGROUND

There is a high prevalence of sleep disorders in Japan, and they are a factor in a decreased quality of life. The main objective of this study was to clarify the background factors of sleep disorders that affect sleep duration, such as subjective symptoms and working hours.

METHODS

We performed a cross-sectional study on the Japanese national statistics data. Answers from a household questionnaire were used to analyze risk factors for decreases in sleep duration. The subjects were a total of 3972 men and women aged 40-59 years, the age group that forms the core of the working population. For the analysis, a univariate analysis (contingency table) between sleep duration (two groups: sleep duration ≥ 6 h and <6 h) and 42 subjective symptoms was carried out. A multivariate analysis (binomial logistic regression) was conducted using sleep duration and subjective health assessment as objective variables, and odds ratios (ORs) adjusted for sex, working hours, and other factors were obtained.

RESULTS

The univariate analysis by subjective symptom showed significant ORs for eight symptoms, including poor sleep quality (OR: 2.24), constipation (OR: 2.24), and dizziness (OR: 1.77). In the multivariate analysis, the model with sleep duration as the objective variable showed significantly adjusted ORs for four variables, including constipation (1.72) and poor sleep quality (1.66). The model with subjective health assessment as the objective variable showed significantly adjusted ORs for eight variables, including dizziness (4.18), while poor sleep quality (1.45) was not significant.

CONCLUSIONS

The present results suggest the presence of subjective symptoms that may be inferred to be related to decreases in sleep duration.

How Sleep Quality Relates to Bodily and Oral Symptoms: An Analysis from Japanese National Statistics

Background: Sleep is one of the most important health-related factors. This cross-sectional study focused on sleep quality relates to systemic symptoms, including dental symptoms. Methods: Resource data were compiled from 7995 men and women aged 30 to 69 years, which is the core of the Japanese working population. The subjects were divided into four groups based on their answers to two questions, one on sleep time and one on sleep sufficiency, and groups were compared with other items in the questionnaire by means of a contingency table analysis (χ2 test). Results: Relationships were found between the sleep groups and basic attributes, the presence of subjective symptoms, and the presence of hospital visits. The items with significant relationships included 14 symptoms, such as lower back pain (p < 0.01) and four diseases, including high blood pressure (p < 0.01). A multinomial logistic regression was conducted with the sleep groups as objective variables. In the poor sleep group, significant odds ratios were found for four items, including hours of work (odds ratio: 2.53) and feeling listless (2.01). Conclusions: The results allowed multiple symptoms and diseases related to sleep quality to be identified, and different trends in the response rates of the groups were found. These results suggest that the useful classification of sleep quality groups according to health problems contributes to understanding the effects of different symptoms.