Subjectively reported sleep improvement with antipsychotic medications in clinical practice: A systematic review, meta-analysis and meta-regression of moderating factors.
Letizia Biso, Marco Carli, Valeria Lucarini, Mario Miniati, Paolo Ossola, Marco Scarselli
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引用次数: 0
Abstract
Background: While some antipsychotics (APs) have been investigated with some controversy for insomnia associated with other mental disorders or off-label due to their sedative properties, evidence for their efficacy and safety remains inconclusive.
Aims: Our systematic review and meta-analysis have analysed comprehensively the impact of first- and second-generation (SGA) APs on subjective sleep measures.
Methods: A research string was used in PubMed, ISI Web of Science, Scopus, Cochrane and ClinicalTrials.gov databases, including both randomised clinical trials (RCTs) and non-RCTs.
Results: Overall, 43 studies were included in the systematic review, and 21 were included in the meta-analysis. APs were more effective than placebo in improving subjective measures of sleep quality and were associated with an improvement in sleep quality from the baseline to the end of the trial. We performed a meta-regression for possible moderators and found a significant effect of age and sex, with older subjects and males responding less to APs' effect on sleep. APs with higher antihistaminergic activity (e.g. quetiapine) improved sleep quality more than the dopaminergic/serotoninergic (e.g. risperidone) or simply serotonergic (e.g. pimavanserine) ones. Individuals with anxiety disorders reported greater effects of APs, especially SGAs with antihistaminergic activity, on sleep, and longer trials reported greater improvement in sleep quality.
Conclusions: APs, mostly SGAs, improved sleep quality more than placebo, and this effect was more pronounced in anxiety disorders, for anti-histaminergic APs, and in longer trials. These results could add another important tile to the mosaic of precision medicine for prescribing APs.
背景：虽然一些抗精神病药（APs）因其镇静特性而被研究用于与其他精神障碍相关的失眠或标签外的失眠，但其有效性和安全性的证据仍不确定。目的：我们的系统综述和荟萃分析全面分析了第一代和第二代（SGA） APs对主观睡眠测量的影响。方法：在PubMed、ISI Web of Science、Scopus、Cochrane和ClinicalTrials.gov数据库中使用研究字符串，包括随机临床试验（rct）和非rct。结果：总体而言，系统评价纳入了43项研究，meta分析纳入了21项研究。APs在改善睡眠质量的主观测量方面比安慰剂更有效，并且与从基线到试验结束的睡眠质量改善有关。我们对可能的调节因素进行了荟萃回归，发现年龄和性别的显著影响，年龄较大的受试者和男性对ap对睡眠的影响反应较小。具有较高抗组胺活性的ap（如奎硫平）比多巴胺能/血清素能（如利培酮）或单纯血清素能（如匹马万塞林）的ap更能改善睡眠质量。患有焦虑症的个体报告说，ap对睡眠有更大的影响，尤其是具有抗组胺能活性的SGAs，而且更长时间的试验报告说，ap对睡眠质量有更大的改善。结论：ap（主要是SGAs）比安慰剂更能改善睡眠质量，而且这种效果在焦虑障碍、抗组胺能ap和更长时间的试验中更为明显。这些结果可能会为精准用药的处方添加另一块重要的瓷砖。
期刊介绍：
The Journal of Psychopharmacology is a fully peer-reviewed, international journal that publishes original research and review articles on preclinical and clinical aspects of psychopharmacology. The journal provides an essential forum for researchers and practicing clinicians on the effects of drugs on animal and human behavior, and the mechanisms underlying these effects. The Journal of Psychopharmacology is truly international in scope and readership.
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