Lujain Ez Eddin, Rebecca Preyra, Fatemeh Ahmadi, Atefeh Jafari, Mohammad Ali Omrani, Flory T. Muanda
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Relative risks (RR) and 95% confidence intervals (CIs) were calculated for outcomes such as dizziness, insomnia, nightmares, drowsiness and delirium.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>Our analysis revealed that β-blocker use was significantly associated with an increased risk of dizziness (RR 1.72, 95% CI [1.39–2.14]; <i>I</i><sup>2</sup> = 1%, 14 studies) compared to placebo. Lipophilic β-blockers, especially propranolol, showed an even greater risk of dizziness (RR 3.13, 95% CI [1.44–6.84]; <i>I</i><sup>2</sup> = 0%, three studies). Propranolol was also associated with increased insomnia risk compared to placebo (RR 1.13, 95% CI [1.00–1.28]; <i>I</i><sup>2</sup> = 0%, five studies). Our data did not show statistically significant increases in the reports of nightmares and somnolence. Other adverse effects, including drowsiness, sleep disturbances, hallucinations and delirium, were noted.</p>\n </section>\n \n <section>\n \n <h3> Conclusions</h3>\n \n <p>Our findings suggest a significant association between β-blocker use and an increased risk of neuropsychiatric adverse events, particularly insomnia and dizziness with higher risks associated with lipophilic β-blocker use. Given the ambiguity surrounding dizziness and its classification as a neuropsychiatric effect, our findings are exploratory, and we cannot exclude a potential cardiovascular origin for dizziness. Most studies (75%) were published before the CONSORT statement in 1996, indicating potential reporting limitations and a lack of recent research. 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Lipophilic β-blockers, especially propranolol, showed an even greater risk of dizziness (RR 3.13, 95% CI [1.44–6.84]; <i>I</i><sup>2</sup> = 0%, three studies). Propranolol was also associated with increased insomnia risk compared to placebo (RR 1.13, 95% CI [1.00–1.28]; <i>I</i><sup>2</sup> = 0%, five studies). Our data did not show statistically significant increases in the reports of nightmares and somnolence. Other adverse effects, including drowsiness, sleep disturbances, hallucinations and delirium, were noted.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Conclusions</h3>\\n \\n <p>Our findings suggest a significant association between β-blocker use and an increased risk of neuropsychiatric adverse events, particularly insomnia and dizziness with higher risks associated with lipophilic β-blocker use. 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引用次数: 0
摘要
目的：本系统综述和荟萃分析旨在评估β-受体阻滞剂使用与神经精神不良事件之间的关系，特别关注短期结果。方法：全面的文献检索确定了报告使用β受体阻滞剂患者神经精神预后的研究，包括随机对照试验和观察性研究。计算头晕、失眠、噩梦、嗜睡和谵妄等结果的相对风险（RR）和95%置信区间（ci）。结果：我们的分析显示β受体阻滞剂的使用与眩晕风险增加显著相关(RR 1.72, 95% CI [1.39-2.14]；I2 = 1%， 14项研究)与安慰剂相比。亲脂性β受体阻滞剂，尤其是普萘洛尔，显示出更大的头晕风险(RR 3.13, 95% CI [1.44-6.84]；I2 = 0%， 3项研究)。与安慰剂相比，心得安也与失眠风险增加相关(RR 1.13, 95% CI [1.00-1.28]；I2 = 0%， 5项研究)。我们的数据在统计上并没有显示出噩梦和嗜睡的显著增加。其他不良反应包括嗜睡、睡眠障碍、幻觉和谵妄。结论：我们的研究结果表明β-受体阻滞剂的使用与神经精神不良事件的风险增加有显著的关联，特别是失眠和头晕，与使用亲脂β-受体阻滞剂相关的风险更高。鉴于围绕头晕及其作为神经精神效应的分类的模糊性，我们的研究结果是探索性的，我们不能排除头晕的潜在心血管起源。大多数研究（75%）是在1996年CONSORT声明之前发表的，这表明潜在的报告局限性和缺乏最近的研究。此外，60%的研究存在高偏倚风险，这强调了对β受体阻滞剂使用的神经精神影响进行更严格和更现代的调查的必要性。
β-Blockers and risk of neuropsychiatric disorders: A systematic review and meta-analysis
Aims
This systematic review and meta-analysis aimed to evaluate the association between β-blocker use and neuropsychiatric adverse events, specifically focusing on short-term outcomes.
Methods
A comprehensive literature search identified studies reporting neuropsychiatric outcomes in patients using β-blockers, including randomized controlled trials and observational studies. Relative risks (RR) and 95% confidence intervals (CIs) were calculated for outcomes such as dizziness, insomnia, nightmares, drowsiness and delirium.
Results
Our analysis revealed that β-blocker use was significantly associated with an increased risk of dizziness (RR 1.72, 95% CI [1.39–2.14]; I2 = 1%, 14 studies) compared to placebo. Lipophilic β-blockers, especially propranolol, showed an even greater risk of dizziness (RR 3.13, 95% CI [1.44–6.84]; I2 = 0%, three studies). Propranolol was also associated with increased insomnia risk compared to placebo (RR 1.13, 95% CI [1.00–1.28]; I2 = 0%, five studies). Our data did not show statistically significant increases in the reports of nightmares and somnolence. Other adverse effects, including drowsiness, sleep disturbances, hallucinations and delirium, were noted.
Conclusions
Our findings suggest a significant association between β-blocker use and an increased risk of neuropsychiatric adverse events, particularly insomnia and dizziness with higher risks associated with lipophilic β-blocker use. Given the ambiguity surrounding dizziness and its classification as a neuropsychiatric effect, our findings are exploratory, and we cannot exclude a potential cardiovascular origin for dizziness. Most studies (75%) were published before the CONSORT statement in 1996, indicating potential reporting limitations and a lack of recent research. Additionally, 60% of studies had a high risk of bias, underscoring the need for more rigorous and contemporary investigations into the neuropsychiatric implications of β-blocker use.
期刊介绍：
Published on behalf of the British Pharmacological Society, the British Journal of Clinical Pharmacology features papers and reports on all aspects of drug action in humans: review articles, mini review articles, original papers, commentaries, editorials and letters. The Journal enjoys a wide readership, bridging the gap between the medical profession, clinical research and the pharmaceutical industry. It also publishes research on new methods, new drugs and new approaches to treatment. The Journal is recognised as one of the leading publications in its field. It is online only, publishes open access research through its OnlineOpen programme and is published monthly.
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