Pharmacotherapy for sleep disturbances in post-traumatic stress disorder (PTSD): A network meta-analysis.
Andreas S Lappas, Eleni Glarou, Zoi A Polyzopoulou, Grace Goss, Maximillian Huhn, Myrto T Samara, Nikos G Christodoulou
Sleep Medicine July 1, 2024 DOI: 10.1016/j.sleep.2024.05.032 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Systematic review and network meta-analysis Randomized Peer reviewed |
|---|---|
| Sample size | 10,481 |
| Population | Patients with post-traumatic stress disorder (PTSD) |
| Interventions | Prazosin SSRIs Mirtazapine z-drugs benzodiazepines Risperidone Quetiapine Hydroxyzine Trazodone Nabilone Paroxetine MDMA-assisted psychotherapy |
| Topics | PTSD |
| Keywords | Insomnia Network meta-analysis Posttraumatic stress disorder Sleep Nightmares/night terrors/bad dreams Mental health treatments |
| Citations | 13 |
| Key findings | Prazosin may be the most effective pharmacotherapy for insomnia, nightmares, and poor sleep quality in PTSD, while SSRIs, Mirtazapine, z-drugs, and benzodiazepines show lack of efficacy. |
Abstract
Sleep disturbances are an important symptom dimension of post-traumatic-stress-disorder (PTSD). There is no meta-analytic evidence examining the effects of all types of pharmacotherapy on sleep outcomes among patients with PTSD. Medline/Embase/PsychInfo/CENTRAL/clinicaltrials.gov/ICTRP, reference lists of published reviews and all included studies were searched for Randomised Controlled Trials (RCTs) examining any pharmacotherapy vs. placebo or any other drug among patients with PTSD. total sleep time, nightmares, sleep quality. sleep onset latency, number of nocturnal awakenings, time spent awake following sleep onset, dropouts due to sleep-related adverse-effects, insomnia/somnolence/vivid-dreams as adverse-effects. Pairwise and network meta-analyses were performed. 99 RCTs with 10,481 participants were included. Prazosin may be the most effective treatment for insomnia (SMD = -0.88, 95%CI = [-1.22;-0.54], nightmares (SMD = -0.44, 95%CI = [-0.84;-0.04]) and poor sleep quality (SMD = -0.55, 95%CI = [-1.01;-0.10]). Evidence is scarce and indicates lack of efficacy for SSRIs, Mirtazapine, z-drugs and benzodiazepines, which are widely used in daily practice. Risperidone and Quetiapine carry a high risk of causing somnolence without having a clear therapeutic benefit. Hydroxyzine, Trazodone, Nabilone, Paroxetine and MDMA-assisted psychotherapy may be promising options, but more research is needed. Underpowered individual comparisons and very-low to moderate confidence in effect estimates hinder the generalisability of the results. More RCTs, specifically reporting on sleep-related outcomes, are urgently needed.