Doroudgar Shadi, Chou Tony I-Fan, Yu Junhua, Trinh Karen, Pal Jai, Perry Paul J
College of Pharmacy, Touro University, Vallejo, California (all authors); and School of Pharmacy, West Coast University, Los Angeles, California (Dr Chou).
Prim Care Companion CNS Disord. 2013;15(6). doi: 10.4088/PCC.13m01558. Epub 2013 Nov 7.
Insomnia is symptomatic of most psychiatric disorders. Non-habit-forming agents such as trazodone and quetiapine are commonly used off-label to treat patients with insomnia. The safety and efficacy of trazodone and quetiapine as medications for treatment of insomnia have never been directly contrasted. The objective of this study was to compare the effectiveness of trazodone to quetiapine among inpatient psychiatric patients by measuring the traditional sleep parameters of total sleep time, number of nighttime awakenings, sleep efficiency, sleep latency, length of hospitalization, and patient-reported side effects.
Participants were recruited from St Helena Hospital Center for Behavioral Health, Vallejo, California. Patient inclusion criteria were age 18 to 65 years, admitted between September 2011 and February 2012, and a physician order for trazodone or quetiapine for insomnia. Exclusion criteria included primary insomnia, pregnancy, concomitant order of trazodone and quetiapine, receiving trazodone or quetiapine up to 2 weeks prior to the study, and inability to coherently communicate. Subjective patient interviews and objective nursing sleep log reviews composed the data set.
On average, mean total sleep time hours were longer among patients receiving trazodone versus those receiving quetiapine according to patients' subjective reports (7.80 vs 6.75, respectively, P < .01) and the nursing sleep logs (9.13 vs 8.68, respectively, P = .04). Patients receiving trazodone experienced fewer mean nighttime awakenings versus those receiving quetiapine (0.52 vs 0.75, respectively, P = .04) according to the nursing sleep log report. Patients receiving trazodone reported more side effects of constipation, nausea, and diarrhea than patients receiving quetiapine.
With respect to total sleep time and nighttime awakenings, trazodone was a more effective alternative than quetiapine. However, patients receiving trazodone experienced more gastrointestinal patient-reported side effects.
失眠是大多数精神疾病的症状。曲唑酮和喹硫平这类非成瘾性药物常被用于治疗失眠，但并非按照药品说明书用药。曲唑酮和喹硫平作为治疗失眠药物的安全性和有效性从未被直接对比过。本研究的目的是通过测量总睡眠时间、夜间觉醒次数、睡眠效率、入睡潜伏期、住院时间以及患者报告的副作用等传统睡眠参数，比较曲唑酮和喹硫平在住院精神科患者中的疗效。
参与者从加利福尼亚州瓦列霍市圣海伦娜行为健康医院中心招募。患者纳入标准为年龄18至65岁，于2011年9月至2012年2月期间入院，且有医生开具的用于治疗失眠的曲唑酮或喹硫平医嘱。排除标准包括原发性失眠、怀孕、同时开具曲唑酮和喹硫平医嘱、在研究前两周内接受过曲唑酮或喹硫平治疗以及无法连贯沟通。患者主观访谈和客观护理睡眠日志回顾构成数据集。
根据患者主观报告，接受曲唑酮治疗的患者平均总睡眠时间比接受喹硫平治疗的患者长（分别为7.80小时和6.75小时，P <.01）；根据护理睡眠日志，前者也更长（分别为9.13小时和8.68小时，P =.04）。根据护理睡眠日志报告，接受曲唑酮治疗的患者平均夜间觉醒次数比接受喹硫平治疗的患者少（分别为0.52次和0.75次，P =.04）。接受曲唑酮治疗的患者报告的便秘、恶心和腹泻等副作用比接受喹硫平治疗的患者更多。
就总睡眠时间和夜间觉醒次数而言，曲唑酮比喹硫平是更有效的选择。然而，接受曲唑酮治疗的患者报告的胃肠道副作用更多。
