Institute for Health Sciences, Catholic University of Portugal, Lisbon, Portugal.
Unidade de Cuidados de Saúde Personalizados Mar, Tavira, Portugal.
Am J Hosp Palliat Care. 2020 Nov;37(11):957-969. doi: 10.1177/1049909120907021. Epub 2020 Feb 26.
The primary function of palliative care is to improve quality of life. The recognition and treatment of symptoms causing suffering is central to the achievement of this goal. Insomnia reduces quality of life of patients under palliative care. Knowledge about prevalence, associated factors, and treatment of insomnia in palliative care is scarce.
Literature review about the prevalence, predictors, and treatment options of insomnia in palliative care patients. Primary sources of investigation were identified and selected through Pubmed and Scopus databases. The research was complemented by reference search in identified articles and selected reviews. OpenGrey and Google Scholar were used for searching grey literature. Study quality analysis was based on the Newcastle-Ottawa Scale.
A total of 65 studies were included in the review. Most studies had acceptable /good quality. The prevalence of insomnia in the included studies ranged from 2.1% to 100%, with a median overall prevalence of 49.5%. Sociodemographic factors such as age; clinical characteristics such as functional status, disease stage, pain, and use of specific drugs, including opioids; psychological factors such as anxiety/depression; and spiritual factors such as feelings of well-being were identified as predictors. The treatment options identified were biological (pharmacological and nonpharmacological), psychological (visualization, relaxation), and spiritual (prayer).
The systematic review showed that the prevalence of insomnia is high, with at least one in 3 patients affected in most studies. Insomnia's risk factors and treatment in palliative care are both associated to physical, psychological, social, and spiritual factors, reflecting its true holistic nature.
缓和医疗的主要功能是提高生活质量。识别和治疗导致痛苦的症状是实现这一目标的核心。失眠会降低接受缓和医疗患者的生活质量。缓和医疗患者中失眠的患病率、相关因素和治疗方法的相关知识十分有限。
对缓和医疗患者失眠的患病率、预测因素和治疗选择进行文献综述。通过 Pubmed 和 Scopus 数据库确定并选择了主要的调查来源。研究还通过确定的文章和选定的综述中的参考文献搜索进行了补充。OpenGrey 和 Google Scholar 用于搜索灰色文献。研究质量分析基于纽卡斯尔-渥太华量表。
综述共纳入 65 项研究。大多数研究的质量为可接受/良好。纳入研究中失眠的患病率从 2.1%到 100%不等，总体患病率中位数为 49.5%。社会人口因素，如年龄；临床特征，如功能状态、疾病阶段、疼痛和使用特定药物，包括阿片类药物；心理因素，如焦虑/抑郁；以及精神因素，如幸福感，被确定为预测因素。确定的治疗选择包括生物（药理学和非药理学）、心理（可视化、放松）和精神（祈祷）。
系统评价表明，失眠的患病率很高，在大多数研究中，至少有三分之一的患者受到影响。缓和医疗中失眠的风险因素和治疗与身体、心理、社会和精神因素都有关，反映了其真正的整体性。
