Tibor Rubin Veteran Affairs Healthcare System, Long Beach, California, USA.
Department of Medicine, University of California, Irvine School of Medicine, Orange, California, USA.
CNS Spectr. 2021 Aug;26(4):338-344. doi: 10.1017/S1092852920001121. Epub 2020 May 4.
Prazosin has been an accepted treatment for patients with post-traumatic stress disorder (PTSD) who experience sleep disturbances, including nightmares. Results of a recent large randomized control trial did not find benefit of prazosin vs placebo in improving such outcomes. A meta-analysis that includes this most recent trial was conducted to examine the pooled effect of prazosin vs placebo on sleep disturbances and overall PTSD symptoms in patients with PTSD.
A systematic review of the published literature on trials comparing prazosin vs placebo for improvement of overall PTSD scores, nightmares, and sleep quality was conducted. Hedges' g standardized mean differences (SMD) between prazosin and placebo were calculated for each outcome across studies.
Six randomized placebo-controlled studies representing 429 patients were included in the analysis, including two studies with a crossover design. Results showed prazosin significantly improved overall PTSD scores (SMD = -0.31; 95% confidence intervals [CI]: -0.62, -0.01), nightmares (SMD = -0.75; 95% CI: -1.24, -0.27), and sleep quality (SMD = -0.57; 95% CI: -1.02, -0.13). In the largest trial, prazosin showed a reduction in clinical outcome measures similar to past studies, but a relatively large placebo effect size, particularly for nightmares, contributed to no treatment differences.
Despite the results of a recent, large randomized study, pooled effect estimates show that prazosin has a statistically significant benefit on PTSD symptoms and sleep disturbances. Limitations that should be considered include heterogeneity of study design and study populations as well as the small number of studies conducted and included in this meta-analysis.
普萘洛尔已被广泛用于治疗创伤后应激障碍（PTSD）患者的睡眠障碍，包括噩梦。最近一项大型随机对照试验的结果并未发现普萘洛尔在改善这些结果方面优于安慰剂。进行了一项包含最新试验的荟萃分析，以检查普萘洛尔与安慰剂在改善 PTSD 患者睡眠障碍和整体 PTSD 症状方面的汇总效果。
对比较普萘洛尔与安慰剂改善整体 PTSD 评分、噩梦和睡眠质量的试验进行了系统的文献综述。计算了每项研究中普萘洛尔与安慰剂之间的 Hedges'g 标准化均数差值（SMD）。
共有 6 项随机安慰剂对照研究（共 429 名患者）纳入分析，其中包括 2 项交叉设计的研究。结果表明，普萘洛尔显著改善了整体 PTSD 评分（SMD=-0.31；95%置信区间[CI]：-0.62，-0.01）、噩梦（SMD=-0.75；95%CI：-1.24，-0.27）和睡眠质量（SMD=-0.57；95%CI：-1.02，-0.13）。在最大的试验中，普萘洛尔在临床结局测量方面的改善与过去的研究相似，但较大的安慰剂效应大小，特别是对噩梦，导致没有治疗差异。
尽管最近进行了一项大型随机研究，但汇总效应估计表明，普萘洛尔对 PTSD 症状和睡眠障碍有统计学上的显著益处。应该考虑的局限性包括研究设计和研究人群的异质性，以及进行和纳入本荟萃分析的研究数量较少。
