Valencia Carlo Yarmila Elena, Saracco-Alvarez Ricardo Arturo, Valencia Carlo Verónica Angela, Vázquez Vega Daniela, Natera Rey Guillermina, Escamilla Orozco Raul Ivan
Health Sciences Program, Universidad Nacional Autonoma de Mexico, Mexico City, Mexico.
Clinical Research, National Institute of Psychiatry Ramon de la Fuente Muñiz, Mexico City, Mexico.
Front Psychiatry. 2023 Jun 27;14:1189768. doi: 10.3389/fpsyt.2023.1189768. eCollection 2023.
Our objective was to conduct a systematic review and meta-analysis of adverse effects on sleep in patients with schizophrenia receiving antipsychotic treatment.
A systematic search was performed in PubMed, Cochrane Central, Embase, Toxline, Ebsco, Virtual Health Library, Web of Science, SpringerLink, and in Database of abstracts of Reviews of Effects of Randomized Clinical Trials to identify eligible studies published from January 1990 to October 2021. The methodological quality of the studies was evaluated using the CONSORT list, and the Cochrane bias tool. Network meta-analysis was performed using the Bayesian random-effects model, with multivariate meta-regression to assess the association of interest.
87 randomized clinical trials were identified that met the inclusion criteria, and 70 articles were included in the network meta-analysis. Regarding the methodological quality of the studies, 47 had a low or moderate bias risk. The most common adverse effects on sleep reported in the studies were insomnia, somnolence, and sedation. The results of the network meta-analysis showed that ziprasidone was associated with an increased risk of insomnia (OR, 1.56; 95% credible interval CrI, 1.18-2.06). Several of the included antipsychotics were associated with a significantly increased risk of somnolence; haloperidol (OR, 1.90; 95% CrI, 1.12-3.22), lurasidone (OR, 2.25; 95% CrI, 1.28-3.97) and ziprasidone (OR, 1.79; 95% CrI, 1.06-3.02) had the narrowest confidence intervals. In addition, perphenazine (OR, 5.33; 95% CrI, 1.92-14.83), haloperidol (OR, 2.61; 95% CrI, 1.14-5.99), and risperidone (OR, 2.41; 95% CrI, 1.21-4.80) were associated with an increased risk of sedation compared with placebo, and other antipsychotics did not differ. According to the SUCRAs for insomnia, chlorpromazine was ranked as the lowest risk of insomnia (57%), followed by clozapine (20%), while flupentixol (26 %) and perospirone (22.5%) were associated with a lower risk of somnolence. On the other hand, amisulpride (89.9%) was the safest option to reduce the risk of sedation.
Insomnia, sedation, and somnolence were the most frequent adverse effects on sleep among the different antipsychotics administered. The evidence shows that chlorpromazine, clozapine, flupentixol, perospirone, and amisulpride had favorable safety profiles. In contrast, ziprasidone, perphenazine, haloperidol, and risperidone were the least safe for sleep.
https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42017078052, identifier: PROSPERO 2017 CRD42017078052.
我们的目标是对接受抗精神病药物治疗的精神分裂症患者睡眠方面的不良反应进行系统评价和荟萃分析。
在PubMed、Cochrane Central、Embase、Toxline、Ebsco、虚拟健康图书馆、科学网、SpringerLink以及随机临床试验效应评价摘要数据库中进行系统检索，以识别1990年1月至2021年10月发表的符合条件的研究。使用CONSORT清单和Cochrane偏倚工具评估研究的方法学质量。采用贝叶斯随机效应模型进行网络荟萃分析，并进行多变量荟萃回归以评估感兴趣的关联。
确定了87项符合纳入标准的随机临床试验，70篇文章纳入网络荟萃分析。关于研究的方法学质量，47项研究的偏倚风险较低或中等。研究中报告的最常见的睡眠不良反应为失眠、嗜睡和镇静。网络荟萃分析结果显示，齐拉西酮与失眠风险增加相关（比值比[OR]，1.56；95%可信区间[CrI]，1.18 - 2.06）。纳入的几种抗精神病药物与嗜睡风险显著增加相关；氟哌啶醇（OR，1.90；95% CrI，1.12 - 3.22）、鲁拉西酮（OR，2.25；95% CrI，1.28 - 3.97）和齐拉西酮（OR，1.79；95% CrI，1.06 - 3.02）的可信区间最窄。此外，与安慰剂相比，奋乃静（OR，5.33；95% CrI，1.92 - 14.83）、氟哌啶醇（OR，2.61；95% CrI，1.14 - 5.99）和利培酮（OR，2.41；95% CrI，1.21 - 4.80）与镇静风险增加相关，其他抗精神病药物则无差异。根据失眠的累积排序曲线下面积（SUCRAs），氯丙嗪失眠风险最低（57%），其次是氯氮平（20%），而氟哌噻吨（26%）和哌罗匹隆（22.5%）嗜睡风险较低。另一方面，氨磺必利（89.9%）是降低镇静风险最安全的选择。
在不同的抗精神病药物中，失眠、镇静和嗜睡是最常见的睡眠不良反应。证据表明，氯丙嗪、氯氮平、氟哌噻吨、哌罗匹隆和氨磺必利具有良好的安全性。相比之下，齐拉西酮、奋乃静、氟哌啶醇和利培酮对睡眠最不安全。
https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42017078052，标识符：PROSPERO 2017 CRD42017078052
