Center for Evidence-Based Medicine and Clinical Research, Taihe Hospital, Hubei University of Medicine, Shiyan, Hubei, China.
Center for Neurological Diseases, Taihe Hospital, Hubei University of Medicine, Shiyan, Hubei, China.
Ann Med. 2024 Dec;56(1):2381696. doi: 10.1080/07853890.2024.2381696. Epub 2024 Jul 26.
The current guidelines and canonical norms of diagnosis or treatment for Post-traumatic stress disorder (PTSD) with sleep disorder are still conflicting and have not yet reached a consensus. This study aimed to unravel the most effective countermeasures between two categories (psychotherapy and pharmacotherapy) put forward by the National Institute for Health and Clinical Excellence (NICE) and World Federation of Societies of Biological Psychiatry (WFSBP) respectively to treat PTSD individuals co-exist with sleep disorders.
Four databases, including PubMed, EMBASE, Cochrane Library, and APA PsyNet, were searched from inception to February 02, 2023.
Twenty articles with 24 Randomized controlled trials (RCTs) and a total number of 1,647 participants were included. As demonstrated in the network meta-analysis comparison results, CBT-I (standardized mean differences (SMD) = -1.51,95% confidence interval (CI):-2.55 to -0.47), CBT-I IRT (SMD = -1.71, 95%CI:-3.39, -0.03), prazosin (SMD = -0.87,95%CI:-1.59 to -0.16) and hydroxyzine (SMD = -1.06, 95%CI: -1.94 to -0.19) significantly reduced PTSD symptoms compared with placebo. In contrast to placebo, CBT-I (SMD = -5.61,95%CI:-8.82 to -2.40) significantly improved sleep quality. For nightmare severity, IRT (SMD =-0.65, 95%CI:-1.00 to -0.31), prazosin (SMD = -1.20,95%CI:-1.72 to -0.67) and hydroxyzine (SMD = -0.98,95%CI:-1.58 to -0.37) significantly reduced nightmare severity in comparison with placebo.
This study suggested that under most circumstances, psychotherapy namely CBT-I had a favorable profile, but pharmacotherapy with prazosin was effective in managing nightmare severity. The sole avail of CBT-I was recommended to improving sleep quality while CBT-I and CBT-I plus IRT showed excellent management of PTSD symptom severity. Exposure to CBT-I isrecommended for depression. The relevant clinical guidelines for the management of individuals with PTSD and sleep disorders may regard this as a reference.
CRD42023415240.
目前，创伤后应激障碍（PTSD）伴睡眠障碍的诊断或治疗的指南和规范标准仍存在冲突，尚未达成共识。本研究旨在探讨英国国家卫生与临床优化研究所（NICE）和世界生物精神病学会联合会（WFSBP）分别提出的两类（心理治疗和药物治疗）中最有效的对策，以治疗 PTSD 合并睡眠障碍的个体。
从建库至 2023 年 2 月 2 日，在四个数据库（PubMed、EMBASE、Cochrane Library 和 APA PsyNet）中进行检索。
纳入 20 项研究，共 24 项随机对照试验（RCT），共 1647 名参与者。网络荟萃分析比较结果显示，CBT-I（标准化均数差（SMD）=-1.51，95%置信区间（CI）：-2.55 至-0.47）、CBT-I IRT（SMD=-1.71，95%CI：-3.39，-0.03）、普萘洛尔（SMD=-0.87，95%CI：-1.59 至-0.16）和羟嗪（SMD=-1.06，95%CI：-1.94 至-0.19）与安慰剂相比，可显著降低 PTSD 症状。与安慰剂相比，CBT-I（SMD=-5.61，95%CI：-8.82 至-2.40）可显著改善睡眠质量。对于噩梦严重程度，IRT（SMD=-0.65，95%CI：-1.00 至-0.31）、普萘洛尔（SMD=-1.20，95%CI：-1.72 至-0.67）和羟嗪（SMD=-0.98，95%CI：-1.58 至-0.37）与安慰剂相比，可显著降低噩梦严重程度。
本研究表明，在大多数情况下，心理治疗，即 CBT-I，具有良好的效果，但药物治疗，如普萘洛尔，对管理噩梦严重程度有效。建议单独使用 CBT-I 来改善睡眠质量，而 CBT-I 和 CBT-I 加 IRT 则显示出对 PTSD 症状严重程度的出色管理。CBT-I 也适用于治疗抑郁。与 PTSD 和睡眠障碍相关的临床指南可能会将此作为参考。
CRD42023415240。
