目的:严重的慢性失眠是一种常见的睡眠障碍,大多是持续性的,需要治疗。药物治疗选择和指南很少,特别是长期治疗。我们的研究旨在探讨一个在实践中的中度至重度慢性失眠的分级治疗方案,考虑对自我报告的睡眠质量和生活质量的影响。
方法:患有中度至重度慢性失眠的患者根据分级治疗方案给予适当的药物治疗,从L-色氨酸(作为首选,效力最低)到Z-药物和联合疗法(作为最后的选择,最有效)。将分级治疗方案的每个步骤测试至少4周。睡眠和生活质量相关数据以问卷形式收集(ISI,PSQI,BDI-II,SF-36)在基线和1、3、6、9和12个月后的治疗过程中。
结果:在86名符合条件的患者中,60.5%开始用L-色氨酸治疗,8.1%开始用褪黑激素治疗。三个月后,12.5%仍在服用L-色氨酸,12.5%在服用褪黑激素。平均ISI有显著下降,PSQI,BDI-II,研究中所有患者治疗3个月后的SF-36评分(n=64)。六个月后,22.2%的人仍在服用L-色氨酸,褪黑激素,或者阿戈美拉汀,其余的已经改用更有效的药物,如抗抑郁药,催眠药,daridorexant,或组合疗法。
结论:相当数量的患者对轻度睡眠药物反应良好,而其他人则证明了他们需要更有效的治疗方法。持续的监测将评估这两种方法的长期有效性。
背景:注册:德国临床试验注册;标题:SchlafqualitätätandLebensqualitätmiteinermedikamenösangzeittherapiebeimoderatebisschwererInsomnie;标识符:DRKS00033175;URL:https://drks。去/搜索/去/审判/DRKS00033175。
OBJECTIVE: Severe chronic insomnia is a common sleep disorder that is mostly persistent and needs to be treated. Pharmacologic treatment options and guidelines are sparse, particularly for long-term treatment. Our
study aims to investigate a graduated therapy scheme for moderate to severe chronic insomnia in practice, considering the effects on self-reported sleep quality and quality of life.
METHODS: Patients with moderate to severe chronic insomnia are given appropriate medication according to a graduated therapy scheme, ranging from L-tryptophan (as the first choice, least potent) to Z-drugs and combination therapies (as the last option, most potent). Each step of the graduated therapy scheme was tested for at least 4 weeks. Sleep- and quality of life-related data were collected in questionnaire form (ISI, PSQI, BDI-II, SF-36) at baseline and during the course of the treatment after 1, 3, 6, 9, and 12 months.
RESULTS: Of 86 eligible patients, 60.5% started treatment with L-tryptophan and 8.1% with melatonin. After 3 months, 12.5% were still taking L-tryptophan and 12.5% were taking melatonin. There was a significant decrease in mean ISI, PSQI, BDI-II, and SF-36 scores after 3 months of treatment for all patients in the
study (n=64). After 6 months, 22.2% were still taking L-tryptophan, melatonin, or agomelatine, and the remainder had switched to more potent drugs such as antidepressants, hypnotics, daridorexant, or combination therapies.
CONCLUSIONS: A significant number of patients already responded favorably to mild sleep medications, while others demonstrated their need for more potent treatments. Ongoing monitoring will evaluate the long-term effectiveness of both approaches.
BACKGROUND: Registy: German Clinical Trials Register; Title: Schlafqualität und Lebensqualität mit einer medikamentösen Langzeittherapie bei moderater bis schwerer Insomnie; Identifier: DRKS00033175; URL: https://drks.de/search/de/
trial/DRKS00033175.