■目前的创伤后应激障碍(PTSD)与睡眠障碍的诊断或治疗指南和规范规范仍然相互矛盾,尚未达成共识。本研究旨在阐明美国国家健康与临床卓越研究所(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)之间最有效的对策,以治疗PTSD个体并存的睡眠障碍。
■四个数据库,包括PubMed,EMBASE,科克伦图书馆,和APAPsyNet,从成立之初到2023年2月2日进行了搜索。
■包括24篇随机对照试验(RCT)和1,647名参与者的20篇文章。如网络荟萃分析比较结果所示,CBT-I(标准化平均差(SMD)=-1.51,95%置信区间(CI):-2.55至-0.47),CBT-I加IRT(SMD=-1.71,95CI:-3.39,-0.03),与安慰剂相比,哌唑嗪(SMD=-0.87,95CI:-1.59至-0.16)和羟嗪(SMD=-1.06,95CI:-1.94至-0.19)显着降低了PTSD症状。与安慰剂相比,CBT-I(SMD=-5.61,95CI:-8.82至-2.40)显著改善睡眠质量。对于噩梦的严重性,IRT(SMD=-0.65,95CI:-1.00至-0.31),与安慰剂相比,哌唑嗪(SMD=-1.20,95CI:-1.72至-0.67)和羟嗪(SMD=-0.98,95CI:-1.58至-0.37)显着降低了噩梦的严重程度。
■这项研究表明,在大多数情况下,心理治疗,即CBT-I有一个良好的形象,但是哌唑嗪的药物治疗在控制噩梦严重程度方面是有效的。建议使用CBT-I来改善睡眠质量,而CBT-I和CBT-I加IRT对PTSD症状的严重程度表现出出色的管理。建议接触CBT-I治疗抑郁症。创伤后应激障碍和睡眠障碍患者管理的相关临床指南可将此作为参考。
■CRD42023415240。
UNASSIGNED: 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.
UNASSIGNED: Four databases, including PubMed, EMBASE, Cochrane Library, and APA PsyNet, were searched from inception to February 02, 2023.
UNASSIGNED: 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 plus 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.
UNASSIGNED: 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.
UNASSIGNED: CRD42023415240.