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Treatment strategy for insomnia disorder: Japanese expert consensus

PURPOSE: There is a lack of evidence regarding answers for clinical questions about treating insomnia disorder. This study aimed to answer the following clinical questions: (1) how to use each hypnotic and non-pharmacological treatment differently depending on clinical situations and (2) how to redu...

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Detalles Bibliográficos
Autores principales: Takaesu, Yoshikazu, Sakurai, Hitoshi, Aoki, Yumi, Takeshima, Masahiro, Ie, Kenya, Matsui, Kentaro, Utsumi, Tomohiro, Shimura, Akiyoshi, Okajima, Isa, Kotorii, Nozomu, Yamashita, Hidehisa, Suzuki, Masahiro, Kuriyama, Kenichi, Shimizu, Eiji, Mishima, Kazuo, Watanabe, Koichiro, Inada, Ken
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10203548/
https://www.ncbi.nlm.nih.gov/pubmed/37229388
http://dx.doi.org/10.3389/fpsyt.2023.1168100
Descripción
Sumario:PURPOSE: There is a lack of evidence regarding answers for clinical questions about treating insomnia disorder. This study aimed to answer the following clinical questions: (1) how to use each hypnotic and non-pharmacological treatment differently depending on clinical situations and (2) how to reduce or stop benzodiazepine hypnotics using alternative pharmacological and non-pharmacological treatments. METHODS: Experts were asked to evaluate treatment choices based on 10 clinical questions about insomnia disorder using a nine-point Likert scale (1 = “disagree” to 9 = “agree”). The responses of 196 experts were collected, and the answers were categorized into first-, second-, and third-line recommendations. RESULTS: The primary pharmacological treatment, lemborexant (7.3 ± 2.0), was categorized as a first-line recommendation for sleep initiation insomnia, and lemborexant (7.3 ± 1.8) and suvorexant (6.8 ± 1.8) were categorized as the first-line recommendations for sleep maintenance insomnia. Regarding non-pharmacological treatments for primary treatment, sleep hygiene education was categorized as the first-line recommendation for both sleep initiation (8.4 ± 1.1) and maintenance insomnia (8.1 ± 1.5), while multicomponent cognitive behavioral therapy for insomnia was categorized as the second-line treatment for both sleep initiation (5.6 ± 2.3) and maintenance insomnia (5.7 ± 2.4). When reducing or discontinuing benzodiazepine hypnotics by switching to other medications, lemborexant (7.5 ± 1.8) and suvorexant (6.9 ± 1.9) were categorized as first-line recommendations. CONCLUSION: Expert consensus indicates that orexin receptor antagonists and sleep hygiene education are recommended as first-line treatments in most clinical situations to treat insomnia disorder.