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Pharmacological interventions to improve sleep in hospitalised adults: a systematic review

OBJECTIVES: Patients often suffer from disturbed sleep in hospital. Poor-quality sleep in hospitalised patients has been associated with significant morbidity and pharmacological sleep aids are often prescribed. The objective of this systematic review is to evaluate the comparative efficacy and safe...

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Autores principales: Kanji, Salmaan, Mera, Alexandru, Hutton, Brian, Burry, Lisa, Rosenberg, Erin, MacDonald, Erika, Luks, Vanessa
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2016
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4986185/
https://www.ncbi.nlm.nih.gov/pubmed/27473952
http://dx.doi.org/10.1136/bmjopen-2016-012108
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author Kanji, Salmaan
Mera, Alexandru
Hutton, Brian
Burry, Lisa
Rosenberg, Erin
MacDonald, Erika
Luks, Vanessa
author_facet Kanji, Salmaan
Mera, Alexandru
Hutton, Brian
Burry, Lisa
Rosenberg, Erin
MacDonald, Erika
Luks, Vanessa
author_sort Kanji, Salmaan
collection PubMed
description OBJECTIVES: Patients often suffer from disturbed sleep in hospital. Poor-quality sleep in hospitalised patients has been associated with significant morbidity and pharmacological sleep aids are often prescribed. The objective of this systematic review is to evaluate the comparative efficacy and safety of pharmacological interventions used for sleep in hospitalised patients. SETTING/PARTICIPANTS: We searched MEDLINE, Embase, the Cochrane database and grey literature for prospective studies that evaluated sleep in hospitalised adults after a pharmacological intervention. PRIMARY AND SECONDARY OUTCOME MEASURES: Two reviewers assessed studies for inclusion and extracted data for efficacy outcomes, including sleep efficiency, sleep latency, sleep fragmentation and objectively measured sleep stage distribution. Risk of bias was assessed and meta-analyses were planned contingent upon homogeneity of the included studies. RESULTS: After screening 1920 citations, 15 studies involving 861 patients were included. Medications studied included benzodiazepines, nonbenzodiazepine sedatives, melatonin, propofol and dexmedetomidine. Five studies were deemed to be of high quality. Heterogeneity and variable outcome reporting precluded meta-analysis in most cases. No consistent trends with respect to sleep efficiency, quality or interruptions were observed identifying a drug or drug class as superior to another or no treatment. Benzodiazepines appeared to be better than no treatment with respect to sleep latency, but this was not consistently demonstrated across all studies. Sleep stage distribution shows that sleep in hospital is dominated by stages N1 and N2. CONCLUSIONS: There is insufficient evidence to suggest that pharmacotherapy improves the quality or quantity of sleep in hospitalised patients suffering from poor sleep. No drug class or specific drug was identified as superior even when compared to placebo or no treatment. Although 15 studies were included, the quality of evidence was limited by their quality and size. Larger, better-designed trials in hospitalised adults are needed.
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spelling pubmed-49861852016-08-19 Pharmacological interventions to improve sleep in hospitalised adults: a systematic review Kanji, Salmaan Mera, Alexandru Hutton, Brian Burry, Lisa Rosenberg, Erin MacDonald, Erika Luks, Vanessa BMJ Open Pharmacology and Therapeutics OBJECTIVES: Patients often suffer from disturbed sleep in hospital. Poor-quality sleep in hospitalised patients has been associated with significant morbidity and pharmacological sleep aids are often prescribed. The objective of this systematic review is to evaluate the comparative efficacy and safety of pharmacological interventions used for sleep in hospitalised patients. SETTING/PARTICIPANTS: We searched MEDLINE, Embase, the Cochrane database and grey literature for prospective studies that evaluated sleep in hospitalised adults after a pharmacological intervention. PRIMARY AND SECONDARY OUTCOME MEASURES: Two reviewers assessed studies for inclusion and extracted data for efficacy outcomes, including sleep efficiency, sleep latency, sleep fragmentation and objectively measured sleep stage distribution. Risk of bias was assessed and meta-analyses were planned contingent upon homogeneity of the included studies. RESULTS: After screening 1920 citations, 15 studies involving 861 patients were included. Medications studied included benzodiazepines, nonbenzodiazepine sedatives, melatonin, propofol and dexmedetomidine. Five studies were deemed to be of high quality. Heterogeneity and variable outcome reporting precluded meta-analysis in most cases. No consistent trends with respect to sleep efficiency, quality or interruptions were observed identifying a drug or drug class as superior to another or no treatment. Benzodiazepines appeared to be better than no treatment with respect to sleep latency, but this was not consistently demonstrated across all studies. Sleep stage distribution shows that sleep in hospital is dominated by stages N1 and N2. CONCLUSIONS: There is insufficient evidence to suggest that pharmacotherapy improves the quality or quantity of sleep in hospitalised patients suffering from poor sleep. No drug class or specific drug was identified as superior even when compared to placebo or no treatment. Although 15 studies were included, the quality of evidence was limited by their quality and size. Larger, better-designed trials in hospitalised adults are needed. BMJ Publishing Group 2016-07-29 /pmc/articles/PMC4986185/ /pubmed/27473952 http://dx.doi.org/10.1136/bmjopen-2016-012108 Text en Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/ This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
spellingShingle Pharmacology and Therapeutics
Kanji, Salmaan
Mera, Alexandru
Hutton, Brian
Burry, Lisa
Rosenberg, Erin
MacDonald, Erika
Luks, Vanessa
Pharmacological interventions to improve sleep in hospitalised adults: a systematic review
title Pharmacological interventions to improve sleep in hospitalised adults: a systematic review
title_full Pharmacological interventions to improve sleep in hospitalised adults: a systematic review
title_fullStr Pharmacological interventions to improve sleep in hospitalised adults: a systematic review
title_full_unstemmed Pharmacological interventions to improve sleep in hospitalised adults: a systematic review
title_short Pharmacological interventions to improve sleep in hospitalised adults: a systematic review
title_sort pharmacological interventions to improve sleep in hospitalised adults: a systematic review
topic Pharmacology and Therapeutics
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4986185/
https://www.ncbi.nlm.nih.gov/pubmed/27473952
http://dx.doi.org/10.1136/bmjopen-2016-012108
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