{"title":"21种抗抑郁药在重度抑郁症急性期治疗期间对睡眠的不良影响：一项系统综述和量效网络荟萃分析。","authors":"Shuzhe Zhou, Pei Li, Xiaozhen Lv, Xuefeng Lai, Zuoxiang Liu, Junwen Zhou, Fengqi Liu, Yiming Tao, Meng Zhang, Xin Yu, Jingwei Tian, Feng Sun","doi":"10.1093/sleep/zsad177","DOIUrl":null,"url":null,"abstract":"<p><strong>Study objectives: </strong>Sleep-related adverse effects during acute treatment with antidepressants undermine adherence and impede remission. We aimed to address subtypes of sleep-related adverse effects and depict the relationship between dose and sleep-related adverse events.</p><p><strong>Methods: </strong>We searched PubMed, Embase, Cochrane Central Register of Controlled Trials, and Web of Science for double-blind randomized controlled trials of depression published before April 30th, 2023. Eligible studies reporting sleep-related adverse effects during short-term monotherapy were included. The odds ratios (ORs) for sleep-related adverse effects were addressed with network meta-analysis. A Bayesian approach was used to depict the dose-effect relationship. Heterogeneity among studies was assessed using the τ2 and I2 statistics. Sensitivity analyses were performed without studies featuring high risk of bias.</p><p><strong>Results: </strong>Studies with 64 696 patients were examined from 216 trials. Compared to placebo, 13 antidepressants showed higher ORs for somnolence, of which fluvoxamine (OR = 6.32; 95% CI: 3.56 to 11.21) ranked the top. Eleven had higher risks for insomnia, reboxetine ranked the top (OR = 3.47; 95% CI: 2.77 to 4.36). The dose-effect relationships curves between somnolence or insomnia and dose included linear shape, inverted U-shape, and other shapes. There was no significant heterogeneity among individual studies. The quality of evidence for results in network meta-analyses was rated as very low to moderate by Grading of Recommendations Assessment, Development, and Evaluation.</p><p><strong>Conclusions: </strong>Most antidepressants had higher risks for insomnia or somnolence than placebo. The diverse relationship curves between somnolence or insomnia and dose of antidepressants can guide clinicians to adjust the doses. These findings suggest clinicians pay more attention to sleep-related adverse effects during acute treatment with antidepressants.</p>","PeriodicalId":49514,"journal":{"name":"Sleep","volume":" ","pages":""},"PeriodicalIF":5.3000,"publicationDate":"2023-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10566234/pdf/","citationCount":"1","resultStr":"{\"title\":\"Adverse effects of 21 antidepressants on sleep during acute-phase treatment in major depressive disorder: a systemic review and dose-effect network meta-analysis.\",\"authors\":\"Shuzhe Zhou, Pei Li, Xiaozhen Lv, Xuefeng Lai, Zuoxiang Liu, Junwen Zhou, Fengqi Liu, Yiming Tao, Meng Zhang, Xin Yu, Jingwei Tian, Feng Sun\",\"doi\":\"10.1093/sleep/zsad177\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Study objectives: </strong>Sleep-related adverse effects during acute treatment with antidepressants undermine adherence and impede remission. We aimed to address subtypes of sleep-related adverse effects and depict the relationship between dose and sleep-related adverse events.</p><p><strong>Methods: </strong>We searched PubMed, Embase, Cochrane Central Register of Controlled Trials, and Web of Science for double-blind randomized controlled trials of depression published before April 30th, 2023. Eligible studies reporting sleep-related adverse effects during short-term monotherapy were included. The odds ratios (ORs) for sleep-related adverse effects were addressed with network meta-analysis. A Bayesian approach was used to depict the dose-effect relationship. Heterogeneity among studies was assessed using the τ2 and I2 statistics. Sensitivity analyses were performed without studies featuring high risk of bias.</p><p><strong>Results: </strong>Studies with 64 696 patients were examined from 216 trials. Compared to placebo, 13 antidepressants showed higher ORs for somnolence, of which fluvoxamine (OR = 6.32; 95% CI: 3.56 to 11.21) ranked the top. Eleven had higher risks for insomnia, reboxetine ranked the top (OR = 3.47; 95% CI: 2.77 to 4.36). The dose-effect relationships curves between somnolence or insomnia and dose included linear shape, inverted U-shape, and other shapes. There was no significant heterogeneity among individual studies. The quality of evidence for results in network meta-analyses was rated as very low to moderate by Grading of Recommendations Assessment, Development, and Evaluation.</p><p><strong>Conclusions: </strong>Most antidepressants had higher risks for insomnia or somnolence than placebo. The diverse relationship curves between somnolence or insomnia and dose of antidepressants can guide clinicians to adjust the doses. 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引用次数: 1
摘要
研究目的：抗抑郁药急性治疗期间与睡眠相关的不良反应会破坏依从性并阻碍病情缓解。我们旨在解决睡眠相关不良反应的亚型，并描述剂量与睡眠相关不良事件之间的关系。方法：我们检索了PubMed、Embase、Cochrane Central Register of Controlled Trials和Web of Science在2023年4月30日之前发表的抑郁症双盲随机对照试验。纳入了报告短期单药治疗期间睡眠相关不良反应的合格研究。睡眠相关不良反应的比值比（OR）通过网络荟萃分析进行处理。使用贝叶斯方法来描述剂量-效应关系。使用τ2和I2统计来评估研究之间的异质性。进行敏感性分析时没有进行具有高偏倚风险的研究。结果：对216项试验中的64696名患者进行了研究。与安慰剂相比，13种抗抑郁药表现出更高的嗜睡ORs，其中氟伏沙明（OR=6.32；95%CI:3.56至11.21）位居榜首。11人失眠风险较高，瑞波西汀排在首位（OR=3.47；95%CI:2.77~4.36）。嗜睡或失眠与剂量之间的量效关系曲线包括线性、倒U形和其他形状。个体研究之间没有显著的异质性。网络荟萃分析结果的证据质量被建议评估、发展和评估分级评定为极低至中等。结论：大多数抗抑郁药比安慰剂有更高的失眠或嗜睡风险。嗜睡或失眠与抗抑郁药剂量之间的不同关系曲线可以指导临床医生调整剂量。这些发现表明临床医生在抗抑郁药的急性治疗过程中更加关注睡眠相关的不良反应。
Adverse effects of 21 antidepressants on sleep during acute-phase treatment in major depressive disorder: a systemic review and dose-effect network meta-analysis.
Study objectives: Sleep-related adverse effects during acute treatment with antidepressants undermine adherence and impede remission. We aimed to address subtypes of sleep-related adverse effects and depict the relationship between dose and sleep-related adverse events.
Methods: We searched PubMed, Embase, Cochrane Central Register of Controlled Trials, and Web of Science for double-blind randomized controlled trials of depression published before April 30th, 2023. Eligible studies reporting sleep-related adverse effects during short-term monotherapy were included. The odds ratios (ORs) for sleep-related adverse effects were addressed with network meta-analysis. A Bayesian approach was used to depict the dose-effect relationship. Heterogeneity among studies was assessed using the τ2 and I2 statistics. Sensitivity analyses were performed without studies featuring high risk of bias.
Results: Studies with 64 696 patients were examined from 216 trials. Compared to placebo, 13 antidepressants showed higher ORs for somnolence, of which fluvoxamine (OR = 6.32; 95% CI: 3.56 to 11.21) ranked the top. Eleven had higher risks for insomnia, reboxetine ranked the top (OR = 3.47; 95% CI: 2.77 to 4.36). The dose-effect relationships curves between somnolence or insomnia and dose included linear shape, inverted U-shape, and other shapes. There was no significant heterogeneity among individual studies. The quality of evidence for results in network meta-analyses was rated as very low to moderate by Grading of Recommendations Assessment, Development, and Evaluation.
Conclusions: Most antidepressants had higher risks for insomnia or somnolence than placebo. The diverse relationship curves between somnolence or insomnia and dose of antidepressants can guide clinicians to adjust the doses. These findings suggest clinicians pay more attention to sleep-related adverse effects during acute treatment with antidepressants.
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