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Advisor(s)
Abstract(s)
Introdução: A esquizofrenia é uma doença psiquiátrica crónica, grave e incapacitante que
afeta milhões de pessoas mundialmente. As perturbações do sono são uma componente
importante nessa população, atingindo uma prevalência de 80%. Apesar da elevada
prevalência, o mecanismo fisiopatológico desta relação ainda é pouco claro e não existem
há data recomendações sólidas para diagnosticar e tratar este problema.
Objetivo:Identificar potenciais tratamentos para as perturbações do sono em doentes com
esquizofrenia.
Métodos: Esta revisão sistemática da literatura incluiu ensaios clínicos aleatorizados
controlados que avaliassem a eficácia de determinada terapêutica farmacológica nas
perturbações do sono em doentes com esquizofrenia, em comparação com um placebo. Para
tal foi realizada uma pesquisa na base de dados PubMed para encontrar estudos publicados
entre janeiro de 2000 e setembro de 2021 sobre esta temática. Os títulos e abstracts foram
depois avaliados de forma independente por dois revisores. O risco de viés foi avaliado
através da “Revised Cochrane risk-of-bias tool for randomized trials (RoB 2) ” e “RoB 2
tool for crossover trials”. O impacto da intervenção no sono foi o outcome principal
avaliado.
Resultados: Foram incluídos cinco ensaios que cumpriram com os critérios de inclusão
definidos. Dois deles estudaram a melatonina, um a eszopiclona, um a olanzapina e um a
lurasidona e a quetiapina. A melatonina provou melhorar a eficiência e profundidade do
sono. A eszopiclona mostrou diminuir a intensidade da insónia e ainda ter um impacto
positivo na memória, bem-estar geral e problemas de concentração. A olanzapina foi
associada a aumento do sono de ondas lentas e não mostrou efeito significativo na memória.
A quetiapina revelou um aumento na sonolência diurna que foi associada a melhoria na
agitação e agravamento da capacidade funcional. Estes efeitos não se verificaram com a
lurasidona.
Discussão: As intervenções estudadas foram na sua globalidade associadas a um melhor
controlo das perturbações do sono na esquizofrenia, mas com grandes variações no que diz
respeito a outcomes secundários e efeitos adversos. Estes fatores deverão ser tidos em conta
no momento da escolha do tratamento para um controlo mais eficaz das perturbações do
sono sem interferir na qualidade de vida dos doentes. Conclusão: As intervenções em estudo – melatonina, eszopiclona, olanzapina, lurasidona
e quetiapina – mostram ser opções válidas no tratamento de distúrbios do sono na
população com esquizofrenia. Recomenda-se investigação futura nesta área para aumentar
a evidência científica destes e outros potenciais tratamentos para as perturbações do sono
em doentes com esquizofrenia.
Introduction: Schizophrenia is a chronic, severe, and disabling psychiatric illness that affects millions of people worldwide. Sleep disorders are an important component in this population, reaching a prevalence of 80%. Despite the high prevalence, the pathophysiological mechanism of this relationship is still unclear and there are no solid recommendations to date to diagnose and treat this problem. Aim: Identify potential treatments for sleep disorders in patients with schizophrenia. Methods: This systematic literature review included randomized controlled clinical trials that evaluated the efficacy of a certain pharmacological therapy on sleep disorders in patients with schizophrenia, compared to a placebo. To this end, a search was carried out in the PubMed database to find studies published between January 2000 and September 2021 on this topic. Titles and abstracts were then independently evaluated by two reviewers. The risk of bias was assessed using the “Revised Cochrane risk-of-bias tool for randomized trials (RoB 2)” and “RoB 2 tool for crossover trials”. The impact of the intervention on sleep was the main outcome assessed. Results: Five trials that met the defined inclusion criteria were included. Two of them studied melatonin, one eszopiclone, one olanzapine and one lurasidone and quetiapine. Melatonin has been proven to improve sleep efficiency and depth. Eszopiclone has been shown to lessen the intensity of insomnia and still has a positive impact on memory, general well-being, and concentration problems. Olanzapine was associated with increased slowwave sleep and showed no significant effect on memory. Quetiapine showed an increase in daytime sleepiness that was associated with improvement in agitation and worsening of functional capacity. These effects were not seen with lurasidone. Discussion: The interventions studied were, in their entirety, associated with better control of sleep disorders in schizophrenia, but with great variations in terms of secondary outcomes and adverse effects. These factors must be taken into account when choosing the treatment for more effective control of sleep disorders without interfering patients' quality of life. Conclusion: The interventions under study – melatonin, eszopiclone, olanzapine, lurasidone, and quetiapine – prove to be valid options in the treatment of sleep disorders in the population with schizophrenia. Future research in this area is recommended to increase the scientific evidence of these and other potential treatments for sleep disorders in patients with schizophrenia.
Introduction: Schizophrenia is a chronic, severe, and disabling psychiatric illness that affects millions of people worldwide. Sleep disorders are an important component in this population, reaching a prevalence of 80%. Despite the high prevalence, the pathophysiological mechanism of this relationship is still unclear and there are no solid recommendations to date to diagnose and treat this problem. Aim: Identify potential treatments for sleep disorders in patients with schizophrenia. Methods: This systematic literature review included randomized controlled clinical trials that evaluated the efficacy of a certain pharmacological therapy on sleep disorders in patients with schizophrenia, compared to a placebo. To this end, a search was carried out in the PubMed database to find studies published between January 2000 and September 2021 on this topic. Titles and abstracts were then independently evaluated by two reviewers. The risk of bias was assessed using the “Revised Cochrane risk-of-bias tool for randomized trials (RoB 2)” and “RoB 2 tool for crossover trials”. The impact of the intervention on sleep was the main outcome assessed. Results: Five trials that met the defined inclusion criteria were included. Two of them studied melatonin, one eszopiclone, one olanzapine and one lurasidone and quetiapine. Melatonin has been proven to improve sleep efficiency and depth. Eszopiclone has been shown to lessen the intensity of insomnia and still has a positive impact on memory, general well-being, and concentration problems. Olanzapine was associated with increased slowwave sleep and showed no significant effect on memory. Quetiapine showed an increase in daytime sleepiness that was associated with improvement in agitation and worsening of functional capacity. These effects were not seen with lurasidone. Discussion: The interventions studied were, in their entirety, associated with better control of sleep disorders in schizophrenia, but with great variations in terms of secondary outcomes and adverse effects. These factors must be taken into account when choosing the treatment for more effective control of sleep disorders without interfering patients' quality of life. Conclusion: The interventions under study – melatonin, eszopiclone, olanzapine, lurasidone, and quetiapine – prove to be valid options in the treatment of sleep disorders in the population with schizophrenia. Future research in this area is recommended to increase the scientific evidence of these and other potential treatments for sleep disorders in patients with schizophrenia.
Description
Keywords
Esquizofrenia Perturbações do Sono Tratamento