| Name: | Description: | Size: | Format: | |
|---|---|---|---|---|
| 840.88 KB | Adobe PDF |
Authors
Abstract(s)
Introdução: A doença de Alzheimer é a forma mais comum de demência. A insónia é a
perturbação do sono mais frequente e as benzodiazepinas constituem a classe
farmacológica mais utilizada no tratamento das perturbações do sono. Atualmente,
verifica-se um aumento significativo do uso de benzodiazepinas como hipnóticos
paralelamente à tendência crescente da prevalência de insónia. Alguma literatura
científica sugere que a utilização crónica de benzodiazepinas se associa ao
desenvolvimento de declínio cognitivo.
Objetivos: Avaliar o recurso a benzodiazepinas aquando da presença de insónia, bem
como o tempo de duração do tratamento, e a sua associação ao desenvolvimento de
demência, especificamente doença de Alzheimer.
Metodologia: Realizou-se uma revisão sistemática da literatura até agosto de 2021
através de pesquisa nas bases de dados MEDLINE e Embase usando uma combinação
dos termos “benzodiazepine*”; “sedative-hypnotic*”; “sedative*”; “sleep medication*”;
“insomnia treatment”; “clonazepam”; “flurazepam”; “temazepam”; “lorazepam”;
“alprazolam”; “triazolam”; “zaleplon”; “zolpidem”; “eszopiclone”; “diazepam”;
“flunitrazepam”; “lormetazepam”; “nitrazepam”; “oxazepam”; “alzheimer’s disease”;
“alzheimer's dementia”; “alzheimer”; “alzheimer disease”; “alzheimer dementia”;
“insomnia”; “sleep disorders”; “Disorders of Initiating and Maintaining Sleep”; “Early
Awakening”. A revisão foi elaborada de acordo com a metodologia PRISMA-P 2020.
Todos os títulos e resumos elegíveis foram avaliados de forma sistemática e
independente por dois revisores com recurso a um formulário de extração de dados. Os
artigos incluídos na revisão cumprem todos os critérios de inclusão e exclusão delineados
no início da mesma. A qualidade foi avaliada através da “JBI Critical Appraisal Checklist
for cohort studies”. O risco de viés foi avaliado através da “Cochrane collaboration’s tool
for assessing risk of bias”: “Risk Of Bias In Non-Randomized Studies - of Interventions
(ROBINS-I)”. A doença de Alzheimer foi o principal outcome avaliado. Após a análise
dos estudos e a avaliação do outcome considerado procedeu-se à síntese narrativa dos
resultados encontrados.
Resultados: Identificaram-se dois estudos coorte, um retrospetivo e um prospetivo,
que enquadravam o objetivo da revisão, bem como os critérios de inclusão e exclusão
definidos. Foi realizado tratamento com benzodiazepinas a 68 participantes no estudo
prospetivo e 4 439 pessoas-ano no estudo retrospetivo. Os participantes tinham idade
igual ou superior a 50 anos e o uso de benzodiazepinas foi superior a um mês. A amostra que realizou tratamento com benzodiazepinas incluía um maior número de pessoas do
sexo feminino, apresentava um maior número de comorbilidades, bem como um menor
nível socioeconómico e menor nível de escolaridade. No estudo retrospetivo verificou-se
um risco significativo de desenvolvimento de doença de Alzheimer, após tratamento com
benzodiazepinas, independentemente da semivida. No estudo prospetivo a prevalência
de doença de Alzheimer não se associou ao tratamento com benzodiazepinas.
Conclusão: O estudo de maior dimensão evidencia um risco significativo de
desenvolvimento de doença de Alzheimer, no entanto, não se verificou uniformidade de
resultados entre os dois estudos. Face ao número reduzido de estudos realizados neste
contexto e atendendo à relevância desta temática, conclui-se que é necessária
investigação futura de forma a compreender a relação estudada, através da realização de
estudos com uma amostra mais abrangente e com um tempo de follow-up mais alargado,
atendendo à necessidade de uniformização dos critérios de diagnóstico e à possibilidade
de causalidade reversa.
Introduction: Alzheimer's disease is the most common form of dementia. Insomnia is the most frequent sleep disorder and benzodiazepines are the most widely used pharmacological class in the treatment of sleep disorders. Currently, there is a significant increase in the use of benzodiazepines as hypnotics in parallel with the increasing trend in the prevalence of insomnia. Some scientific literature suggests that the chronic use of benzodiazepines is associated with the development of cognitive decline. Objectives: To evaluate the use of benzodiazepines in the presence of insomnia, as well as the duration of treatment, and its association with the development of dementia, specifically Alzheimer's disease. Methodology: A systematic review of the literature was carried out until August 2021 through research in the MEDLINE and Embase databases using a combination of the terms “benzodiazepine*”; “sedative-hypnotic*”; “sedative*”; “sleep medication*”; “insomnia treatment”; “clonazepam”; “flurazepam”; “temazepam”; “lorazepam”; “alprazolam”; “triazolam”; “zaleplon”; “zolpidem”; “eszopiclone”; “diazepam”; “flunitrazepam”; “lormetazepam”; “nitrazepam”; “oxazepam”; “alzheimer’s disease”; “alzheimer's dementia”; “alzheimer”; “alzheimer disease”; “alzheimer dementia”; “insomnia”; “sleep disorders”; “Disorders of Initiating and Maintaining Sleep”; “Early Awakening”. The review was prepared according to the PRISMA-P 2020 methodology. All eligible titles and abstracts were evaluated systematically and independently by two reviewers using a data extraction form. The articles included in the review meet all the inclusion and exclusion criteria outlined at the beginning of the review. Quality was assessed using the "JBI Critical Appraisal Checklist for cohort studies". The risk of bias was assessed using the "Cochrane collaboration's tool for assessing risk of bias": "Risk Of Bias In Non-Randomized Studies - of Interventions (ROBINS-I)". Alzheimer's disease was the main outcome evaluated. After the analysis of the studies and the evaluation of the outcome considered, the narrative synthesis of the results found was carried out. Results: Two cohort studies were identified, one retrospective and one prospective, which met the objective of the review, as well as the inclusion and exclusion criteria defined. Treatment with benzodiazepines was performed on 68 participants in the prospective study and 4 439 person-years in the retrospective study. Participants were 50 years of age or older and the minimum length of use was one month. The sample that underwent treatment with benzodiazepines included a greater number of female people, had a higher number of comorbidities, as well as a lower socioeconomic level and lower level of education. In the retrospective study, there was a significant risk of developing Alzheimer's disease after treatment with benzodiazepines, regardless of half-life. In the prospective study, the prevalence of Alzheimer's disease was not associated with treatment with benzodiazepines. Conclusion: The larger study shows a significant risk of developing Alzheimer's disease, however, there was no uniformity of results between the two studies. Given the small number of studies carried out in this context and given the relevance of this topic, it is concluded that future research is necessary aiming to understand the relationship studied, by conducting studies with a larger sample and with a longer follow-up time, given the need for standardization of diagnostic criteria and the possibility of reverse causality.
Introduction: Alzheimer's disease is the most common form of dementia. Insomnia is the most frequent sleep disorder and benzodiazepines are the most widely used pharmacological class in the treatment of sleep disorders. Currently, there is a significant increase in the use of benzodiazepines as hypnotics in parallel with the increasing trend in the prevalence of insomnia. Some scientific literature suggests that the chronic use of benzodiazepines is associated with the development of cognitive decline. Objectives: To evaluate the use of benzodiazepines in the presence of insomnia, as well as the duration of treatment, and its association with the development of dementia, specifically Alzheimer's disease. Methodology: A systematic review of the literature was carried out until August 2021 through research in the MEDLINE and Embase databases using a combination of the terms “benzodiazepine*”; “sedative-hypnotic*”; “sedative*”; “sleep medication*”; “insomnia treatment”; “clonazepam”; “flurazepam”; “temazepam”; “lorazepam”; “alprazolam”; “triazolam”; “zaleplon”; “zolpidem”; “eszopiclone”; “diazepam”; “flunitrazepam”; “lormetazepam”; “nitrazepam”; “oxazepam”; “alzheimer’s disease”; “alzheimer's dementia”; “alzheimer”; “alzheimer disease”; “alzheimer dementia”; “insomnia”; “sleep disorders”; “Disorders of Initiating and Maintaining Sleep”; “Early Awakening”. The review was prepared according to the PRISMA-P 2020 methodology. All eligible titles and abstracts were evaluated systematically and independently by two reviewers using a data extraction form. The articles included in the review meet all the inclusion and exclusion criteria outlined at the beginning of the review. Quality was assessed using the "JBI Critical Appraisal Checklist for cohort studies". The risk of bias was assessed using the "Cochrane collaboration's tool for assessing risk of bias": "Risk Of Bias In Non-Randomized Studies - of Interventions (ROBINS-I)". Alzheimer's disease was the main outcome evaluated. After the analysis of the studies and the evaluation of the outcome considered, the narrative synthesis of the results found was carried out. Results: Two cohort studies were identified, one retrospective and one prospective, which met the objective of the review, as well as the inclusion and exclusion criteria defined. Treatment with benzodiazepines was performed on 68 participants in the prospective study and 4 439 person-years in the retrospective study. Participants were 50 years of age or older and the minimum length of use was one month. The sample that underwent treatment with benzodiazepines included a greater number of female people, had a higher number of comorbidities, as well as a lower socioeconomic level and lower level of education. In the retrospective study, there was a significant risk of developing Alzheimer's disease after treatment with benzodiazepines, regardless of half-life. In the prospective study, the prevalence of Alzheimer's disease was not associated with treatment with benzodiazepines. Conclusion: The larger study shows a significant risk of developing Alzheimer's disease, however, there was no uniformity of results between the two studies. Given the small number of studies carried out in this context and given the relevance of this topic, it is concluded that future research is necessary aiming to understand the relationship studied, by conducting studies with a larger sample and with a longer follow-up time, given the need for standardization of diagnostic criteria and the possibility of reverse causality.
Description
Keywords
Alzheimer Benzodiazepinas Insónia