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      Pharmacologic Treatment Options for Insomnia in Patients with Schizophrenia

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          Abstract

          Background: Symptoms of sleep disorders, such as disturbances in sleep initiation and continuity, are commonly reported in patients with schizophrenia, especially in the acute phase of illness. Studies have shown that up to 80% of patients diagnosed with schizophrenia report symptoms of insomnia. Sleep disturbances have been shown to increase the risk of cognitive dysfunction and relapse in patients with schizophrenia. Currently, there are no medications approved specifically for the treatment of insomnia in patients with schizophrenia. Methods: A literature search was performed through OVID and PubMed to compile publications of pharmacotherapy options studied to treat insomnia in patients with schizophrenia. Articles were reviewed from 1 January 2000 through 1 March 2018 with some additional earlier articles selected if deemed by the authors to be particularly relevant. Results: Pharmacotherapies collected from the search results that were reviewed and evaluated included melatonin, eszopiclone, sodium oxybate, and antipsychotics. Conclusions: Overall, this review confirmed that there are a few evidence-based options to treat insomnia in patients with schizophrenia, including selecting a more sedating second-generation antipsychotic such as paliperidone, or adding melatonin or eszopiclone. Further randomized controlled trials are needed.

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          Clinical Practice Guideline for the Pharmacologic Treatment of Chronic Insomnia in Adults: An American Academy of Sleep Medicine Clinical Practice Guideline.

          Michael J Sateia, Daniel J. Buysse, Andrew Krystal … (2017)
          The purpose of this guideline is to establish clinical practice recommendations for the pharmacologic treatment of chronic insomnia in adults, when such treatment is clinically indicated. Unlike previous meta-analyses, which focused on broad classes of drugs, this guideline focuses on individual drugs commonly used to treat insomnia. It includes drugs that are FDA-approved for the treatment of insomnia, as well as several drugs commonly used to treat insomnia without an FDA indication for this condition. This guideline should be used in conjunction with other AASM guidelines on the evaluation and treatment of chronic insomnia in adults.
          Article 0 comments Cited 326 times – based on 0 reviews     Review now
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            The efficacy and safety of exogenous melatonin for primary sleep disorders. A meta-analysis.

            Nina Buscemi, Ben Vandermeer, Nicola Hooton … (2005)
            Exogenous melatonin has been increasingly used in the management of sleep disorders. To conduct a systematic review of the efficacy and safety of exogenous melatonin in the management of primary sleep disorders. A number of electronic databases were searched. We reviewed the bibliographies of included studies and relevant reviews and conducted hand-searching. Randomized controlled trials (RCTs) were eligible for the efficacy review, and controlled trials were eligible for the safety review. One reviewer extracted data, while the other verified data extracted. The Random Effects Model was used to analyze data. Melatonin decreased sleep onset latency (weighted mean difference [WMD]: -11.7 minutes; 95% confidence interval [CI]: -18.2, -5.2)); it was decreased to a greater extent in people with delayed sleep phase syndrome (WMD: -38.8 minutes; 95% CI: -50.3, -27.3; n=2) compared with people with insomnia (WMD: -7.2 minutes; 95% CI: -12.0, -2.4; n=12). The former result appears to be clinically important. There was no evidence of adverse effects of melatonin. There is evidence to suggest that melatonin is not effective in treating most primary sleep disorders with short-term use (4 weeks or less); however, additional large-scale RCTs are needed before firm conclusions can be drawn. There is some evidence to suggest that melatonin is effective in treating delayed sleep phase syndrome with short-term use. There is evidence to suggest that melatonin is safe with short-term use (3 months or less).
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              Efficacy and safety of exogenous melatonin for secondary sleep disorders and sleep disorders accompanying sleep restriction: meta-analysis.

              Nina Buscemi, Ben Vandermeer, Nicola Hooton … (2006)
              To conduct a systematic review of the efficacy and safety of exogenous melatonin in managing secondary sleep disorders and sleep disorders accompanying sleep restriction, such as jet lag and shiftwork disorder. 13 electronic databases and reference lists of relevant reviews and included studies; Associated Professional Sleep Society abstracts (1999 to 2003). The efficacy review included randomised controlled trials; the safety review included randomised and non-randomised controlled trials. QUALITY ASSESSMENT: Randomised controlled trials were assessed by using the Jadad Scale and criteria by Schulz et al, and non-randomised controlled trials by the Downs and Black checklist. One reviewer extracted data and another reviewer verified the data extracted. The inverse variance method was used to weight studies and the random effects model was used to analyse data. Six randomised controlled trials with 97 participants showed no evidence that melatonin had an effect on sleep onset latency in people with secondary sleep disorders (weighted mean difference -13.2 (95% confidence interval -27.3 to 0.9) min). Nine randomised controlled trials with 427 participants showed no evidence that melatonin had an effect on sleep onset latency in people who had sleep disorders accompanying sleep restriction (-1.0 (-2.3 to 0.3) min). 17 randomised controlled trials with 651 participants showed no evidence of adverse effects of melatonin with short term use (three months or less). There is no evidence that melatonin is effective in treating secondary sleep disorders or sleep disorders accompanying sleep restriction, such as jet lag and shiftwork disorder. There is evidence that melatonin is safe with short term use.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Medicines (Basel)
                Journal ID (iso-abbrev): Medicines (Basel)
                Journal ID (publisher-id): medicines
                Title: Medicines
                Publisher: MDPI
                ISSN (Electronic): 2305-6320
                Publication date (Electronic): 11 August 2018
                Publication date Collection: September 2018
                Volume: 5
                Issue: 3
                Electronic Location Identifier: 88
                Affiliations
                [1 ]McLean Hospital, Belmont, MA 02478, USA; lauren.stummer@ 123456rwjbh.org
                [2 ]Hackensack University Medical Center-Hackensack Meridian Health, Hackensack, NJ 07601, USA; marija.markovic@ 123456hackensackmeridian.org
                [3 ]Ernest Mario School of Pharmacy at Rutgers, the State University of New Jersey, Piscataway, NJ 08854, USA
                [4 ]Monmouth Medical Center-RWJBarnabas Health, Long Branch, NJ 07740, USA
                Author notes
                [* ]Correspondence: mmaroney@ 123456pharmacy.rutgers.edu ; Tel.: +1-732-222-5200 x 31442
                Author information
                https://orcid.org/0000-0002-2718-6787
                Article
                Publisher ID: medicines-05-00088
                DOI: 10.3390/medicines5030088
                PMC ID: 6165340
                PubMed ID: 30103483
                SO-VID: 207e13f5-a45c-4a51-a669-fb3328757a82
                Copyright © © 2018 by the authors.
                License:

                Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license ( http://creativecommons.org/licenses/by/4.0/).

                History
                Date received : 29 June 2018
                Date accepted : 10 August 2018
                Categories
                Subject: Review

                Keywords: insomnia,schizophrenia,pharmacotherapy,paliperidone,melatonin,sodium oxybate,eszopiclone,antipsychotics
                Data availability:
                Keywords: insomnia, schizophrenia, pharmacotherapy, paliperidone, melatonin, sodium oxybate, eszopiclone, antipsychotics

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