Dataset Information

Efficacy and Tolerability of Gabapentin in Adults with Sleep Disturbance in Medical Illness: A Systematic Review and Meta-analysis.

ABSTRACT:

Background and purpose

The aim of this study was to systematically review the efficacy and tolerability of gabapentin in the treatment of sleep disturbance in patients with medical illness.

Methods

PubMed was searched for randomized, double-blinded, placebo-controlled trials that reported sleep changes during gabapentin treatment up to November 2015.

Findings

This review included 26 studies involving 4,684 participants. Except for Composite Endpoint 3 [standardized mean difference (SMD)?=?0.09, 95% confidence interval (CI): -0.05-0.22] compared with the placebo group, the gabapentin group showed superior outcomes on our endpoints: Composite Endpoint 1 (SMD?=?0.50, 95% CI: 0.28-0.71), Composite Endpoint 2 (SMD?=?-0.53, 95% CI: -0.77 to -0.30), Composite Endpoint 4 (SMD?=?-0.38, 95% CI: -0.58 to -0.19), Composite Endpoint 5 [risk ratio (RR)?=?1.79, 95% CI: 1.24-2.58], and Composite Endpoint 6 (RR?=?0.48, 95% CI: 0.32-0.72). However, the patients in the gabapentin group showed worse tolerance than those in the placebo group (RR?=?1.38, 95% CI: 1.08-1.76).

Implications

This study is the first to systematically assess the clinical value of gabapentin for the treatment of sleep disorders. We found that regardless the type of sleep outcomes, gabapentin displayed stable treatment efficacy for sleep disturbance in patients with medical illness. However, when an average dose of approximately 1,800?mg/day was used, the risk of treatment discontinuation or drug withdrawal was relatively high. We recommend that further studies confirm these findings in patients with primary sleep disorders.

SUBMITTER: Liu GJ

PROVIDER: S-EPMC5510619 | biostudies-literature | 2017

REPOSITORIES: biostudies-literature

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Publications

Efficacy and Tolerability of Gabapentin in Adults with Sleep Disturbance in Medical Illness: A Systematic Review and Meta-analysis.

Liu Guang Jian GJ Karim Md Rezaul MR Xu Li Li LL Wang Song Lin SL Yang Chao C Ding Li L Wang Yun-Fu YF

Frontiers in neurology 20170714

<h4>Background and purpose</h4>The aim of this study was to systematically review the efficacy and tolerability of gabapentin in the treatment of sleep disturbance in patients with medical illness.<h4>Methods</h4>PubMed was searched for randomized, double-blinded, placebo-controlled trials that reported sleep changes during gabapentin treatment up to November 2015.<h4>Findings</h4>This review included 26 studies involving 4,684 participants. Except for Composite Endpoint 3 [standardized mean dif ...[more]

PMID: 28769860

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Project description:RationaleSleep disturbance during intensive care unit (ICU) admission is common and severe. Sleep disturbance has been observed in survivors of critical illness even after transfer out of the ICU. Not only is sleep important to overall health and well being, but patients after critical illness are also in a physiologically vulnerable state. Understanding how sleep disturbance impacts recovery from critical illness after hospital discharge is therefore clinically meaningful.ObjectivesThis Systematic Review aimed to summarize studies that identify the prevalence of and risk factors for sleep disturbance after hospital discharge for critical illness survivors.Data sourcesPubMed (January 4, 2017), MEDLINE (January 4, 2017), and EMBASE (February 1, 2017).Data extractionDatabases were searched for studies of critically ill adult patients after hospital discharge, with sleep disturbance measured as a primary outcome by standardized questionnaire or objective measurement tools. From each relevant study, we extracted prevalence and severity of sleep disturbance at each time point, objective sleep parameters (such as total sleep time, sleep efficiency, and arousal index), and risk factors for sleep disturbance.SynthesisA total of 22 studies were identified, with assessment tools including subjective questionnaires, polysomnography, and actigraphy. Subjective questionnaire studies reveal a 50-66.7% (within 1 mo), 34-64.3% (>1-3 mo), 22-57% (>3-6 mo), and 10-61% (>6 mo) prevalence of abnormal sleep after hospital discharge after critical illness. Of the studies assessing multiple time points, four of five questionnaire studies and five of five polysomnography studies show improved aspects of sleep over time. Risk factors for poor sleep varied, but prehospital factors (chronic comorbidity, pre-existing sleep abnormality) and in-hospital factors (severity of acute illness, in-hospital sleep disturbance, pain medication use, and ICU acute stress symptoms) may play a role. Sleep disturbance was frequently associated with postdischarge psychological comorbidities and impaired quality of life.ConclusionsSleep disturbance is common in critically ill patients up to 12 months after hospital discharge. Both subjective and objective studies, however, suggest that sleep disturbance improves over time. More research is needed to understand and optimize sleep in recovery from critical illness.

Project description:BackgroundStudies have investigated the relationship between sleep disturbance and postoperative delirium (PD) but have controversial results. A systematic review and meta-analysis have a high level of evidence to comprehensively evaluate the effect of sleep disturbance on PD. Our study aims to provide available evidence regarding the effect of sleep disturbance on PD.MethodsPubMed, Embase, Cochrane Library, and Web of Science databases were searched for relevant studies from database inception to April 28, 2021. The eligible studies were identified according to the "PICOS" principles. Odds ratio (OR) was used to indicate the effect index, and 95% confidence interval (CI) was applied to express the effect size. The heterogeneity was tested. Subgroup analyses, meta-regression, and sensitivity analysis were also applied. Begg's test was used to test potential publication bias. The modified Newcastle-Ottawa Scale (NOS) was used to evaluate the literature quality.ResultsTotally, 18 articles including 2,714 patients were enrolled, with most of the included literature being of moderate to high quality. The results of systematic and meta-analysis suggested that sleep disturbance was associated with an increased risk of PD (OR: 3.731; 95% CI: 2.338 to 5.956). Subgroup analysis results demonstrated that sleep disturbance in patients aged <65 years (OR: 6.072; 95% CI: 3.054 to 12.071), aged ≥65 years (OR: 2.904; 95% CI: 1.487 to 5.671), and undergoing cardiac (OR: 3.390; 95% CI: 1.359 to 8.453), orthopedic (OR: 3.943; 95% CI: 2.219 to 7.008), or other surgeries (OR: 4.963; 95% CI: 2.156 to 11.420) increased the risk of PD (all P<0.005). Moreover, increased risk of PD was found for both preoperative (OR: 2.804; 95% CI: 1.517 to 5.184) and postoperative (OR: 6.302; 95% CI: 3.794 to 10.467) sleep disturbance (all P<0.005). No associations between obstructive sleep apnea (OSA; OR: 2.008; 95% CI: 0.753 to 5.354; P=0.164), insomnia (OR: 4.005; 95% CI: 0.636 to 25.203; P=0.139) and risk of PD were observed.ConclusionsOur study indicated the relationship between sleep disturbance and the risk of PD. Patients undergoing surgical treatments should pay attention to their sleep quality. However, more research is needed to confirm its relationship.

Dataset Information

Efficacy and Tolerability of Gabapentin in Adults with Sleep Disturbance in Medical Illness: A Systematic Review and Meta-analysis.

Background and purpose

Methods

Findings

Implications

Publications

Efficacy and Tolerability of Gabapentin in Adults with Sleep Disturbance in Medical Illness: A Systematic Review and Meta-analysis.

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