Pharmacologic and hormonal treatments for menopausal sleep disturbances: A network meta-analysis of 43 randomized controlled trials and 32,271 menopausal women.

Aged Female Humans Menopause Middle Aged Network Meta-Analysis Randomized Controlled Trials as Topic Sleep
Efficacy Menopause Network meta-analysis Sleep Systematic review Tolerability

Journal

Sleep medicine reviews
ISSN: 1532-2955
Titre abrégé: Sleep Med Rev
Pays: England
ID NLM: 9804678

Informations de publication

Date de publication:
06 2021
Historique:
received: 24 06 2020
revised: 20 12 2020
accepted: 08 02 2021
pubmed: 10 4 2021
medline: 23 11 2021
entrez: 9 4 2021
Statut: ppublish

Résumé

This network meta-analysis aimed at investigating efficacy/tolerability of pharmacologic/hormonal interventions for menopausal sleep disturbances. Major databases were searched for randomized controlled trials (RCTs) examining pharmacologic or hormonal interventions with either placebo or active controlled designs. Primary outcomes were improvements in sleep disturbance severity/tolerability (i.e., overall dropout rates), whereas secondary outcome was adverse event-related discontinuation rates. Analysis of 43 RCTs with 25 treatment arms involving 32,271 women during/after menopausal transition (age: 61.24 ± 4.23, duration: 90.83 ± 66.29 wks) showed therapeutic effect of melatonin-fluoxetine [SMD = -2.47 (95% CI:-4.19-0.74)] against sleep disturbances compared to placebo. Subgroup analysis of 15 RCTs on vasomotor symptoms demonstrated superior benefits of gabapentin [SMD = -1.04 (95% CI:-1.90-0.18)], oral combined hormone therapy [SMD = -0.62 (95% CI:-1.06-0.18)], and bazedoxifene-conjugated estrogens [SMD = -0.50 (95% CI:-0.96-0.04)] to placebo/control. Despite benefits of raloxifene-only [SMD = -1.86 (95% CI:-3.09-0.63)] and raloxifene-oral estrogen [SMD = -2.64 (95% CI:-4.64-0.63)], patient selection may be a confounder. Dropout rates were comparable between interventions and placebo/control. Eszopiclone [RR = 3.84 (95% CI: 1.14-12.87)] and oral combined hormone therapy [RR = 2.51 (95% CI: 1.04-6.07)] were associated with higher rates of adverse event-related discontinuation. The results support combined estrogen-progesterone therapy for menopausal sleep disturbances associated with vasomotor symptoms but showed no significant effects of hypnotics in this clinical setting.

Identifiants

DOI: 10.1016/j.smrv.2021.101469 PMID: 33836486
pubmed: 33836486
pii: S1087-0792(21)00054-X
doi: 10.1016/j.smrv.2021.101469
pii:
doi:

Types de publication

Journal Article Meta-Analysis Research Support, Non-U.S. Gov't Review

Langues

eng

Sous-ensembles de citation

IM

Pagination

101469

Informations de copyright

Copyright © 2021 Elsevier Ltd. All rights reserved.

Déclaration de conflit d'intérêts

Conflicts of interest The authors do not have any conflicts of interest to disclose.

Auteurs

Yu-Shian Cheng (YS)

Department of Psychiatry, Tsyr-Huey Mental Hospital, Kaohsiung Jen-Ai's Home, Kaohsiung, Taiwan; Institute of Biomedical Sciences, National Sun Yat-sen University, Kaohsiung, Taiwan.

Ping-Tao Tseng (PT)

Institute of Biomedical Sciences, National Sun Yat-sen University, Kaohsiung, Taiwan; Prospect Clinic for Otorhinolaryngology & Neurology, Kaohsiung, Taiwan; Department of Psychology, College of Medical and Health Science, Asia University, Taichung, Taiwan.

Ming-Kung Wu (MK)

Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan; Department of Chemical Engineering and Institute of Biotechnology and Chemical Engineering, I-Shou University, Kaohsiung, Taiwan.

Yu-Kang Tu (YK)

Institute of Epidemiology & Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan; Department of Dentistry, National Taiwan University Hospital, Taipei, Taiwan.

Yi-Cheng Wu (YC)

Department of Sports Medicine, Landseed International Hospital, Taoyuan, Taiwan.

Dian-Jeng Li (DJ)

Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Addiction Science, Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, Kaohsiung, Taiwan.

Tien-Yu Chen (TY)

Department of Psychiatry, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan; Institute of Brain Science, National Yang-Ming University, Taipei, Taiwan.

Kuan-Pin Su (KP)

Institute of Neural and Cognitive Sciences, China Medical University Hospital, Taichung, Taiwan; Department of Psychiatry & Mind-Body Interface Laboratory (MBI-Lab), China Medical University Hospital, Taichung, Taiwan; College of Medicine, China Medical University, Taichung, Taiwan.

Brendon Stubbs (B)

Physiotherapy Department, South London and Maudsley NHS Foundation Trust, London, UK; Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, De Crespigny Park, London, UK; Faculty of Health, Social Care and Education, Anglia Ruskin University, Chelmsford, UK.

Andre F Carvalho (AF)

Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Centre for Addiction & Mental Health (CAMH), Toronto, ON, Canada.

Pao-Yen Lin (PY)

Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan; Institute for Translational Research in Biomedical Sciences, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan.

Yutaka J Matsuoka (YJ)

Department of Psychiatry & Mind-Body Interface Laboratory (MBI-Lab), China Medical University Hospital, Taichung, Taiwan; Division of Health Care Research, Center for Public Health Sciences, National Cancer Center Japan, Tokyo, Japan.

Yen-Wen Chen (YW)

Prospect Clinic for Otorhinolaryngology & Neurology, Kaohsiung, Taiwan.

Cheuk-Kwan Sun (CK)

Department of Emergency Medicine, E-Da Hospital, Kaohsiung, Taiwan; School of Medicine for International Students, College of Medicine, I-Shou University, Kaohsiung, Taiwan. Electronic address: lawrence.c.k.sun@gmail.com.

Yow-Ling Shiue (YL)

Institute of Biomedical Sciences, National Sun Yat-sen University, Kaohsiung, Taiwan. Electronic address: shirley@imst.nsysu.edu.tw.

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