Although prior meta-analyses exist, none included the large Prazosin and Combat Trauma PTSD (PACT) trial, which adds substantive new data and insights, and raises questions, regarding the likely effects of prazosin on nightmares, sleep quality, PTSD symptoms. Several randomized controlled trials (RCTs) have reported the effects of prazosin on nightmares in patients with PTSD, but individual trial results have been imprecise, and there remains uncertainty about the associations of prazosin with overall sleep quality and overall PTSD symptoms. Prazosin, a centrally acting α1-adrenergic receptor antagonist, was hypothesized to counteract noradrenergic stimulation and, therefore, potentially reduce the startle response and primitive fear response. Beginning in 2010, the AASM gave only one pharmacological agent, prazosin, a level-A recommendation for the treatment of nightmares in adults. antidepressants, antipsychotics, and benzodiazepine) on sleep disturbances in PTSD, are still a matter of controversy. With respect to pharmacological treatment, the effects of various drugs (i.e. Of these, IRT, a well-supported cognitive behavioral intervention, was given a level-A recommendation for the treatment of PTSD-associated nightmares by the American Academy of Sleep Medicine (AASM) in 2010, and is still recommended in a recent AASM position paper. Some variants of cognitive behavioral therapy (CBT) including sleep dynamic therapy, lucid dreaming therapy, and systematic desensitization, exposure, relaxation and rescripting therapy, and image rehearsal therapy (IRT) have received attention as potential treatments for nightmares. In recent years, some non-pharmacological treatment options, such as progressive deep muscle relaxation training, hypnosis, eye movement desensitization and reprocessing, have been suggested as options for the treatment of nightmares. Nightmares and other sleep disturbances often persist at clinically significant levels following PTSD treatment, and require additional targeted treatment interventions. Recurrent nightmares have been associated with poor overall sleep quality, depression, and heightened risk of suicide. Nightmares are a highly prevalent and distressing feature of PTSD. Post-traumatic stress disorder (PTSD) is a maladaptive response to a traumatic event and is characterized by intrusive thoughts related to the event, negative mood and cognitions, avoidance of reminders of the event, and heightened arousal and reactivity. Our findings indicate that additional studies are needed before considering downgrading the use of prazosin in the treatment of nightmares in patients with PTSD. In conclusion, the use of prazosin was associated with an improvement of nightmare symptoms. In terms of acceptability, there was no significant difference between the prazosin group and the placebo group with respect to discontinuation for all causes (odds ratio (OR) = 1.00, 95% CI = 0.62–1.62). In our meta-analysis, prazosin resulted in a statistically significant improvement in nightmares (standardized mean difference (SMD) = −1.13, 95% confidence interval (CI) = −1.91 to −0.36), but was not more beneficial than placebo for overall PTSD symptoms (SMD = −0.45, 95% CI = −0.95 to 0.05) and sleep quality (SMD = −0.44, 95%CI = −1.44 to 0.55). The analysis included data from eight trials involving 286 PTSD patients in the prazosin group and 289 PTSD patients in the placebo group. MEDLINE, EMBASE, all EBM databases, PsycIFNO and CINAHL were systematically searched from inception date to October 2018 for randomized clinical trials that included reporting of nightmares, sleep quality or overall PTSD symptoms. Previous studies have reached mixed conclusions regarding the effects of prazosin on nightmares, sleep quality and overall PTSD symptoms in patients with PTSD. Nightmares are a highly prevalent and distressing feature of post-traumatic stress disorder (PTSD).
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