Psychotherapeutic and pharmacological agents for post-traumatic stress disorder with sleep disorder: Network meta-analysis

Objective: The current guidelines and canonical norms of diagnosis or treatment for post-traumatic stress disorder (PTSD) with sleep disorder are still conflicting and have not yet reached a consensus. This study aimed to unravel the most effective countermeasures between two categories (psychotherapy and pharmacotherapy) put forward by the National Institute for Health and Clinical Excellence (NICE) and World Federation of Societies of Biological Psychiatry (WFSBP) respectively to treat PTSD individuals co-exist with sleep disorders.

Methods: Four databases, including PubMed, EMBASE, Cochrane Library, and APA PsyNet, were searched from inception to February 02, 2023.

Results: Twenty articles with 24 Randomized controlled trials (RCTs) and a total number of 1,647 participants were included. As demonstrated in the network meta-analysis comparison results, CBT-I (standardized mean differences (SMD) = -1.51, 95% confidence interval (CI): -2.55 to -0.47), CBT-I plus IRT (SMD = -1.71, 95% CI: -3.39, -0.03), prazosin (SMD = -0.87,95% CI: -1.59 to -0.16) and hydroxyzine (SMD = -1.06, 95% CI: -1.94 to -0.19) significantly reduced PTSD symptoms compared with placebo. In contrast to placebo, CBT-I (SMD = -5.61,95% CI: -8.82 to -2.40) significantly improved sleep quality. For nightmare severity, IRT (SMD =-0.65, 95% CI: -1.00 to -0.31), prazosin (SMD = -1.20,95% CI: -1.72 to -0.67) and hydroxyzine (SMD = -0.98, 95%CI: -1.58 to -0.37) significantly reduced nightmare severity in comparison with placebo.

Conclusions: This study suggested that under most circumstances, psychotherapy namely CBT-I had a favorable profile, but pharmacotherapy with prazosin was effective in managing nightmare severity. The sole avail of CBT-I was recommended to improving sleep quality while CBT-I and CBT-I plus IRT showed excellent management of PTSD symptom severity. Exposure to CBT-I is recommended for depression. The relevant clinical guidelines for the management of individuals with PTSD and sleep disorders may regard this as a reference.