Tratamento da Insónia no Doente Idoso Hospitalizado

Autores

DOI:

https://doi.org/10.24950/rspmi.458

Palavras-chave:

Distúrbios do Início e da Manutenção do Sono, Hospitalização, Idoso

Resumo

Existem múltiplos fatores que podem contribuir para uma má qualidade de sono no doente idoso hospitalizado. Os clínicos têm à disposição várias intervenções não farmacológicas e farmacológicas. O presente artigo pretende fazer uma revisão narrativa das diferentes opções terapêuticas. No tratamento da insónia do doente idoso hospitalizado deve ser dada primazia às medidas não farmacológicas que irão melhorar a qualidade do sono e consequentemente melhorar o bem-estar e a sua recuperação. Algumas medidas podem ser aplicadas durante o dia sendo disso exemplo minimizar sestas diurnas, prevenir e tratar delirium bem como pesquisar e tratar doenças do sono que não estejam diagnosticadas. Relativamente às medidas farmacológicas, mais do que salientar os fármacos com menos efeitos prejudiciais, pretendemos reforçar a evicção de alguns fármacos, pelos seus efeitos adversos e impacto nas outras comorbilidades destes doentes, como as benzodiazepinas com semivida longa e os anti-histamínicos.

Outros fármacos a considerar na prática clínica são os não-benzodiazepinicos como o zolpidem e antidepressivos com efeito sedativo como a mirtazapina e a trazodona.

Downloads

Não há dados estatísticos.

Referências

Berlin RM. Management of insomnia in hospitalized patients. Ann Intern Med. 1984;100:398-404. doi:10.7326/0003-4819-100-3-398

Meissner HH, Riemer A, Santiago SM, Stein M, Goldman MD, Williams AJ. Failure of physician documentation of sleep complaints in hospitalized patients. West J Med. 1998;169:146-9.

Isaia G, Corsinovi L, Bo M, et al. Insomnia among hospitalized elderly patients: Prevalence, clinical characteristics and risk factors. Arch Gerontol Geriatr. 2011;52:133-7. doi:10.1016/j.archger.2010.03.001

Reis C, Dias S, Rodrigues AM, Santos-Pereira P, Michelis G, Aimonino N, et al. Sleep duration, lifestyles and chronic diseases: A cross-sectional population-based study. Sleep Sci. 2018;11:217-30. doi:10.5935/1984- 0063.20180036

Riemann D, Baglioni C, Bassetti C, Bjorvatn B, Dolenc Groselj L, Ellis JG, et al. European guideline for the diagnosis and treatment of insomnia. J Sleep Res. 2017;26:675-700. doi:10.1111/jsr.12594

Flaherty JH. Insomnia Among Hospitalized Older Persons. Clin Geriatr Med. 2008;24:51-67. doi:10.1016/j.cger.2007.08.012

Hshieh TT, Yang T, Gartaganis SL, Yue J, Inouye SK. Hospital Elder Life Program: Systematic Review and Meta-analysis of Effectiveness. Am J Geriatr Psychiatry. 2018;26:1015-33. doi:10.1016/j.jagp.2018.06.007

Lenhart SE, Buysse DJ. Treatment of insomnia in hospitalized patients. Ann Pharmacother. 2001;35:1449-57. doi:10.1345/aph.1A040

Koski RR. Treatment of Insomnia in Hospitalized Patients. US Pharm. 2011;36.

Riemann D, Baglioni C, Bassetti C, Bjorvatn B, Dolenc Groselj L, Ellis JG, et al. European guideline for the diagnosis and treatment of insomnia. J Sleep Res. 2017;26:675-700. doi: 10.1111/jsr.12594.

Woodward M. Hypnosedatives in the Elderly. CNS Drugs. 1999;11:263-79.

Grunstein R. Insomnia. Diagnosis and management. Aust Fam Physician. 2002;31:995-1000.

Kamel NS, Gammack JK. Insomnia in the Elderly: Cause, Approach, and Treatment. Am J Med. 2006;119:463-9. doi:10.1016/j.amjmed.2005.10.051

Laugsand LE, Strand LB, Platou C, Vatten LJ, Janszky I. Insomnia and the risk of incident heart failure: A population study. Eur Heart J. 2014;35:1382- 93. doi:10.1093/eurheartj/eht019

Direção Geral da Saúde. Norma – tratamento sintomático da ansiedade e insónia com benzodiazepinas e fármacos análogos. Número 055/2011. Lisboa: DGS; 2015.

Chiaro G, Castelnovo A, Bianco G, Maffei P, Manconi M. Severe Chronic Abuse of Zolpidem in Refractory Insomnia. J Clin Sleep Med. 2018;14:1257-9. doi:10.5664/jcsm.7240

Sateia MJ, Buysse DJ, Krystal AD, Neubauer DN, Heald JL. Clinical Practice Guideline for the Pharmacologic Treatment of Chronic Insomnia in Adults: An American Academy of Sleep Medicine Clinical Practice Guideline. J Clin Sleep Med. 2017;13:307-49. doi: 10.5664/jcsm.6470.

Patel D, Steinberg J, Patel P. Insomnia in the Elderly: A Review. J Clin Sleep Med. 2018;14:1017-24. doi: 10.5664/jcsm.7172.

Infarmed. Circular Informativa N.o 111/CD/8.1.7. Zolpidem – Conclusão Da Revisão de Segurança.; 2014. [accessed April 2021] Disponível em: http://www.infarmed.pt.

Dolder CR, Nelson MH. Hypnosedative-induced complex behaviours : incidence, mechanisms and management. CNS Drugs. 2008;22:1021-36. doi: 10.2165/0023210-200822120-00005.

Stranks EK, Crowe SF. The acute cognitive effects of zopiclone, zolpidem, zaleplon, and eszopiclone: a systematic review and meta-analysis. J Clin Exp Neuropsychol. 2014;36:691-700. doi: 10.1080/13803395.2014.928268.

Tom SE, Wickwire EM, Park Y, Albrecht JS. Nonbenzodiazepine sedative hypnotics and risk of fall-related injury. Sleep. 2016;39:1009-14. doi:10.5665/sleep.5742

Sun Y, Lin C, Lu C, Hsu C, Kao C. Association Between Zolpidem and Suicide: A Nationwide Population-Based Case-Control Study. Mayo Clin Proc. 2015:1-8. doi:10.1016/j.mayocp.2015.10.022

Kripke DF, Langer RD, Kline LE. Hypnotics’ association with mortality or cancer: A matched cohort study. BMJ Open. 2012;2. doi:10.1136/bmjopen-2012-000850

Young JS, Bourgeois JA, Hilty DM, Hardin KA. Sleep in hospitalized medical patients, Part 2: Behavioral and pharmacological management of sleep disturbances. J Hosp Med. 2009;4:50-9. doi:10.1002/jhm.397

Jaffer KY, Chang T, Vanle B, Dang J, Steiner AJ, Loera N, et al. Trazodone for Insomnia: A Systematic Review. Innov Clin Neurosci. 2017;14:24-34.

Leonard SD, Karlamangla A. Dose-Dependent Sedating and Stimulating Effects of Mirtazapine. Proc UCLA Heal. 2015;19. doi:10.1016/j. smrv.2010.11.003

Altınyazar V, Kiylioglu N. Insomnia and dementia: is agomelatine treatment helpful? Case report and review of the literature. Ther Adv Psychopharmacol. 2016;6:263-8. doi:10.1177/2045125316646064

Infarmed. Circular Informativa N.o 211/CD/8.1.7. Agomelatina – Recomendações de Segurança.; 2014. [accessed April 2021] Disponível em: http:// www.infarmed.pt

Auld F, Maschauer EL, Morrison I, Skene DJ, Riha RL. Evidence for the efficacy of melatonin in the treatment of primary adult sleep disorders. Sleep Med Rev. 2017;34:10-22. doi:10.1016/j.smrv.2016.06.005

European Medicines Agency. Anexo I - Resumo das Características do Medicamento - Circardin. 2012:1-29. [accessed April 2021] Disponível em: http://www.ema.europa.eu/docs/pt_PT/document_library/EPAR_Product_Information/human/000829/WC500041059.pdf.

White B, Snyder HS, Patel MV. Evaluation of Medications Used for Hospitalized Patients With Sleep Disturbances: A Frequency Analysis and Literature Review. J Pharm Pract. 2021:089719002110178. doi:10.1177/08971900211017857

Olde Rikkert MGM, Rigaud ASP. Melatonin in elderly patients with insomnia: A systematic review. Z Gerontol Geriatr. 2001;34:491-7. doi:10.1007/s003910170025

Schroeck JL, Ford J, Conway EL, et al. Review of Safety and Efficacy of Sleep Medicines in Older Adults. Clin Ther. 2016;38:2340-72. doi:10.1016/j.clinthera.2016.09.010

Alves M, Macedo IM, Távora C, Silva JF, Fonseca T. Sleep Disturbances Management in Elderly Hospitalized Patients. J Pharm Pract. 2021;8971900211053287. doi:10.1177/08971900211053287

Bromley SM. Chronic Insomnia : A Practical Review. Am Fam Physician. 1999;60:1431-8.

Staevska M, Gugutkova M, Lazarova C, Kralimarkova T, Dimitrov V, Zuberbier T, et al. Night-time sedating H1 -antihistamine increases daytime somnolence but not treatment efficacy in chronic spontaneous urticaria: a randomized controlled trial. Br J Dermatol. 2014;171:148-54. doi: 10.1111/bjd.12846.

Hayley AC, Williams LJ, Kennedy GA, Holloway KL, Berk M, Brennan-Olsen SL, etal. Excessive daytime sleepiness and falls among older men and women: cross-sectional examination of a population-based sample. BMC Geriatr. 2015 ;15:74. doi: 10.1186/s12877-015-0068-2.

American Geriatrics Society 2012 Beers Criteria Update Expert Panel. American Geriatrics Society updated Beers Criteria for potentially inappropriate medication use in older adults. J Am Geriatr Soc. 2012;60:616-31. doi: 10.1111/j.1532-5415.2012.03923.x.

Thannickal TC, Moore RY, Nienhuis R, Ramanathan L, Gulyani S, Aldrich M, et al. Reduced number of hypocretin neurons in human narcolepsy. Neuron. 2000;27:469-74. doi: 10.1016/s0896-6273(00)00058-1.

Janto K, Prichard JR, Pusalavidyasagar S. An update on dual orexin receptor antagonists and their potential role in insomnia therapeutics. J Clin Sleep Med. 2018;14:1399-408. doi:10.5664/jcsm.7282

Herring WJ, Snyder E, Budd K, Hutzelmann J, Snavely D, Liu K, et al. Orexin receptor antagonism for treatment of insomnia: a randomized clinical trial of suvorexant. Neurology. 2012;79:2265-74. doi: 10.1212/ WNL.0b013e31827688ee.

Mignot E, Mayleben D, Fietze I, Leger D, Zammit G, Bassetti CL, et al. Safety and efficacy of daridorexant in patients with insomnia disorder: results from two multicentre, randomised, double-blind, placebo-controlled, phase 3 trials. Lancet Neurol. 2022;21:125-39. doi: 10.1016/S1474- 4422(21)00436-1. Erratum in: Lancet Neurol. 2022 Jan 20: Erratum in: Lancet Neurol. 2022;21:e6.

Mieda M, Tsujino N, Sakurai T. Differential roles of orexin receptors in the regulation of sleep/ wakefulness. Front Endocrinol. 2013;4:57. doi: 10.3389/fendo.2013.00057.

Campos L. Protocolos em Medicina interna. Lisboa: Lidel ; 2013.

Downloads

Publicado

22-09-2022

Como Citar

1.
Távora C, Silva J, Alves M, Fonseca T, Paiva TP. Tratamento da Insónia no Doente Idoso Hospitalizado. RPMI [Internet]. 22 de Setembro de 2022 [citado 7 de Dezembro de 2022];29(3):215-20. Disponível em: https://revista.spmi.pt/index.php/rpmi/article/view/458

Edição

Secção

Artigos de Revisão

Categorias