Sleep Science Friday: The burden of polypharmacy in sleep disorders
05 February 2021
Knowledge of pharmacokinetics and pharmacodynamics is essential to the understanding of potential drug-drug interactions and their consequences. We invite you to watch the e-lesson on the effects of pharmacological agents on sleep and vigilance given by Prof.Tarja Porkka-Heiskanen. You will learn about the brain-related factors which affect the drug effects, mechanisms of neurotransmission, and vigilance-related side effects of commonly used medications.
Polypharmacy, defined as the use of multiple (or even excessive and unjustified) medication is one of the challenges of modern medicine. It is very frequent in comorbid and elderly patients (Patel P. et al. 2017 ) and was shown to be associated with adverse effects and drug-drug interactions. The latter includes pharmacokinetic (an interaction at the level of absorption, distribution, metabolism, and/or excretion) and pharmacodynamic (an additive interaction or a counteraction at the level of receptor sites) interactions (Palleria C. et al. 2013). Both types of drug-drug interactions were shown to occur frequently (exceeding 50%) with drugs used to treat psychiatric pathology, seizures and sleep disorders (Nelson S. et al. 2014 ), and with the inappropriate use of sedatives and hypnotics in particular.
No less important is the understanding of the impact of sleep-related medications on brain function and sleep parameters in comorbid patients. The Journal of Sleep Research has recently published a collaborative Swiss-German randomised, double‐blind, placebo‐controlled crossover study which assessed the safety of the sedative medication Daridorexant in patients with comorbid chronic obstructive pulmonary disease and insomnia (Boof M. et al. 2021). The authors demonstrated that Daridorexantcan be safely used as it does not impair nocturnal respiratory function and improves sleep parameters. The identification of clinically significant drug-drug interactions and their proper management are a necessary step to prevent deleterious consequences. Deprescribing these drugs are one of the approaches to decrease the burden of polypharmacy and, in particular, of the inappropriate use of drugs (Pottie K. et al. 2018, Bjerre L. et al, 2018 ; Lee J et al. 2019 ). The approaches should be flexible, individualized, and include a gradual taper according to a developed plan, assessment of favourable predictors and psychological factors (Allary A et al. 2020 ), perceived barriers and facilitators (Kuntz J. et al. 2018 ), specific education provided by medical doctors, nurses (Reynolds J. et al. 2020 ), leaflets (Wilson M et al. 2018 ), pharmacists (Kuntzet al, 2019 ), social support, active engagement of patients and caregivers (Garfinkel D. 2018 ), as well as GPs (Carrier H. et al. 2019 ), physical medicine methods (Geller A. et al. 2012), lifestyle interventions (Martinez-Gomez et al., 2018 ) and close monitoring. Behavioral therapies alone or cognitive behavioral therapy (CBT) were shown to be highly helpful (Hintze et al. 2020). The combination of different methods shows higher efficacy and safety (Reeve E. et al, 2017 ) and leads to a decrease in adverse effects and drug-drug interactions (Garfinkel D., 2018 ).
You can learn more about CBT in insomnia, and find news from the European Academy for Cognitive-Behavorial Treatment of Insomnia here .
Recent publications from the ESRS members:
- DelRosso,Mogavero and Ferri (2021) Restless Sleep Disorder, Restless Legs Syndrome and Periodic Limb movement Disorder – Sleep in Motion! Pediatr Pulmonol.
- Alventeet al. (2021) . Autonomic Mechanisms Of Blood Pressure Alterations During Sleep In Orexin/Hypocretin-Deficient Narcoleptic Mice. Sleep.
- SvedmyrS et al. (2021). Superior hypertension control with betablockade in the European Sleep Apnea Database. J Hypertens.
- RaposoD et al. (2021). Drug-Induced Sleep Endoscopy in Pediatric Obstructive Sleep Apnea. Otolaryngol Head Neck Surg.
- Santoso et al. (2021) Poor sleep quality among newly diagnosed head and neck cancer patients: prevalence and associated factors. Support Care Cancer.
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