Hostname: page-component-586b7cd67f-l7hp2 Total loading time: 0 Render date: 2024-11-23T01:19:23.290Z Has data issue: false hasContentIssue false

El reto del insomnio crónico: ¿es el tratamiento hipnótico discontinuo una opción’ viable?

Published online by Cambridge University Press:  12 May 2020

G. Hajak
Affiliation:
Departamento de Psiquiatría y Psicoterapia, Universidad de Regensburg, Alemania
R. Cluydts
Affiliation:
Departamento de Psicología, Universidad Libre de Bruselas, Bélgica
H. Allain
Affiliation:
CHU de Rennes, Laboratorio de Farmacología Experimental y Clínica, Facultad de Medicina, Rennes, Francia
E. Estivill
Affiliation:
Instituto Universitario Dexeus, Barcelona, España
L. Parrino
Affiliation:
Centro de Medicina del Sonno, Instituto de Neurología, Universidad de Parma, Italia
M.G. Terzano
Affiliation:
Centro de Medicina del Sonno, Instituto de Neurología, Universidad de Parma, Italia
J.K. Walsh
Affiliation:
Unidad de Medicina y Centro de Investigación del Sueño, St. Luke's Hospital, Chesterfield, MO, EE.UU.
Get access

Resumen

Los efectos adversos del insomnio sobre la salud y la calidad de vida son asuntos que reciben una atención cada vez mayor. Sin embargo, los estudios han mostrado uniformemente que la mayoría de las personas que sufren de insomnio no buscan ayuda médica, quizá, en parte, a causa de una preocupación por volverse dependientes de la medicación hipnótica. El tratamiento del insomnio crónico plantea un dilema particular, ya que el tratamiento hipnótico continuo está limitado en muchos países a un máximo de cuatro semanas, y no es fácil disponer de tratamiento conductual. El tratamiento hipnótico discontinuo del insomnio crónico ofrece una opción distinta prometedora para los numerosos pacientes cuyos síntomas no requieren el consumo de fármacos todas las noches, aliviando los temores de dependencia psicológica de la medicación y respetando los límites regulatorios sobre el uso de hipnóticos al tiempo que proporciona a los pacientes alivio adecuado de los síntomas. La viabilidad práctica y la eficacia de este enfoque se han demostrado con zolpidem, utilizando diversos regímenes de tratamiento y diseños de estudio. Hasta ahora, se han finalizado seis ensayos clínicos en más de 4.000 pacientes. Los resultados publicados muestran que el tratamiento del insomnio es efectivo, sin datos de asociación de acontecimientos adversos con un régimen discontinuo o de aumento de uso del hipnótico durante el periodo de tratamiento.

Type
Revisión
Copyright
Copyright © European Psychiatric Association 2003

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Bibliografía

World Health Organization-Division of Mental Health and Prevention of Substance Abuse. Insomnia—an International Consensus Conference Report. Versailles, 13-15 October 1996. World Health Organization; 1998.Google Scholar
National Center on Sleep Disorders Research, National Heart, Lung and Rlood Institute, National Institutes of Health, Insomnia: assessment and management in primary care. Sleep 1999; 22(Suppl 2): S402–8.Google Scholar
American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 4th ed. Washington (DC): American Psychiatric Association; 1994.Google Scholar
World Health Organization. International Classification of Diseases, tenth revision, chapter V (F): Mental and Behavioural Disorders (excluding disorders of psychological development). Clinical descriptions and guidelines. Geneva: World Health Organization; 1992.Google Scholar
Hajak, G.Insomnia in primary care. Sleep 2000; 23(Suppl 3): S5463.Google ScholarPubMed
Ustiin, T, Privett, M, Lecrubier, Y, Weiller, E, Simon, G, Korten, A, et al.Form, frequency and burden of sleep problems in general health care. Eur J Psychiatry 1996; ll(Suppl 1): 5S10S.CrossRefGoogle Scholar
Hohagen, F, Rink, K, Kappler, C, Schramm, E, Riemann, D, Weyerer, S, et al.Prevalence and treatment of insomnia in general practice. A longitudinal study. Eur Arch Psychiatry Clin Neurosci 1993; 242(6): 329–36.CrossRefGoogle ScholarPubMed
Ganguli, M, Reynolds, CF, Gilby, JE.Prevalence and persistence of sleep complaints in a rural older community sample: the MoVIES project. J Am Geriatr Soc 1996; 44(7): 778–84.CrossRefGoogle Scholar
Katz, DA, McHorney, CA.Clinical correlates of insomnia in patients with chronic illness. Arch Intern Med 1998; 158(10): 1099–107.CrossRefGoogle ScholarPubMed
Roth, T, Ancoli-Israel, S.Daytime consequences and correlates of insomnia in the United States: results of the 1991 National Sleep Foundation Survey. II. Sleep 1999; 22(Suppl .2): S3548.Google ScholarPubMed
Ford, DE, Kamerow, DB.Epidemiologic study of sleep disturbances and psychiatric disorders. An opportunity for prevention? JAMA 1989; 262(11): 1479–84.Google ScholarPubMed
Stoller, MK.Economic effects of insomnia. Clin Ther 1994; 16(5): 873–97.Google ScholarPubMed
Gillin, JC.Are sleep disturbances risk factors for anxiety, depressive and addictive disorders? Acta Psychiatr Scand Suppl 1998; 393: 3943.CrossRefGoogle ScholarPubMed
Jenkins, CD, Stanton, BA, Niemcryk, SJ, Rose, RM.A scale for the estimation of sleep problems in clinical research. J Clin Epidemiol 1988; 4l(4):313–21.CrossRefGoogle Scholar
Carney, RM, Freedland, KE, Jaffe, AS.Insomnia and depression prior to myocardial infarction. Psychosom Med 1990; 52(6):603–9.CrossRefGoogle ScholarPubMed
Bonnet, MH, Arand, DL.Heart rate variability in insomniacs and matched normal sleepers. Psychosom Med 1998; 60(5):6l05.CrossRefGoogle ScholarPubMed
Cole, SR, Kawachi, I, Sesso, HD, Paffenbarger, RS, Lee, IM.Sense of exhaustion and coronary heart disease among college alumni. Am J Cardiol 1999; 84(12): 1401–5.CrossRefGoogle ScholarPubMed
Schwartz, S, McDowell, Anderson W, Cole, SR, Cornoni-Huntley, J, Hays, JC, Blazer, D.Insomnia and heart disease: a review of epidemiologic studies. J Psychosom Res 1999; 47(4): 313–33.CrossRefGoogle ScholarPubMed
Ferini-Strambi, L, Bianchi, A, Zucconi, M, Oldani, A, Catronovo, V, Smirne, S.The impact of cyclic alternating pattern on heart rate variability during sleep in healthy young adults. Clin Neurophysiol 2000; 111(1): 99101.CrossRefGoogle ScholarPubMed
Ferri, R, Parrino, L, Smerieri, A, Terzano, MG, Elia, M, Musumeci, SA, et al.Cyclic alternating pattern and spectral analysis of heart rate variability during normal sleep. J Sleep Res 2000; 9(1): 13–8.CrossRefGoogle ScholarPubMed
Costa, E, Silva, JA, Chase, M, Sartorius, N, Roth, T.Special report from a symposium held by the World Health Organization and the World Federation of Sleep Research Societies: an overview of insomnias and related disorders-recognition, epidemiology, and ' rational management. Sleep 1996; 19(5): 412–6.CrossRefGoogle Scholar
Ohayon, MM.Prevalence of DSM-IV diagnostic criteria of insomnia: distinguishing insomnia related to men tal disorders from sleep disorders. J Psychiatr Res 1997; 31(3): 333–46.CrossRefGoogle Scholar
Ancoli-Israel, S, Roth, T.Characteristics of insomnia in the United States: results of the 1991 National Sleep Foundation Survey I. Sleep 1999; 22(Suppl 2): S34753.Google ScholarPubMed
Leger, D, Guilleminault, C, Dreyfus, JP, Delahaye, C, Paillard, M.Prevalence of insomnia in a survey of 12,778 adults in France. J Sleep Res 2000; 9(1): 3542. ,CrossRefGoogle Scholar
Shochat, T, Umphress, J, Israel, AG, Ancoli-Israel, S.Insomnia in primary care patients. Sleep 1999; 22(Suppl 2): S35965.Google ScholarPubMed
Simon, GE, VonKoff, M.Prevalence, burden and treatment of insomnia in primary care. Am J Psychiatry 1997; 154(10): 1417–23.Google ScholarPubMed
Walsh, JK, Engelhardt, CL.The direct costs of insomnia in the United States for 1995. Sleep 1999; 22(Suppl 2): S38693.Google ScholarPubMed
Leger, D, Levy, E, Paillard, M.The direct costs of insomnia in France. Sleep 1999;22(Suppl 2):S394401.Google ScholarPubMed
Nino-Murcia, G.Diagnosis and treatment of insomnia and risks associated with lack of treatment. J Clin Psychiatry 1992; 53(Suppl): 43–7.Google ScholarPubMed
Simen, S, Hajak, G, Schlaf, G, Westenhofer, J, Rodenbeck, A, Bandelow, B, et al.Chronic sleep complaints. Results of a representative survey in Germany. Nervenarzt 1995; 66: 686–95.Google Scholar
Kageyama, T, Kabuto, M, Nitta, H, Kurokawa, Y, Taira, K, Suzuki, S, et al.Prevalence of use of medically prescribed hypnotics among adult Japanese women in urban residential areas. Psychiatry Clin Neurosci 1998; 52(1): 6974.CrossRefGoogle ScholarPubMed
Everitt, DE, Avorn, J, Baker, MW.Clinical decisionmaking in the evaluation and treatment of insomnia. Am J Med 1990; 89(3): 357–62.CrossRefGoogle ScholarPubMed
Terzano, MG, Parrino, L, Spaggiari, MC.The cyclic alternating pattern sequences in the dynamic organization of sleep. Electroenceph Clin Neurophysiol 1988; 69: 437–47.CrossRefGoogle Scholar
Scharf, MB, Stover, R, McDannold, M, Kaye, H, Berkowitz, DV.Comparative effects of sleep on a standard mattress to an experimental foam surface on sleep architecture and CAP rates. Sleep 1997; 20: 11972000.CrossRefGoogle Scholar
Terzano, MG, Parrino, L.Evaluation of EEG cyclic alternating pattern during sleep in insomniacs and Controls under placebo and acute treatment with zolpidem. Sleep 1992; 15: 6470.CrossRefGoogle ScholarPubMed
Terzano, MG, Parrino, L, Boselli, M, Spaggiari, MC, Di, Giovanni G, Smerieri, A.Sensitivity of cyclic alternating pattern to prolonged pharmacotherapy: a 5-week study evaluating zolpidem in insomniac patients. Clin Neuropharmacol 1997; 20: 447–54.CrossRefGoogle ScholarPubMed
American, Sleep Disorders Association.Practice parameters for the indications for polysomnography and related procedures. Polysomnography Task Forcé, American Sleep Disorders Association Standards of Practice Committee. Sleep 1997; 20(6): 406–22.Google Scholar
Ohayon, MM, Caulet, M, Arbus, L, Billard, M, Coquerel, A, Guieu, JD, et al.Are prescribed medications effective in the treatment of insomnia complaints? J Psychosom Res 1999; 47(4): 359–68.CrossRefGoogle ScholarPubMed
Walsh, JK, Schweitzer, PK.Ten-year trends in the pharmacological treatment of insomnia. Sleep 1999; 22(3): 371–5.Google ScholarPubMed
National Sleep Foundation. Omnibus Sleep in America Poli. 2000.Google Scholar
Mellinger, GD, Balter, MB, Uhlenhuth, EH.Insomnia and its treatment. Prevalence and correlates Arch Gen Psychiatry 1985; 42(3): 225–32.CrossRefGoogle ScholarPubMed
Balter, MB, Uhlenhuth, EH.New epidemiologic findings about insomnia and its treatment. J Clin Psychiatry 1992; 53(Suppl 12): 34–9.Google ScholarPubMed
Roehrs, T, Pedrosi, B, Rosenthal, L, Roth, T.Hypnotic sel-fadministration and dose-escalation. Psychopharmacology (Berl) 1996; 127(2): 150–4.CrossRefGoogle ScholarPubMed
Roth, T.New trends in insomnia management. J Psychopharmacol 1999; 13(4 Suppl l):S3740.CrossRefGoogle ScholarPubMed
Kripke, DF.Chronic hypnotic use: the neglected problem. In: Koella, WP, Ruther, E, Schulz, H, editors. Sleep '84. Stuttgart: Gustav Fischer Verlag; 1985, 338–40.Google Scholar
Gustafson, R.Treating insomnia with a self-administered muscle relaxation training program: a follow-up. Psychol Rep 1992; 70(1): 124–6.CrossRefGoogle ScholarPubMed
Morin, CM, Hauri, PJ, Espié, CA, Spielman, AJ, Buysse, DJ, Bootzin, RR.Nonpharmacological treatment of chronic insomnia. An American Academy of Sleep Medicine review. Sleep 1999; 22(8): 1134–56.Google ScholarPubMed
Hryshko-Mullen, AS.Behavioral treatment of insomnia: the Wilford Hall Insomnia Program. Mil Med 2000; 165(3): 200–7.CrossRefGoogle ScholarPubMed
Cluydts, R, Peeters, K, de, Bouyalski I, Lavoisy, J.Comparison of continuous versus intermittent administration of zolpidem in chronic insomniacs: a double-blind, randomized pilot study. J Int Med Res 1998; 26(1): 1324.CrossRefGoogle ScholarPubMed
Hajak, G, Cluydts, R, Declerck, A, Estivill, E, Middleton, A, Sonka, K, et al.Continuous versus non-nightly use of zolpidem in chronic insomnia: results of a large-scale, double-blind, randomized, out-patient study. Int Clin Psychopharmacology 2002; 17: 917.CrossRefGoogle Scholar
Allain, H, Arbus, L, Schiick, S, and the Zolpidem Study Group. Efficacy and safety of zolpidem administered "as needed" in primary insomnia. Results of a double-blind, placebo-controlled study. Clin Drug Invest 2001; 21(6): 391400.Google Scholar
Walsh, JK, Roth, T, Randazzo, A, Erman, M, Jamieson, A, Scharf, M, et al.Eight weeks of non-nightly use of zolpidem for primary insomnia. Sleep 2000; 23(8): 1087–96.CrossRefGoogle ScholarPubMed
Cluydts, R, Heyde, K, De, Volder I.Polysomnographic findings during non-continuous administration of zolpidem. Sleep Medicine Reviews 2002; 6(Suppl D):S1321.CrossRefGoogle ScholarPubMed
Hajak, G, Bandelow, B, Zulley, J, Pittrow, D."As needed" pharmacotherapy combined with stimulus control treatment in chronic insomnia-assessment of a novel intervention strategy in a primary care setting. Ann Clin Psychiatry 2002; 14: 17.CrossRefGoogle Scholar
Ohayon, MM, Caulet, M, Guilleminault, C.How a general population perceives its sleep and how this relates to the complaint of insomnia. Sleep 1997; 20: 715–23.CrossRefGoogle ScholarPubMed
Ohayon, MM, Caulet, M, Priest, RG, Guilleminault, C.DSM-IV and ICSD-90 insomnia symptoms and sleep dissatisfaction. Br J Psychiatry 1997; 171: 382–8.CrossRefGoogle ScholarPubMed
Ohayon, MM, Zulley, J.Correlates of global sleep dissatisfaction in the Germán population. Sleep 2001; 24: 780–7.Google ScholarPubMed