Pharmacological interventions to improve sleep in people with Alzheimer’s disease: a meta-analysis of randomized controlled trials

ABSTRACT

Introduction

This systematic review and meta-analysis evaluates the evidence from randomized controlled trials (RCTs) involving pharmacological interventions for improving sleep in people with Alzheimer’s disease (AD).

Methods

A systematic literature search in eight databases from January 2000 to July 2023 focusing on RCTs that compared a pharmacological intervention with a placebo for enhancing sleep in people with AD. The authors registered the study protocol at Prospero, followed the PRISMA guidelines, and produced the pooled estimates using random-effect or IVhet models.

Results

Eight different interventions and 29 different sleep outcomes were examined in 14 RCTs included in this review. Eszopiclone positively affected sleep efficiency, as did orexin antagonists. However, there was no difference when melatonin was used. The interventions demonstrated low discontinuation rates and a few adverse drug reactions.

Conclusion

Although melatonin was the most investigated intervention, the evidence for its efficacy is inconclusive. On the other hand, trazodone and orexin receptor antagonists showed promising results; however, more RCTs are needed for definite answers.

KEYWORDS:

• Alzheimer’s disease
• adverse event
• dementia
• melatonin
• randomized controlled trials
• sleep disorder

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Supplementary material

Supplemental data for this article can be accessed online at https://doi.org/10.1080/14737175.2024.2341004

Author’s contributions

All authors contributed to this paper. SS Hasan conceptualized the research idea. A Bedward, J Kaur, S Seedat, and H Donohue were involved in screening, data extraction, interpretation, and writing the first draft. SS Hasan was involved in data analysis, interpretation, and manuscript revision. MK Rasheed, A Javed, and CS Kow were involved in interpreting results and manuscript revision.

Additional information

Funding

This paper was not funded.