阿片类药物使用障碍与睡眠障碍共病的治疗干预：一项范围综述

文献信息

中文摘要

背景： 阿片类药物使用障碍（OUD）属于更广泛的物质使用障碍谱系，常并发抑郁、焦虑、PTSD（创伤后应激障碍）和睡眠障碍等精神症状，其中失眠尤为常见。这些精神症状既可能是OUD的促发因素，也可能是其后果，从而强化了一种复杂的双向关系，使治疗和康复更加困难。尽管双重障碍具有临床重要性，但睡眠损害是尤为相关却研究不足的治疗靶点，且在OUD中针对精神症状或障碍背景下睡眠障碍的文献仍然有限。本范围综述考察在存在焦虑、抑郁和PTSD等精神障碍或症状的情况下，针对OUD和睡眠障碍的药物与非药物干预。
方法： 本综述遵循系统综述和荟萃分析首选报告条目扩展版范围综述（PRISMA-ScR）指南，使用以下关键词：（“sleep”或“insomnia”）AND（“depression”或“anxiety”或“PTSD”或“post-traumatic stress disorder”或“posttraumatic stress disorder”）AND（“opioid use disorder”或“OUD”或“opioid addiction”）。睡眠呼吸障碍被排除。参与者为正在接受戒断或治疗的OUD或阿片依赖成人（>18岁）。研究聚焦于定量和定性研究设计。
结果： 共纳入15项研究，包括1,167名OUD或阿片依赖成人，并分为药物干预（靶向阿片或非阿片受体）和非药物干预。大多数干预是阿片替代或拮抗剂治疗的辅助治疗。纳曲酮诱导的失眠常见，但未显著影响情绪，并可通过劳拉西泮缓解。非阿片药物治疗结果不一：胍法辛被认为可能增加失眠风险，但可减轻压力和渴求，而阿米替林、普拉西泮、屈大麻酚和神经递质前体补充剂在改善睡眠和戒断症状方面显示出潜力。
结论： 更好地描述和管理OUD伴精神症状个体的睡眠损害，可能降低复发风险、增强情绪调节并减少自我用药。临床医生应将OUD、精神症状和睡眠之间复杂的相互作用纳入综合照护。需要进一步研究以阐明这些相互作用，并支持制定整合的、循证的治疗和预防策略。

英文摘要

BACKGROUND: Opioid use disorder (OUD) is part of the broader spectrum of substance use disorders often complicated by psychiatric symptoms such as depression, anxiety, PTSD (Post-Traumatic Stress Disorder), and sleep disturbances, with insomnia being particularly frequent. These psychiatric symptoms may act as precipitating factors and consequences of OUD, reinforcing a complex bidirectional relationship that complicates treatment and recovery. Despite the clinical importance of dual disorders, sleep impairments are particularly relevant yet understudied therapeutic targets and literature addressing sleep disturbances in the context of psychiatric symptoms or disorders in OUD remains limited. This scoping review examines pharmacological and non-pharmacological interventions of OUD and sleep disturbances in the presence of psychiatric disorders or symptoms, such as anxiety, depression, and PTSD.
METHODS: This review follows the Preferred Reporting Items for Systematic Reviews and Meta-analyses extension for Scoping Reviews (PRISMA-ScR) guidelines using the following keywords: ("sleep" OR "insomnia") AND ("depression" OR "anxiety" OR "PTSD" OR "post-traumatic stress disorder" OR "posttraumatic stress disorder") AND ("opioid use disorder" OR "OUD" OR "opioid addiction. Sleep disordered breathing was excluded. Participants were adults (> 18 years old) with OUD or opioid dependence undergoing withdrawal or treatment. The study focused on quantitative and qualitative study designs.
RESULTS: Fifteen studies including 1,167 adults with OUD or opioid dependence were selected and categorized into pharmacological (targeting opioid or non-opioid receptors) and non-pharmacological interventions. Most interventions were adjunctive to opioid substitution or antagonist therapies. Naltrexone-induced insomnia was common but did not significantly affect mood and could be mitigated with lorazepam. Non-opioid pharmacotherapies yielded mixed results: guanfacine is suggested to increase insomnia risk but reduce stress and craving, while amitriptyline, prazepam, dronabinol, and neurotransmitter-precursor-supplements showed potential in improving sleep and withdrawal symptoms.
CONCLUSIONS: Improved characterization and management of impaired sleep in individuals with OUD and psychiatric symptoms may reduce relapse risk, enhance emotional regulation, and decrease self-medication. Clinicians should consider the complex interplay between OUD, psychiatric symptoms, and sleep as part of comprehensive care. Further research is needed to clarify these interactions and support the development of integrated, evidence-based strategies for treatment and prevention.
CLINICAL TRIAL NUMBER: Not applicable.