Effekten av smertebehandling på søvn hos sykehjemsbeboere med demens og depresjon

Forskere fra Universitetet i Bergen har i denne studien undersøkt kortidseffekten av smertebehandling på søvn hos sykehjemsbeboere med depresjon og demens. Studien inkluderte 106 beboere fra 47 ulike sykehjem i Norge i en dobbelblindet placebokontrollert randomisert klinisk studie.

Smertebehandling med paracetamol/placebo eller buprenorphine transdermal system/placebo ble trappet gradvis opp. Søvn ble målt med aktigrafi i 14 sammenhengende dager; 1 uke med baselinemålinger og 1 uke med pågående smertebehandling. Resultatene indikerer at målt med aktigrafi forbedret søvnen seg i gruppen som fikk aktiv smertebehandling, sammenlignet med placebo.  Imidlertid er den underliggende årsaken til endringen ukjent, og man kan ikke si hvorvidt endringen er av subjektiv verdi for beboeren.  

Effects of pain treatment on sleep in nursing home patientswith dementia and depression: A multicenter placebocontrolledrandomized clinical trial
Publisert i International Journal of Geriatric Psychiatry

Kjersti Marie Blytt, Bjørn Bjorvatn, Bettina Husebø, Elisabeth Flo

OBJECTIVE: To investigate the effects of pain treatment on sleep in nursing home (NH) patients with dementia and depression.

METHODS: A multicenter, 2-armed, double-blinded, placebo-controlled, randomized clinical trial conducted between August 2014 and September 2016. One hundred six long-term patients from 47 NHs in Norway with dementia and depression according to the Mini-Mental State Examination and the Cornell Scale for Depression in Dementia were included. Patients received stepwise pain treatment in which those who did not use analgesics were randomized to receive either paracetamol (3 g/day) or placebo tablets; those who already used pain treatment were allocated to buprenorphine transdermal system (max. 10 μg/h/7 days) or placebo transdermal patches. Sleep was assessed continuously for 14 days by actigraphy, 1 week of baseline measurement, and 1 week of ongoing treatment. The following sleep parameters were evaluated: total sleep time, sleep efficiency (SE), sleep onset latency (SOL), wake after sleep onset, early morning awakening (EMA), and number of wake bouts.

RESULTS: In the intervention group (paracetamol/buprenorphine), SE (70%-72%), SOL (32-24 min), and EMA (50-40 min) improved compared with the control group (SE, 70%-67%; SOL, 47-60 min; EMA, 31-35 min). Treatment effects were significant (P < .01, P < .05, and P < .05, respectively).

CONCLUSION: Compared with placebo, pain treatment improved sleep as measured with actigraphy. This implies that sleep, pain, and depression in NH patients should be critically evaluated and that pain treatment should be considered to be a potentially beneficial treatment.