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Relevant bibliographies by topics / Somnolence

Academic literature on the topic 'Somnolence'

Author: Grafiati

Published: 4 June 2021

Last updated: 21 September 2023

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Dissertations / Theses
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Journal articles on the topic "Somnolence"

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Covassin, Naima, and Virend K. Somers. "Somnolence." Hypertension 68, no. 5 (November 2016): 1100–1102. http://dx.doi.org/10.1161/hypertensionaha.116.07073.

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Billiard, M. "Somnolence." Médecine du Sommeil 1, no. 2 (December 2004): 1. http://dx.doi.org/10.1016/s1769-4493(04)70170-3.

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Tavares, Stella, Flávio Alóe, Valentim Gentil, and Milberto Scaff. "Excessive somnolence." Sao Paulo Medical Journal 114, no. 4 (August 1996): 1231–38. http://dx.doi.org/10.1590/s1516-31801996000400008.

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Excessive somnolence can be quite a incapacitating manifestation, and is frequently neglected by physicians and patients. This article reviews the determinant factors, the evaluation and quantification of diurnal somnolence, and the description and treatment of the main causes of excessive somnolence.

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Petiau, C., and J. Krieger. "Somnolence diurne pathologique." La Revue de Médecine Interne 18, no. 3 (March 1997): 210–18. http://dx.doi.org/10.1016/s0248-8663(97)89297-1.

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SHUSTER, JOEL. "Pramipexole and somnolence." Nursing 30, no. 8 (August 2000): 81. http://dx.doi.org/10.1097/00152193-200030080-00039.

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Ryan, Janis. "Radiation Somnolence Syndrome." Journal of Pediatric Oncology Nursing 17, no. 1 (January 2000): 50–53. http://dx.doi.org/10.1177/104345420001700107.

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Billiard, Michel, and Yves Dauvilliers. "Somnolence et psychiatrie." EMC - Psychiatrie 1, no. 1 (January 2004): 1–6. http://dx.doi.org/10.1016/s0246-1072(03)00111-1.

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Salthun-Lassalle, Bénédicte. "Alzheimer : combattre la somnolence." Cerveau & Psycho N° 145, no. 7 (July 8, 2022): 12. http://dx.doi.org/10.3917/cerpsy.145.0012.

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Arnulf, Isabelle. "Somnolence et maladies neurologiques." Revue Neurologique 178 (April 2022): S175—S176. http://dx.doi.org/10.1016/j.neurol.2022.02.101.

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Besset, A. "Exploration de la somnolence." Médecine du Sommeil 1, no. 2 (December 2004): 15–21. http://dx.doi.org/10.1016/s1769-4493(04)70172-7.

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Dissertations / Theses on the topic "Somnolence"

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Bourré, Nicolas. "Détection de la somnolence au volant." Thèse, Université du Québec à Trois-Rivières, 2009. http://depot-e.uqtr.ca/1295/1/030120528.pdf.

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Ohayon, Maurice Moyses. "Étude épidémiologique comparative de la somnolence diurne." Lyon 1, 1997. http://www.theses.fr/1997LYO1T352.

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Leproult, Rachel. "Vigilence et somnolence: marqueurs subjectifs, cognitifs, électroencéphalographiques, métaboliques et endocriniens." Doctoral thesis, Universite Libre de Bruxelles, 2001. http://hdl.handle.net/2013/ULB-DIPOT:oai:dipot.ulb.ac.be:2013/211539.

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Beaulieu-Bonneau, Simon. "Somnolence, fatigue et fonctionnement attentionnel suite à un traumatisme craniocérébral." Thesis, Université Laval, 2012. http://www.theses.ulaval.ca/2012/29276/29276.pdf.

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Cette thèse doctorale s’intéresse aux conséquences à long terme suite à un traumatisme craniocérébral (TCC) modéré à sévère. L’étude vise à documenter la présence, la sévérité et les corrélats des problèmes de somnolence, de fatigue et de sommeil. Un second objectif est d’évaluer les aspects attentionnels de vitesse de traitement de l’information, d’attention sélective et d’attention soutenue. Dans un troisième temps, la thèse a pour but d’explorer les relations entre la somnolence, la fatigue et le sommeil, d’une part, et le fonctionnement attentionnel, d’autre part. Vingt-deux adultes ayant subi un TCC modéré à sévère entre 1 et 11 ans avant leur implication dans l’étude sont comparés à 22 participants contrôles appariés selon l’âge, le sexe et le niveau d’éducation. L’étude comporte un enregistrement polysomnographique nocturne et diurne, trois tests neuropsychologiques d’attention, une tâche sur un simulateur de conduite automobile, et des mesures subjectives de somnolence, de fatigue et de sommeil. Les résultats du premier article démontrent un niveau de fatigue significativement plus élevé chez les participants TCC, alors que les groupes ne diffèrent pas sur les mesures de somnolence objective ou subjective. L’impact des problèmes de somnolence sur la productivité générale, le temps passé au lit dans la nuit, et la fréquence et la durée des siestes dans la journée sont significativement plus élevés dans le groupe TCC. Les résultats du deuxième article révèlent que les participants TCC performent significativement moins bien aux mesures de vitesse de traitement de l’information et d’attention soutenue dérivées des tests neuropsychologiques et de la tâche de conduite simulée, alors que les groupes ne diffèrent pas sur l’attention sélective. Des associations significatives sont démontrées entre une performance attentionnelle inférieure et une moins bonne continuité du sommeil ou un niveau plus élevé de somnolence, principalement dans le groupe TCC. Aucune relation n’est observée entre les mesures d’attention et de fatigue. Les résultats de la thèse suggèrent que la fatigue est un symptôme plus proéminent que la somnolence plusieurs années après un TCC modéré à sévère. Le recours à des stratégies compensatoires telles que d’augmenter les opportunités de sommeil semble être une pratique courante. Les résultats confirment que la vitesse de traitement de l’information demeure affectée plusieurs années après un TCC et indiquent que l’attention soutenue pourrait aussi être compromise. L’attention semble être reliée à la continuité du sommeil et à la somnolence, suggérant que les patients, cliniciens et chercheurs devraient porter attention à cette interaction.
This doctoral dissertation focused on sleepiness, fatigue, sleep, and attention in the long term following traumatic brain injury (TBI). The study aimed to document the presence and severity of sleepiness, fatigue and sleep problems. Another objective was to assess the attentional aspects of speed of information processing, selective attention, and sustained attention. The dissertation was also intended to explore the relationships between sleepiness, fatigue, and sleep, on one hand, and attentional functioning, on the other hand. Twenty-two adults who had sustained a moderate to severe TBI between 1 and 11 years prior to their enrolment in the study were compared to 22 control participants matched on age, sex, and education. The main outcome measures included nighttime and daytime polysomnographic recordings, three neuropsychological tests of attention, a driving simulator task, and subjective measures of sleepiness, fatigue, and sleep. Results of the first empirical paper indicated a significantly higher level of fatigue in TBI participants compared to controls, whereas groups did not differ on objective or subjective sleepiness measures. The impact of sleepiness on general productivity, the time spent in bed at night, and the frequency and duration of daytime napping were greater in the TBI group. Results of the second empirical paper revealed a poorer performance in TBI compared to control individuals on measures tapping speed of information processing and sustained attention derived from the neuropsychological tests and the driving simulator task, while groups did not differ on selective attention. Significant correlations were observed between poorer attentional performance and poorer sleep continuity or higher levels of sleepiness, mainly in the TBI group. No relationship was found between cognitive performance and subjective fatigue. This dissertation suggests that fatigue is a more prominent symptom than sleepiness when assessed several years after TBI. The use of compensatory strategies such as increasing sleep opportunities appears to be a common practice. Results add to the existing evidence that speed of information processing is still impaired several years after TBI and indicate that sustained attention may also be compromised. Attention seems to be associated with sleep continuity and daytime sleepiness, suggesting that patients, clinicians, and researchers alike should take notice of this interaction.
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Philip, Pierre. "Déterminants intrinsèques et extrinsèques de la somnolence diurne : à propos d'études sur la privation de sommeil." Bordeaux 2, 1997. http://www.theses.fr/1997BOR28478.

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Dubois, Muriel. "Nouvelles recherches sur l'effet d'assoupissement dans la persuasion." Grenoble 2, 1996. http://www.theses.fr/1996GRE29013.

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Dans ce travail sont presentees, dans un premier temps, les differentes theories, en persuasion, rendant compte de l'effet d'assoupissement (tres controverse). Dans un deuxieme temps, sont envisages les effets des differents facteurs etudies (credibilite de la source, effet du temps. . . ) sur l'impact d'un "message lateral" ("communication indirecte" c'est a dire non directement liee aux arguments persuasifs) et sur l'efficacite de communications persuasives. Cinq experimentations, portant sur plus de sept cents personnes, ont permis la mise a jour de certains effets surprenants comme : un "superassoupissement", une credibilisation importante de la source et le role non negligeable du message lateral en tant que variable independante. Des propositions d'explications theoriques sont presentees ; notamment en termes de traitement et d'integration de l'information. D'autres effets, classiques, ont ete reproduits (lien du temps avec l'attitude, le rappel des arguments; dissociation, relation entre modalites intra versus intersujets)
FIRST, ARE PRESENTED IN THIS WORK, THE DIFFERENT THEORIES ABOUT THE SLEEPER EFFECT (A VERY CONTROVERSIAL EFFECT); AND SECOND, IS EXAMINED THE INFLUENCE OF SEVERAL FACTORS (SOURCE CREDIBILITY, EFFECT OF TIME. . . ) ON THE IMPACT OF A "LATERAL MESSAGE" ("INDIRECT COMMUNICATION" THAT IS: NOT DIRECTLY RELATED WITH PERSUASIVE ARGUMENTS) AND ON PERSUASIVE COMMUNICATION EFFICIENCY. FIVE EXPERIMENTS, USING OVER THAN SEVEN HUNDRED SUBJECTS, HAD RESULTS SOMETIMES SURPRISING, SUCH AS : A "SUPERSLEEPER", AN INCREASED SOURCE CREDIBILITY AND AN IMPORTANT EFFECT OF THE LATERAL MESSAGE AS INDEPENDANT VARIABLE. SOME THEORETICAL EXPLANATIONS ARE GIVEN (USING INFORMATION INTEGRATION AND INFORMATION PROCESSING THEORIES). OTHER CLASSICAL EFFECTS ARE REPLICATED (LINK BETWEEN TIME AND ATTITUDE, ARGUMENTS RECALL; DISSOCIATION, COMPARISON OF BETWEENAND within-SUBJECTS PROCEDURES)

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Poupard, Laurent. "Dynamique de l'activité cérébrale et de la respiration pendant la somnolence." Paris 12, 1998. http://www.theses.fr/1998PA120020.

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Ce travail propose une etude de la somnolence a travers l'analyse de l'activite neurologique et respiratoire chez 14 sujets normaux en legere privation de sommeil. Dans la premiere partie de ce travail, nous caracterisons le comportement temporel des ondes alpha presentes dans l'activite electroencephalo--graphique lors de la somnolence. La distribution des temps d'emission alpha de duree t exhibe une loi de puissance fonction de t. L'exposant correspondant est egal a 1. 750. 13. Nous montrons que ce resultat peut etre compris a travers le modele de boettcher et paczuski a l'interieur de la classe des systemes critiques auto-organises. La deuxieme partie de ce travail est consacree a l'application physiologique et cognitive de ce resultat. Nous avons montre que dans cette longue periode de somnolence avec lutte contre l'endormissement, les influences corticales operent de maniere intermittente contribuant a destabiliser le controle de la respiration. Les deux parametres tendance et entropie respiratoires extraits des series chronologiques (frequence respiratoire) forment un couple complementaire evoluant generalement en opposition de phase et permettant ainsi de definir un etat d'hypovigilance predisposant a l'endormissement, sans que celui-ci soit predictible.

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ZBILI, BELAICHE RUTH. "Interet de la polygraphie dans le bilan d'une somnolence diurne excessive chez l'enfant de moins de 15 ans : rapport somnolence narcolepsie ; a propos de 4 cas." Aix-Marseille 2, 1992. http://www.theses.fr/1992AIX20114.

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Sharabaty, Hassan. "Diagnostic de la somnolence d'un opérateur : analyse automatique de signaux physiologiques." Phd thesis, Université Paul Sabatier - Toulouse III, 2007. http://tel.archives-ouvertes.fr/tel-00197161.

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Depuis plusieurs années le LAAS-CNRS travaille sur la problématique de la détection de la baisse de vigilance d'un conducteur d'automobile à partir de l'analyse du mode de conduite, afin de réduire le grand nombre des accidents routiers. Dans ce contexte, nous nous sommes intéressés de dégager une mesure référante de l'hypovigilance qui permettrait, par comparaison, de valider le système de mesure embarqué associant des mesures comportementales. Cette thèse a porté sur l'analyse automatique des signaux physiologiques (EEG, EOG) permettant de caractériser la somnolence; et s'est inscrit dans le cadre du projet européen SENSATION. Ce travail s'articule en 2 parties. La première est dédiée à l'analyse des EEG et commence par une présentation de la forme d'onde des signaux à analyser et des phénomènes représentatifs de la somnolence, puis des techniques d'analyse susceptibles de répondre au problème posé : transformé de Fourier, décomposition en Ondelettes, transformation de Hilbert Huang; Pour la suite de l'étude, nous avons sélectionnée la transformation de Hilbert-Huang. La précision de cette méthode sera étudier qualitativement, avant de présenter l'algorithme développé et les premiers résultats obtenus sur des signaux réels. Les conclusions de l'analyse de la précision nous ont amené à modifier l'algorithme proposé par Huang en normalisant les composantes fournies par la transformation de Huang sur l'ensemble de la fenêtre d'analyse avant application de la transformation de Hilbert. La deuxième partie de la thèse est donc consacrée à la localisation et la caractérisation des clignements des yeux dans l'EOG. Avant de présenter l'algorithme développé, nous décrivons le signal étudié et le modèle de clignement proposé. Nous comparons ensuite, sur une base de données constituée durant des expériences menées sur un simulateur de conduite, les résultats obtenus par notre algorithme à une analyse semi-automatique. Une fois la détection des clignements validée, nous com parons le degré de somnolence déterminé après mise en place des règles utilisées par les experts à l'analyse visuelle des signaux. Le bilan du travail réalisé et les perspectives d'amélioration des résultats concluront ce travail.

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Bastuji, Hélène. "Traitement cognitif de l'information sensorielle au cours du sommeil et de la somnolence chez l'homme : étude au moyen de potentiels évoqués auditifs." Lyon 1, 1999. http://www.theses.fr/1999LYO1T275.

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Books on the topic "Somnolence"

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La somnolence: Roman. Bordeaux: Finitude, 2009.

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1952-, Hurlbut Spring, and Power Plant (Art gallery), eds. Spring Hurlbut: La somnolence. Toronto, Ont., Canada: Power Plant, 1995.

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Sleepiness: Causes, consequences, and treatment. Cambridge: Cambridge University Press, 2011.

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author, Hileman Jane, and Bianchi John illustrator, eds. Time to get up! King of Prussia, Pennsylvania]: American Reading Company, 2011.

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Somnolences: Roman. Montréal: Triptyque, 2001.

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Kolikov, Targa. L'EXPLOSION INÉVITABLE DU VOLCAN SOMNOLENT - Roman. Paris: Editions L'Harmattan, 2009.

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La somnolencia de la razón: Reflexiones sobre organización social, economía y bienestar en tiempos de crisis. Madrid: Biblioteca Nueva, 2011.

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Sorensen, Benjamin A. The Two Sides of Somnolence. Emily Martha Sorensen, 2020.

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Thorpy, Michael J., and Michel Billiard. Sleepiness: Causes, Consequences and Treatment. Cambridge University Press, 2011.

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Thorpy, Michael J., and Michel Billiard. Sleepiness: Causes, Consequences and Treatment. Cambridge University Press, 2010.

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Book chapters on the topic "Somnolence"

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Jensen, Lindsay G., Loren K. Mell, Christin A. Knowlton, Michelle Kolton Mackay, Filip T. Troicki, Jaganmohan Poli, Edward J. Gracely, et al. "Somnolence Syndrome." In Encyclopedia of Radiation Oncology, 802. Berlin, Heidelberg: Springer Berlin Heidelberg, 2013. http://dx.doi.org/10.1007/978-3-540-85516-3_243.

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Cunningham, Jacqueline L. "Acute Radiation Somnolence." In Encyclopedia of Clinical Neuropsychology, 53. Cham: Springer International Publishing, 2018. http://dx.doi.org/10.1007/978-3-319-57111-9_87.

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Cunningham, Jacqueline L. "Acute Radiation Somnolence." In Encyclopedia of Clinical Neuropsychology, 1. Cham: Springer International Publishing, 2017. http://dx.doi.org/10.1007/978-3-319-56782-2_87-3.

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Cunningham, Jacqueline L. "Acute Radiation Somnolence." In Encyclopedia of Clinical Neuropsychology, 35. New York, NY: Springer New York, 2011. http://dx.doi.org/10.1007/978-0-387-79948-3_87.

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Peter, Helga, and Thomas Penzel. "Disorders of Excessive Somnolence." In Springer Reference Medizin, 1. Berlin, Heidelberg: Springer Berlin Heidelberg, 2020. http://dx.doi.org/10.1007/978-3-642-54672-3_459-1.

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Stacy, Charles B. "Sleep Disorders, Somnolence, and Fatigue." In Mount Sinai Expert Guides, 120–25. Chichester, UK: John Wiley & Sons, Ltd, 2016. http://dx.doi.org/10.1002/9781118621042.ch10.

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Berg, Stefan, Per Wekell, and Anders Fasth. "Sudden Dizziness, Somnolence and Diplopia." In Pediatric Immunology, 603–9. Cham: Springer International Publishing, 2019. http://dx.doi.org/10.1007/978-3-030-21262-9_111.

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Battista, James, Renee Monderer, and Michael Thorpy. "Excessive Daytime Somnolence Associated with Parkinson’s Disease." In Disorders of Sleep and Circadian Rhythms in Parkinson's Disease, 107–16. Vienna: Springer Vienna, 2015. http://dx.doi.org/10.1007/978-3-7091-1631-9_8.

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Deutsch, Nina. "Somnolence After V-P Shunt Revision in an Infant." In Anesthesia STAT! Acute Pediatric Emergencies in PACU, 33–44. Cham: Springer International Publishing, 2023. http://dx.doi.org/10.1007/978-3-031-24396-7_3.

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Prathap Kumar, B., P. Janani, K. Dhanush, Hanumantha Lakshmi Narayana, C. Karaka Teja, and K. Ganesh. "Discerning of In-Somnolence Using Body Sensors to Predict Vital Measurements." In ICT Analysis and Applications, 671–79. Singapore: Springer Nature Singapore, 2022. http://dx.doi.org/10.1007/978-981-19-5224-1_67.

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Conference papers on the topic "Somnolence"

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Villanueva, Alonica, Renzo Leru L. Benemerito, Mark Jetro M. Cabug-Os, Royce B. Chua, Cyrille Kristein D. C. Rebeca, and Menchie Miranda. "Somnolence Detection System Utilizing Deep Neural Network." In 2019 International Conference on Information and Communications Technology (ICOIACT). IEEE, 2019. http://dx.doi.org/10.1109/icoiact46704.2019.8938460.

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Daimon, N., J. Hashimoto, F. Yano, M. Fujikake, H. Ide, and S. P. Ninomija. "A study about relation between monotonous work and somnolence." In 1992 14th Annual International Conference of the IEEE Engineering in Medicine and Biology Society. IEEE, 1992. http://dx.doi.org/10.1109/iembs.1992.5761666.

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Daimon, Hashimoto, Yano, Fujikake, Ide, and Ninomija. "A Study About Relation Between Monotonous Work And Somnolence." In Proceedings of the Annual International Conference of the IEEE Engineering in Medicine and Biology Society. IEEE, 1992. http://dx.doi.org/10.1109/iembs.1992.592989.

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Patel, Rohan, Mayur Patel, and Jaldip Patel. "Real Time Somnolence Detection System In OpenCV Environment for Drivers." In 2018 Second International Conference on Inventive Communication and Computational Technologies (ICICCT). IEEE, 2018. http://dx.doi.org/10.1109/icicct.2018.8473234.

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Ruiz Ramos, J., A. Juanes-Borrego, L. López-Vinardell, A. Plaza-Diaz, I. Conejo-Marin, M. Blazquez-Andion, M. Puig-Campmany, and MA Mangues-Bafalluy. "4CPS-093 Drug-induced somnolence in frailty patients attending an emergency department." In 26th EAHP Congress, Hospital pharmacists – changing roles in a changing world, 23–25 March 2022. British Medical Journal Publishing Group, 2022. http://dx.doi.org/10.1136/ejhpharm-2022-eahp.125.

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K Mc Fadden, Samantha, Filipy Borghi, João V. Uzita, Priscila Cristina da Silva, Carolina da Silva, Camila Lidiane de Morais, Érica A. M. Camargo, and Dora Maria Grassi Kassisse. "Relationship between psychosocial stress, resilience, sleep quality and somnolence in undergraduate pharmacy students." In XXV Congresso de Iniciação Cientifica da Unicamp. Campinas - SP, Brazil: Galoa, 2017. http://dx.doi.org/10.19146/pibic-2017-78968.

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Rarmirez Garcia, Laura, Daniel López Padilla, A. Cerezo Lajas, Soledad López Martin, Milagros Llanos Flores, Elena Rodríguez Jimeno, Elena Ojeda Castillejo, and Pilar de Lucas Ramos. "CPAP in the elderly with non-severe obstructive sleep apnea: effect on cardiovascular events and somnolence." In ERS International Congress 2017 abstracts. European Respiratory Society, 2017. http://dx.doi.org/10.1183/1393003.congress-2017.pa2276.

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Francois, Clementine, Jerome Wertz, Murielle Kirkove, and Jacques G. Verly. "Evaluation of the performance of an experimental somnolence quantification system in terms of reaction times and lapses." In 2014 36th Annual International Conference of the IEEE Engineering in Medicine and Biology Society (EMBC). IEEE, 2014. http://dx.doi.org/10.1109/embc.2014.6944951.

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Bazurto-zapata, M., E. M. Duenas-Meza, C. A. Torres-Duque, and M. Gonzalez-Garcia. "Correlation Between Desaturation Indexes and Obstructive Sleep Apnea Severity and Somnolence in Adults Diagnosed with Type 2 Polysomnography." In American Thoracic Society 2020 International Conference, May 15-20, 2020 - Philadelphia, PA. American Thoracic Society, 2020. http://dx.doi.org/10.1164/ajrccm-conference.2020.201.1_meetingabstracts.a4143.

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Banta, Erin M., Timothy Craig, Cathy Mende, and Crystal Rhoads. "Comparison Of Fluticasone-salmeterol To Placebo In Patients With COPD And Associated Poor Sleep Or Excessive Daytime Somnolence." In American Thoracic Society 2010 International Conference, May 14-19, 2010 • New Orleans. American Thoracic Society, 2010. http://dx.doi.org/10.1164/ajrccm-conference.2010.181.1_meetingabstracts.a2867.

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Reports on the topic "Somnolence"

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Chou, Roger, Jesse Wagner, Azrah Y. Ahmed, Ian Blazina, Erika Brodt, David I. Buckley, Tamara P. Cheney, et al. Treatments for Acute Pain: A Systematic Review. Agency for Healthcare Research and Quality (AHRQ), December 2020. http://dx.doi.org/10.23970/ahrqepccer240.

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Objectives. To evaluate the effectiveness and comparative effectiveness of opioid, nonopioid pharmacologic, and nonpharmacologic therapy in patients with specific types of acute pain, including effects on pain, function, quality of life, adverse events, and long-term use of opioids. Data sources. Electronic databases (Ovid® MEDLINE®, PsycINFO®, Embase®, the Cochrane Central Register of Controlled Trials, and the Cochrane Database of Systematic Reviews) to August 2020, reference lists, and a Federal Register notice. Review methods. Using predefined criteria and dual review, we selected randomized controlled trials (RCTs) of outpatient therapies for eight acute pain conditions: low back pain, neck pain, other musculoskeletal pain, neuropathic pain, postoperative pain following discharge, dental pain (surgical or nonsurgical), pain due to kidney stones, and pain due to sickle cell disease. Meta-analyses were conducted on pharmacologic therapy for dental pain and kidney stone pain, and likelihood of repeat or rescue medication use and adverse events. The magnitude of effects was classified as small, moderate, or large using previously defined criteria, and strength of evidence was assessed. Results. One hundred eighty-three RCTs on the comparative effectiveness of therapies for acute pain were included. Opioid therapy was probably less effective than nonsteroidal anti-inflammatory drugs (NSAIDs) for surgical dental pain and kidney stones, and might be similarly effective as NSAIDs for low back pain. Opioids and NSAIDs were more effective than acetaminophen for surgical dental pain, but opioids were less effective than acetaminophen for kidney stone pain. For postoperative pain, opioids were associated with increased likelihood of repeat or rescue analgesic use, but effects on pain intensity were inconsistent. Being prescribed an opioid for acute low back pain or postoperative pain was associated with increased likelihood of use of opioids at long-term followup versus not being prescribed, based on observational studies. Heat therapy was probably effective for acute low back pain, spinal manipulation might be effective for acute back pain with radiculopathy, acupressure might be effective for acute musculoskeletal pain, an opioid might be effective for acute neuropathic pain, massage might be effective for some types of postoperative pain, and a cervical collar or exercise might be effective for acute neck pain with radiculopathy. Most studies had methodological limitations. Effect sizes were primarily small to moderate for pain, the most commonly evaluated outcome. Opioids were associated with increased risk of short-term adverse events versus NSAIDs or acetaminophen, including any adverse event, nausea, dizziness, and somnolence. Serious adverse events were uncommon for all interventions, but studies were not designed to assess risk of overdose, opioid use disorder, or long-term harms. Evidence on how benefits or harms varied in subgroups was lacking. Conclusions. Opioid therapy was associated with decreased or similar effectiveness as an NSAID for some acute pain conditions, but with increased risk of short-term adverse events. Evidence on nonpharmacological therapies was limited, but heat therapy, spinal manipulation, massage, acupuncture, acupressure, a cervical collar, and exercise were effective for specific acute pain conditions. Research is needed to determine the comparative effectiveness of therapies for sickle cell pain, acute neuropathic pain, neck pain, and management of postoperative pain following discharge; effects of therapies for acute pain on non-pain outcomes; effects of therapies on long-term outcomes, including long-term opioid use; and how benefits and harms of therapies vary in subgroups.

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Viswanathan, Meera, Jennifer Cook Middleton, Alison Stuebe, Nancy Berkman, Alison N. Goulding, Skyler McLaurin-Jiang, Andrea B. Dotson, et al. Maternal, Fetal, and Child Outcomes of Mental Health Treatments in Women: A Systematic Review of Perinatal Pharmacologic Interventions. Agency for Healthcare Research and Quality (AHRQ), April 2021. http://dx.doi.org/10.23970/ahrqepccer236.

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Background. Untreated maternal mental health disorders can have devastating sequelae for the mother and child. For women who are currently or planning to become pregnant or are breastfeeding, a critical question is whether the benefits of treating psychiatric illness with pharmacologic interventions outweigh the harms for mother and child. Methods. We conducted a systematic review to assess the benefits and harms of pharmacologic interventions compared with placebo, no treatment, or other pharmacologic interventions for pregnant and postpartum women with mental health disorders. We searched four databases and other sources for evidence available from inception through June 5, 2020 and surveilled the literature through March 2, 2021; dually screened the results; and analyzed eligible studies. We included studies of pregnant, postpartum, or reproductive-age women with a new or preexisting diagnosis of a mental health disorder treated with pharmacotherapy; we excluded psychotherapy. Eligible comparators included women with the disorder but no pharmacotherapy or women who discontinued the pharmacotherapy before pregnancy. Results. A total of 164 studies (168 articles) met eligibility criteria. Brexanolone for depression onset in the third trimester or in the postpartum period probably improves depressive symptoms at 30 days (least square mean difference in the Hamilton Rating Scale for Depression, -2.6; p=0.02; N=209) when compared with placebo. Sertraline for postpartum depression may improve response (calculated relative risk [RR], 2.24; 95% confidence interval [CI], 0.95 to 5.24; N=36), remission (calculated RR, 2.51; 95% CI, 0.94 to 6.70; N=36), and depressive symptoms (p-values ranging from 0.01 to 0.05) when compared with placebo. Discontinuing use of mood stabilizers during pregnancy may increase recurrence (adjusted hazard ratio [AHR], 2.2; 95% CI, 1.2 to 4.2; N=89) and reduce time to recurrence of mood disorders (2 vs. 28 weeks, AHR, 12.1; 95% CI, 1.6 to 91; N=26) for bipolar disorder when compared with continued use. Brexanolone for depression onset in the third trimester or in the postpartum period may increase the risk of sedation or somnolence, leading to dose interruption or reduction when compared with placebo (5% vs. 0%). More than 95 percent of studies reporting on harms were observational in design and unable to fully account for confounding. These studies suggested some associations between benzodiazepine exposure before conception and ectopic pregnancy; between specific antidepressants during pregnancy and adverse maternal outcomes such as postpartum hemorrhage, preeclampsia, and spontaneous abortion, and child outcomes such as respiratory issues, low Apgar scores, persistent pulmonary hypertension of the newborn, depression in children, and autism spectrum disorder; between quetiapine or olanzapine and gestational diabetes; and between benzodiazepine and neonatal intensive care admissions. Causality cannot be inferred from these studies. We found insufficient evidence on benefits and harms from comparative effectiveness studies, with one exception: one study suggested a higher risk of overall congenital anomalies (adjusted RR [ARR], 1.85; 95% CI, 1.23 to 2.78; N=2,608) and cardiac anomalies (ARR, 2.25; 95% CI, 1.17 to 4.34; N=2,608) for lithium compared with lamotrigine during first- trimester exposure. Conclusions. Few studies have been conducted in pregnant and postpartum women on the benefits of pharmacotherapy; many studies report on harms but are of low quality. The limited evidence available is consistent with some benefit, and some studies suggested increased adverse events. However, because these studies could not rule out underlying disease severity as the cause of the association, the causal link between the exposure and adverse events is unclear. Patients and clinicians need to make an informed, collaborative decision on treatment choices.

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