title: Comparative meta-analysis of prazosin and imagery rehearsal therapy for nightmare frequency, sleep quality, and posttraumatic stress.
abstract: OBJECTIVE
  In this meta-analysis, we compare the short-term efficacy of prazosin vs. IRT on nightmares, sleep quality, and posttraumatic stress symptoms (PTSS).
  
  
  METHODS
  Reference databases were searched for randomized controlled trials using IRT or prazosin for nightmares, sleep disturbance, and/or PTSS. Effect sizes were calculated by subtracting the mean posttest score in the control group from the mean posttest score in the treatment group, and dividing the result by the pooled standard deviation of both groups. Mixed effects models were performed to evaluate effects of treatment characteristics, as well as sample characteristics (veteran vs. civilian) on treatment efficacy.
  
  
  RESULTS
  Four studies used prazosin, 10 used IRT alone or in combination with another psychological treatment, and 1 included a group receiving prazosin and another group receiving IRT. Overall effect sizes of both treatments were of moderate magnitude for nightmare frequency, sleep quality, and PTSS (p < 0.01). Effect size was not significantly different with type of treatment (psychological vs. pharmacological) on nightmare frequency (p = 0.79), sleep quality (p = 0.65), or PTSS, (p = 0.52). IRT combined with CBT for insomnia showed more improvement in sleep quality compared to prazosin (p = 0.03), IRT alone (p = 0.03), or IRT combined with another psychological intervention, (p < 0.01).
  
  
  CONCLUSIONS
  Although IRT interventions and prazosin yield comparable acute effects for the treatment of nightmares, adding CBT for insomnia to IRT seems to enhance treatment outcomes pertaining to sleep quality and PTSS. More randomized clinical trials with long-term follow-up are warranted.
  
  
  CONCLUSIONS
  A commentary on this article appears in this issue on page 9.
authors.affiliation: Department of Pulmonary and Sleep Medicine, Naval Medical Center, San Diego, CA.
authors.forename: Gilbert
authors.initials: G
authors.lastname: Seda
authors.affiliation: School of Nursing, University of Murcia, Murcia, Spain.|Department of Medicine, National Jewish Health, Denver, CO.
authors.forename: Maria M
authors.initials: MM
authors.lastname: Sanchez-Ortuno
authors.affiliation: Department of Medicine, Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado Denver, Denver, CO.|Denver Veterans Affairs Medical Center, Denver, CO.
authors.forename: Carolyn H
authors.initials: CH
authors.lastname: Welsh
authors.affiliation: Department of Pulmonary Medicine, Children's Hospital Colorado and University of Colorado Denver, Denver, CO.
authors.forename: Ann C
authors.initials: AC
authors.lastname: Halbower
authors.affiliation: Department of Medicine, National Jewish Health, Denver, CO.|Duke University Medical Center, Durham, NC.
authors.forename: Jack D
authors.initials: JD
authors.lastname: Edinger
mesh_terms: D058668:Adrenergic alpha-1 Receptor Antagonists / Q000627:therapeutic use; D004325:Dreams / Q000187:drug effects* / Q000523:psychology; D005260:Female; D006801:Humans; D019018:Imagery, Psychotherapy / Q000379:methods*; D008297:Male; D011224:Prazosin / Q000627:therapeutic use*; D012893:Sleep Wake Disorders / Q000150:complications / Q000188:drug therapy / Q000628:therapy*; D013313:Stress Disorders, Post-Traumatic / Q000150:complications / Q000523:psychology / Q000628:therapy*; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D058668:Adrenergic alpha-1 Receptor Antagonists; D011224:Prazosin
keywords: cognitive behavior therapy; imagery rehearsal therapy; insomnia; nightmares; posttraumatic stress disorder; prazosin