title: Meta-analysis of the efficacy and safety of prazosin versus placebo for the treatment of nightmares and sleep disturbances in adults with posttraumatic stress disorder.
abstract: Although sleep disturbances occur commonly in patients with posttraumatic stress disorder (PTSD) and are associated with adverse outcomes and increased suicidality, they are often inadequately addressed by antidepressant medications.
  
  
  OBJECTIVE
  This review aims to assess whether prazosin reduces nightmares, sleep disturbances, and illness severity in adults with PTSD.
  
  
  METHODS
  Electronic databases (PubMed, PsycINFO) were searched in September 2014 for randomized controlled trials in adults. Search terms included posttraumatic stress disorder, prazosin, nightmares, and sleep disturbance. Included studies used prazosin and provided objective outcome data related to nightmares and/or sleep quality.
  
  
  RESULTS
  Six studies (191 participants) met the criteria for inclusion. Prazosin was more effective than placebo in improving nightmares (standardized mean difference [SMD] = 1.022, 95% confidence interval [CI] [0.41, 1.62], p = .001), sleep quality (SMD = 0.93, 95% CI [-0.02, 1.88], p = .054; and SMD = 1.14, 95% CI [0.24, 2.03], p = .01), and illness severity (SMD = 1.20, 95% CI [0.79, 1.61], p = .001, with no significant effect on systolic (SMD = -0.01, 95% CI [-0.40, 0.37], p = .94) or diastolic (SMD = 0.30, 95% CI [-0.09, 0.68], p = .154) blood pressure.
  
  
  CONCLUSIONS
  PTSD-related nightmares, sleep disturbances, and overall illness severity showed a significant response to treatment with prazosin. With careful dose titration, prazosin was well tolerated and had no significant sustained effect on blood pressure.
authors.affiliation: a Department of Psychiatry , University of Maryland School of Medicine , Baltimore , Maryland , USA.
authors.forename: Kirsten C
authors.initials: KC
authors.lastname: George
authors.affiliation: a Department of Psychiatry , University of Maryland School of Medicine , Baltimore , Maryland , USA.
authors.forename: Lisa
authors.initials: L
authors.lastname: Kebejian
authors.affiliation: a Department of Psychiatry , University of Maryland School of Medicine , Baltimore , Maryland , USA.
authors.forename: Leigh J
authors.initials: LJ
authors.lastname: Ruth
authors.affiliation: a Department of Psychiatry , University of Maryland School of Medicine , Baltimore , Maryland , USA.
authors.forename: Christopher W T
authors.initials: CW
authors.lastname: Miller
authors.affiliation: a Department of Psychiatry , University of Maryland School of Medicine , Baltimore , Maryland , USA.
authors.forename: Seth
authors.initials: S
authors.lastname: Himelhoch
mesh_terms: D058668:Adrenergic alpha-1 Receptor Antagonists / Q000627:therapeutic use*; D000328:Adult; D004325:Dreams / Q000187:drug effects*; D006801:Humans; D011224:Prazosin / Q000627:therapeutic use*; D012893:Sleep Wake Disorders / Q000188:drug therapy*; D013313:Stress Disorders, Post-Traumatic / Q000188:drug therapy*
chemical_list: D058668:Adrenergic alpha-1 Receptor Antagonists; D011224:Prazosin
keywords: Nightmares; posttraumatic stress disorder; prazosin; sleep disturbance