Abstract
BackgroundChronic insomnia is common in patients with arteriosclerotic cerebral small vessel disease (CSVD) and aggravates the cognitive impairment caused by CSVD. Low-dose trazodone is effective in treating insomnia, but it is unclear whether it can also improve cognitive function in CSVD patients. This study was performed to explore the effects of trazodone on sleep quality and cognitive function in CSVD comorbid with chronic insomnia.MethodsThis was a randomized, double-blind, placebo-controlled pilot study. Forty patients suffering from arteriosclerotic CSVD and insomnia were recruited from an outpatient clinic. Participants were randomized individually to receive either trazodone (study group) or a placebo (control group) for 4 weeks. The primary outcome was the cognitive score on the Montreal Cognitive Assessment scale (MoCA). Secondary outcomes included sleep parameters measured with polysomnography (PSG) and the Pittsburgh Sleep Quality Index.ResultsTrazodone caused significantly better improvements in concentration and recall abilities, measured with MoCA, as well as in PSG parameters such as sleep efficiency, N3 sleep ratio, and sleep continuity than the placebo, with no significant differences in the occurrence of side effects. The improvement of sleep quality was correlated with increased concentration and recall abilities.ConclusionsA low dose of trazodone seems acceptable and effective in reducing insomnia severity and improving concentration and recall abilities in this pilot study. The improvement of cognition could be achieved by alleviation of insomnia severity. Considering the high incidence of insomnia in CSVD patients, the results of this preliminary study support the use of low-dose trazodone to deal with insomnia and cognitive impairment in CSVD.
Highlights
Cerebral small vessel disease (CSVD) refers to the syndrome of clinical, cognitive, imaging, and pathological manifestations caused by various small vascular diseases [1], among which arteriosclerotic CSVD is the most common type [1]
The following PSG parameters were collected as we reported in a previous study [4]: sleep onset latency (SOL), total sleep time (TST), sleep efficiency (SE), wake after sleep onset (WASO), proportion of sleep stages (N1, N2, N3, and rapid eye movement [REM]), apnea-hypopnea index (AHI), and arousal index (ArI)
Forty patients were randomly assigned to the trazodone and placebo groups, among which 30 patients completed all follow-ups and evaluations (16 in the study group and 14 in the control group)
Summary
Cerebral small vessel disease (CSVD) refers to the syndrome of clinical, cognitive, imaging, and pathological manifestations caused by various small vascular diseases [1], among which arteriosclerotic CSVD is the most common type [1]. The most common sleep disorder in elderly individuals, is often comorbid with physical diseases including cerebral vascular disease [3]. Chronic insomnia is common in patients with arteriosclerotic cerebral small vessel disease (CSVD) and aggravates the cognitive impairment caused by CSVD. Lowdose trazodone is effective in treating insomnia, but it is unclear whether it can improve cognitive function in CSVD patients. This study was performed to explore the effects of trazodone on sleep quality and cognitive function in CSVD comorbid with chronic insomnia
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