2023 Guidelines on the Diagnosis and Treatment of Insomnia in Adults - Brazilian Sleep Association

Luciano Ferreira Drager; Márcia Assis; Andrea Frota Rego Bacelar; Dalva Lucia Rollemberg Poyares; Silvia Gonçalves Conway; Gabriel Natan Pires; Alexandre Pinto de Azevedo; Alicia Carissimi; Allan Luiz Eckeli; Álvaro Pentagna; Carlos Maurício Oliveira Almeida; Clélia Maria Ribeiro Franco; Emmanuelle Silva Tavares Sobreira; Fernando Gustavo Stelzer; Giuliana Macedo Mendes; Gisele Richter Minhoto; Ila Marques Porto Linares; Ksdy Maiara Moura Sousa; Livia Leite Góes Gitaí; Lucia Sukys-Claudino; Manoel Alves Sobreira-Neto; Marcio Andrei Zanini; Regina Margis; Sandra Cristina Gonçalves Martinez

doi:10.1055/s-0043-1776281

2023 Guidelines on the Diagnosis and Treatment of Insomnia in Adults - Brazilian Sleep Association

Sleep Sci. 2023 Nov 22;16(Suppl 2):507-549. doi: 10.1055/s-0043-1776281. eCollection 2023 Oct.

Authors

Luciano Ferreira Drager^{1

2}, Márcia Assis^{1

3}, Andrea Frota Rego Bacelar^{1

4}, Dalva Lucia Rollemberg Poyares^{5

6}, Silvia Gonçalves Conway^{7

8

9}, Gabriel Natan Pires^{5

6}, Alexandre Pinto de Azevedo⁷, Alicia Carissimi^{10

11}, Allan Luiz Eckeli¹², Álvaro Pentagna¹³, Carlos Maurício Oliveira Almeida¹⁴, Clélia Maria Ribeiro Franco¹⁵, Emmanuelle Silva Tavares Sobreira^{9

16

17}, Fernando Gustavo Stelzer¹², Giuliana Macedo Mendes¹⁸, Gisele Richter Minhoto¹⁹, Ila Marques Porto Linares^{7

20}, Ksdy Maiara Moura Sousa^{5

21}, Livia Leite Góes Gitaí²², Lucia Sukys-Claudino²³, Manoel Alves Sobreira-Neto¹⁶, Marcio Andrei Zanini²⁴, Regina Margis²⁵, Sandra Cristina Gonçalves Martinez²⁶

Affiliations

¹ Associação Brasileira do Sono, São Paulo, SP, Brazil.
² Unidades de HipertenSão, Instituto do Coração (InCor) e Disciplina de Nefrologia, Universidade de São Paulo, São Paulo, SP, Brazil.
³ Clínica do Sono de Curitiba, Hospital São Lucas, Curitiba, Brazil.
⁴ Clínica Bacelar - Neuro e Sono, Rio de Janeiro, RJ, Brazil.
⁵ Departamento de Psicobiologia, Universidade Federal de São Paulo, São Paulo, Brazil.
⁶ Instituto do Sono, São Paulo, SP, Brazil.
⁷ Instituto de Psiquiatria (IPq), Universidade de São Paulo, São Paulo, SP, Brazil.
⁸ Departamento de Otoneurologia, Universidade de São Paulo, São Paulo, SP, Brazil.
⁹ AkasA - Formação e Conhecimento, São Paulo, SP, Brazil.
¹⁰ Faculdade Dom Bosco, Porto Alegre, RS, Brazil.
¹¹ Cronosul Clínica de Psicologia do Sono, Psicoterapia e Neuropsicologia, Porto Alegre, RS, Brazil.
¹² Departamento de Neurociências e Ciências do Comportamento, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil.
¹³ Hospital das Clínicas (HCFMUSP), Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil.
¹⁴ Departamento de Neurologia, Universidade Estadual do Amazonas, UEA, Brazil.
¹⁵ Hospital Universitário Oswaldo Cruz (HUOC), Universidade Federal de Pernambuco, Recife, PE, Brazil.
¹⁶ Universidade Federal do Ceará, Fortaleza, CE, Brazil.
¹⁷ Clínica Sinapse Diagnóstico, Fortaleza, CE, Brazil.
¹⁸ Instituto de Especialidades e Sono, Goiânia, GO, Brazil.
¹⁹ Pontifícia Universidade Católica do Paraná (PUCPR), Curitiba, PR, Brazil.
²⁰ Instituto da Criança, Faculdade de Medicina, Universidade de São Paulo (FMUSP), São Paulo, SP, Brazil.
²¹ SleepUp Tecnologia e Saúde LTDA, São Paulo, SP, Brazil.
²² Faculdade de Medicina, Universidade Federal de Alagoas, AL, Brazil.
²³ Disciplina de Neurologia, Universidade Federal de Santa Catarina (UFSC), Florianópolis, SC, Brazil.
²⁴ Instituto de Assistência Médica ao Servidor Público Estadual (IAMPSE), São Paulo, SP, Brazil.
²⁵ Private clinic, Porto Alegre, RS, Brazil.
²⁶ Universidade Estadual de Campinas (UNICAMP), Campinas, SP, Brazil.

Abstract

Chronic insomnia disorder (simplified in this document as insomnia) is an increasingly common clinical condition in society and a frequent complaint at the offices of different areas of health practice (particularly Medicine and Psychology). This scenario has been accompanied by a significant evolution in treatment, as well as challenges in approaching patients in an appropriately way. This clinical guideline, coordinated by the Brazilian Sleep Association and the Brazilian Association of Sleep Medicine and counting on the active participation of various specialists in the area, encompasses an update on the diagnosis and treatment of insomnia in adults. To this end, it followed a structured methodology. Topics of interest related to diagnosis were written based on theoretical framework, evidence in the literature, and professional experience. As for the topics related to the treatment of insomnia, a series of questions were developed based on the PICO acronym (P - Patient, problem, or population; I - Intervention; C - Comparison, control, or comparator; O - Outcome). The work groups defined the eligible options within each of these parameters. Regarding pharmacological interventions, only the ones currently available in Brazil or possibly becoming available in the upcoming years were considered eligible. Systematic reviews were conducted to help prepare the texts and define the level of evidence for each intervention. The final result is an objective and practical document providing recommendations with the best scientific support available to professionals involved in the management of insomnia.

Keywords: adults; diagnosis; insomnia; treatment.

Brazilian Sleep Association. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. ( https://creativecommons.org/licenses/by-nc-nd/4.0/ ).

Publication types

Review