Pharmacological treatment with prazosin and psychological treatment with imagery rehearsal therapy (IRT) are the two main treatments of posttraumatic nightmares. The American Academy of Sleep Medicine task force recently listed IRT as the recommended treatment for trauma-related nightmares and changed the recommendation of prazosin to ‘may be used’. This new recommendation was based on a single prazosin trial and not on a meta-analytic review of all available trials. The current meta-analysis aims to fill this gap in the literature. Eight studies on IRT and seven studies on prazosin (N = 1.078) were analyzed based on the random effects model. Relative to control groups, prazosin had a moderate to large effect on nightmare frequency (g = 0.61), posttraumatic stress symptoms (g = 0.81), and sleep quality (g = 0.85). IRT showed small to moderate effects on nightmare frequency (g = 0.51), posttraumatic symptoms (g = 0.31), and sleep quality (g = 0.51). No significant differences in effect were observed between prazosin and IRT on any of these outcomes (all p's > 0.10). It is concluded that downgrading the recommendation of prazosin may be a premature decision and that the aggregated results in this meta-analysis clearly show efficacy of both treatments.

创伤后噩梦的两种主要治疗方法是使用哌唑嗪进行药理治疗以及使用图像排练治疗（IRT）进行心理治疗。美国睡眠医学科学院特别工作组最近将IRT列为创伤相关噩梦的推荐治疗方法，并将哌唑嗪的建议更改为“可以使用”。这项新的建议是基于单一的哌唑嗪试验，而不是基于所有可用试验的荟萃分析。当前的荟萃分析旨在填补文献中的空白。基于随机效应模型，分析了八项有关IRT的研究和七项有关哌唑嗪的研究（N = 1.078）。相对于对照组，哌唑嗪对梦 night发作频率（g = 0.61），创伤后应激症状（g = 0.81）和睡眠质量（g  = 0.85）。IRT对梦night频率（g  = 0.51），创伤后症状（g  = 0.31）和睡眠质量（g  = 0.51）表现出中度的影响。在任何这些结果中，哌唑嗪和IRT之间的作用均未观察到显着差异（所有p均> 0.10）。结论是降级推荐的哌唑嗪可能是一个过早的决定，这项荟萃分析的汇总结果清楚地表明了两种治疗方法的有效性。