The efficacy and safety of drug treatments for chronic insomnia in adults: a meta-analysis of RCTs.

Abstract

BACKGROUND:

Hypnotics have a role in the management of acute insomnia; however, the efficacy and safety of pharmacological interventions in the management of chronic insomnia is unclear.

OBJECTIVE:

The objective of this paper is to conduct a systematic review of the efficacy and safety of drug treatments for chronic insomnia in adults.

DATA SOURCES:

Twenty-one electronic databases were searched, up to July 2006.

STUDY SELECTION:

Randomized double-blind, placebo-controlled trials were eligible. Quality was assessed using the Jadad scale. Data were pooled using the random effects model.

DATA SYNTHESIS:

One hundred and five studies were included in the review. Sleep onset latency, as measured by polysomnography, was significantly decreased for benzodiazepines (BDZ), (weighted mean difference: -10.0 minutes; 95% CI: -16.6, -3.4), non-benzodiazepines (non-BDZ) (-12.8 minutes; 95% CI: -16.9, -8.8) and antidepressants (ADP) (-7.0 minutes; 95% CI: -10.7, -3.3). Sleep onset latency assessed by sleep diaries was also improved (BDZ: -19.6 minutes; 95% CI: -23.9, -15.3; non-BDZ: -17.0 minutes; 95% CI: -20.0, -14.0; ADP: -12.2 minutes; 95% CI: -22.3, -2.2). Indirect comparisons between drug categories suggest BDZ and non-BDZ have a similar effect. All drug groups had a statistically significant higher risk of harm compared to placebo (BDZ: risk difference [RD]: 0.15; non-BDZ RD: 0.07; and ADP RD: 0.09), although the most commonly reported adverse events were minor. Indirect comparisons suggest that non-BDZ are safer than BDZ.

CONCLUSIONS:

Benzodiazepines and non-benzodiazepines are effective treatments in the management of chronic insomnia, although they pose a risk of harm. There is also some evidence that antidepressants are effective and that they pose a risk of harm.

• Authors: Nina Buscemi, Ben Vandermeer, Carol Friesen, Liza Bialy, Michelle Tubman, Maria Ospina, Terry P Klassen, Manisha Witmans
• Journal: Journal of general internal medicine (J Gen Intern Med) Vol. 22 Issue 9 Pg. 1335-50 (Sep 2007) ISSN: 1525-1497 [Electronic] United States
• PMID: 17619935 (Publication Type: Comparative Study, Journal Article, Meta-Analysis, Research Support, N.I.H., Extramural, Systematic Review)

Chemical References

• Antidepressive Agents
• Hypnotics and Sedatives
• Benzodiazepines

Topics

• Adult
• Aged
• Antidepressive Agents (adverse effects, therapeutic use)
• Benzodiazepines (adverse effects, therapeutic use)
• Female
• Humans
• Hypnotics and Sedatives (adverse effects, therapeutic use)
• Male
• Middle Aged
• Polysomnography (methods)
• Randomized Controlled Trials as Topic (methods)
• Sleep Initiation and Maintenance Disorders (drug therapy, epidemiology, physiopathology)