A qualitative investigation of long-term zopiclone use and sleep quality among Vietnam war veterans with PTSD.

Abstract

BACKGROUND:

Self-reported sleep difficulties are common among patients with posttraumatic stress disorder (PTSD), but the routine use of hypnosedatives over extended periods is not generally recommended.

OBJECTIVE:

To examine the effects of the extended use of zopiclone among a cohort of patients with combat-related PTSD.

METHODS:

We conducted a 6-month follow-up cohort study of zopiclone usage characteristics for 26 combat veterans with PTSD. Psychometric and sleep assessments were also conducted at baseline and 6 months.

RESULTS:

The mean baseline score obtained on the tranquilizer dependence questionnaire was 20.4 +/- 13.4, below the cutoff score proposed as indicative of a high likelihood of dependence (23 points). Eight (30.7%) subjects exceeded the proposed cutoff score for dependence at baseline. Most (n = 24) subjects reported poor sleep quality at baseline. Actigraphy revealed that the mean sleep efficiency score was 71.2 +/- 13.7% at baseline. A cohort of 13 men was available for inclusion in the follow-up phase of the study. The tranquilizer dependence questionnaire score at follow-up was broadly similar to the baseline score after a further 6 months of zopiclone use (18.9 at baseline compared with 19.9 +/- 2.6 at follow-up). Individual analysis revealed that the tranquilizer dependence scale score increased for 5 subjects and decreased for 8 subjects at follow-up. Four (30.7%) subjects in the follow-up cohort exceeded the proposed cutoff score for dependence at baseline and 6 (46.1%) subjects exceeded it at follow-up. Actigraphy data were consistent across measurements for individual subjects at baseline and follow-up, with similar mean sleep efficiency scores at baseline and after 6 months of treatment with zopiclone (69.6 +/- 12.7% at baseline; 71.33 +/- 19.0% at follow-up). The proportion of relatively poor sleepers (5/13 at baseline and 4/13 at follow-up) remained essentially unchanged.

CONCLUSIONS:

Overall, the results of this study suggest that, although the subjects in the follow-up phase of the research continued to use zopiclone on a regular basis for an extended period, the efficacy of this intervention for addressing PTSD-related sleep disturbance was low. Extended treatment with zopiclone may not necessarily be associated with increased risk for dependence. Further robust research to examine the consequences of long-term zopiclone therapy for PTSD-related sleep disturbance is warranted.

• Authors: Christopher P Alderman, Andrew L Gilbert
• Journal: The Annals of pharmacotherapy (Ann Pharmacother) Vol. 43 Issue 10 Pg. 1576-82 (Oct 2009) ISSN: 1542-6270 [Electronic] United States
• PMID: 19706738 (Publication Type: Journal Article)

Chemical References

• Azabicyclo Compounds
• Hypnotics and Sedatives
• Piperazines
• zopiclone

Topics

• Australia
• Azabicyclo Compounds (adverse effects, therapeutic use)
• Cohort Studies
• Combat Disorders (drug therapy)
• Follow-Up Studies
• Humans
• Hypnotics and Sedatives (adverse effects, therapeutic use)
• Male
• Middle Aged
• Piperazines (adverse effects, therapeutic use)
• Sleep Initiation and Maintenance Disorders (drug therapy, etiology)
• Stress Disorders, Post-Traumatic (drug therapy)
• Substance-Related Disorders (epidemiology, etiology)
• Time Factors
• Veterans (psychology)