Work

0380 Objective and Subjective Effects of Four Classes of Hypnotics on Sleep Continuity in Patients With Chronic Insomnia: a First Pass Analysis

Year: 2017

Type: article

Study designs: Systematic Review, Meta-Analysis

Abstract: Little is known about the relative efficacy of the medications used to treat insomnia. Accordingly, a meta-analysis was undertaken to examine how objective (PSG) and subjective (sleep diary) measures of sleep continuity vary by drug class. PubMed searches, from 1967-June 2016, yielded 327 possible articles. Inclusion criteria were that the studies: 1) were randomized placebo controlled trials of medications commonly used as hypnotics (BZs, BZRAs, SADs, DORAs, or melatonin agonists [MELA]); 2) were between 1 and 14 days in duration; 3) had pre- and post-treatment sleep continuity data and reported as means and standard deviations (or equivalent). Studies were excluded if they allowed for non-nightly dosing (or middle-of-the-night dosing) and/or included participants not diagnosed with insomnia based on DSM or ICSD criteria. Weighted effect sizes (ES) were computed for the pre-post change data and were compared to the study placebo condition. Between class differences were assessed using a threshold approach (if the ES of one class was 2x larger than another, the difference [for this preliminary analysis] was considered to be significant). Sufficient data were available for only BZRAs, SADs, DORAs, and MELA. On PSG measures, the relative efficacy for the four classes of medications were as follows: SL (BZRAs=MELAs>DORAs=SADs); WASO (SADs>BZRA=DORAs>MELAs); and TST (BZRAs=SADs=DORAs>MELAs). On sleep diary measures, the relative efficacy for the four classes of medications were as follows: SL (BZRAs >MELAs=DORAs=SADs); WASO (BZRAs=SADs > DORAs=MELAs); and TST (BZRAs=SADs>DORAs=MELAs). These preliminary results suggest that, on PSG measures, BZRAs and MELAs have larger effects on sleep initiation and SADs have larger effects on sleep maintenance. On sleep diary measures, BZRAs have larger effects on sleep initiation and BZRAs and SADs have larger effects on sleep maintenance. Overall, BZRAs appear to have the best average hypnotic efficacy of the classes of medications evaluated in the present analysis. Partial support provided by R56AG050620 and R01AG041783.

Source: SLEEP

DOI: 10.1093/sleepj/zsx050.379