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The Efficacy and Safety of Drug Treatments for Chronic Insomnia in Adults: A Meta-analysis of RCTs

  • Nina Buscemi
  • Ben Vandermeer
  • Carol Friesen
  • Liza Bialy
  • Michelle Tubman
  • Maria Ospina
  • Terry P. Klassen
  • Manisha Witmans
Clinical Review

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.

KEY WORDS

drug treatment chronic insomnia 

Notes

Acknowledgment

We are grateful to members of the technical expert panel for providing input on the direction of the review.

Financial Support

This study was conducted under contract to the Agency for Healthcare Research and Quality (Contract No.C400_000_021), Rockville, MD., funded by the Office of Medical Applications of Research, National Institutes of Health, Bethesda, MD. The study was presented at the NIH State_of_the_Science Conference on Manifestations and Management of Chronic Insomnia in Adults in June 2005.

Disclaimer

The authors of this article are responsible for its contents, including any clinical or treatment recommendations. No statement in this article should be construed as an official position of the Agency for Healthcare Research and Quality, the Office of Medical Applications of Research or the U.S. Department of Health and Human Services.

Conflict of Interest

The corresponding author declares, on behalf of all authors, that there are no conflicts of interest to disclose.None disclosed

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Copyright information

© Society of General Internal Medicine 2007

Authors and Affiliations

  • Nina Buscemi
    • 1
  • Ben Vandermeer
    • 1
  • Carol Friesen
    • 1
  • Liza Bialy
    • 1
    • 3
  • Michelle Tubman
    • 1
  • Maria Ospina
    • 1
  • Terry P. Klassen
    • 1
  • Manisha Witmans
    • 2
  1. 1.University of Alberta/Capital Health Evidence-Based Practice Centre, Department of PediatricsUniversity of AlbertaAlbertaCanada
  2. 2.Department of PediatricsUniversity of AlbertaAlbertaCanada
  3. 3.Aberhart Centre OneEdmontonCanada

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