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

被引:290
作者
Buscemi, Nina
Vandermeer, Ben
Friesen, Carol
Bialy, Liza
Tubman, Michelle
Ospina, Maria
Klassen, Terry P.
Witmans, Manisha
机构
[1] Alberhart Ctr 1, Edmonton, AB T6J 2G3, Canada
[2] Univ Alberta, Dept Pediat, Capital Hlth Evidence Based Practice Ctr, Edmonton, AB, Canada
[3] Univ Alberta, Dept Pediat, Edmonton, AB, Canada
基金
美国国家卫生研究院; 美国医疗保健研究与质量局;
关键词
drug; treatment; chronic; insomnia;
D O I
10.1007/s11606-007-0251-z
中图分类号
R19 [保健组织与事业(卫生事业管理)];
学科分类号
摘要
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 analysis: 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.
引用
收藏
页码:1335 / 1350
页数:16
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