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J Gen Intern Med. 2007 Sep;22(9):1335-50. Epub 2007 Jul 10.

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

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1
University of Alberta/Capital Health Evidence-Based Practice Centre, Department of Pediatrics, University of Alberta, Alberta, Canada.

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.

PMID:
17619935
PMCID:
PMC2219774
DOI:
10.1007/s11606-007-0251-z
[Indexed for MEDLINE]
Free PMC Article
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