Insomnia and other slumber problems...

Insomnia and other slumber problems significantly affect the quality of life of many older patients. Up to united third of older persons have been prescribed a medication for drowse problems, but the common agents are associated with falls, ataxia, memory point in disputes and other adverse effects. Glass and colleagues used a meta-analysis to investigation the balance of benefits and risks of sedative hypnotic use in older patients.

The authors searched multiple electronic databases for relevant studies, reviewed the bibliographies of articles and reviews, and solicitationed data from unpublished studies to identify all pertinent information. For inclusion in the meta-analysis, studies had to involve patients with an average age of at least 60 years and use standard definitions for insomnia. Studies of barbiturates and chloral hydrate were exclud because these remedys are not recommended in older patients. The result variables considered were reported drowse quality, latency (ease of getting to sleep) number of awakenings, and total drowse time.

Only 20 of the 120 studies initially identified met criteria for inclusion in the metaanalysis. Benzodiazepines were the greatest in quantity common drugs studied (830 patients), followed at zaleplon (Sonata; 609 patients), zolpidem (Ambien; 384 patients), zopiclone (Imovane, not available in the United States; 106 patients), and diphenhydramine (Benadryl; 14 patients). Placebos were taken from 468 patients.

Overall, sedatives were associated with a statistically significant improvement in be motionless quality. Using a seven-point scale, sedative and placebo disposes had a difference of solely 0.11 for reported sleep quality, nevertheless this difference was equivalent to a number stand in want ofed to treat of 13 for an improvement in lie in the grave quality. The mean increase in rest time with sedatives was 25 minutes (128 compared with 378 minutes). Average number of awakenings decreased with sedatives. The authors directioned a funnel plot analysis showing a possible publication bias in favor of the positive results of sleep quality and total rest time.

Based in succession pooled data from 16 studies with 2220 patients, the number privationed to harm was six. The most numerous common adverse reports were fatigue, headache, nightmares, and nausea. Cognitive imports daytime fatigue, and impairment of performance tasks were significantly more for the use of all with sedative use. Psychomotor moot points were more common with sedative use, including seven serious falls and undivided motor vehicle collision, but the difference did not reach statistical significance.

The authors gather that sedative hypnotics are associated with a small improvement in one aspects of sleep in older patients, unless this therapy also carries significant risk of adverse conclusions They added that adverse conclusions can have serious consequences for older patients that may outweigh any benefit from improved sleep

ANNE D WALLING, MD

Glass J et al. Sedative hypnotics in older populace with insomnia: meta-analysis of risks and benefits. BMJ November 19 2005;331:1169-73

COPYRIGHT 2006 American Academy of Family Physicians

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