Effect of age on hypnotics’ efficacy and safety in insomnia: A systematic review and meta-analysis

IF 3.8 2区医学 Q1 CLINICAL NEUROLOGY Sleep medicine Pub Date : 2024-11-14 DOI:10.1016/j.sleep.2024.11.023

Nguyen Patrick Viet-Quoc , Dang-Vu Thien Thanh , Leduc Philippe (candidate) , Champagne Sebastien , Saidi Lidia (student) , Desmarais Philippe

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Abstract

Objective

This systematic review and meta-analysis evaluates the efficacy in improving sleep quality and safety of hypnotics in individuals aged 65 years or older compared to those under 65 years.

Methods

MEDLINE, EMBASE, Web of Science, and EBM Reviews were searched for randomized clinical trials comparing hypnotics to the placebo in adults with chronic insomnia between Jan 2000 and Dec 2022. The efficacy outcome included all participant self-assessments sleep quality questionnaires. The safety outcome included acceptability and tolerance. Standardized mean differences (SMD) was estimated using a random effect model.

Results

We included 17 and 53 clinical trials with 3688 and 14,720 participants in the ≥65 years and <65 years group respectively. The SMD for the sleep quality outcome was −0.36 [Confidence interval (CI) 95 %: 0.45;-0.26] in the ≥65 years group compared to −0.51 [95%CI: 0.61; −0.41] in the <65 years group (p = 0.02). Differences in efficacy were observed between pharmacological classes. The overall SMD for the tolerance outcome was - 0.25 [95%CI: 0.34; −0.16] favoring the placebo group (p < 0.001). In the ≥65 years group the SMD was −0.07 [95%CI: 0.21; 0.08] compared to −0.31 [95%CI: 0.41; −0.21] in the <65 years group (p = 0.01). There were no differences for acceptability.

Conclusion

We found that some hypnotics classes could be less effective in older individuals. We encourage authors to include details on multimorbidity and polypharmacy in their publications.

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年龄对失眠症催眠药疗效和安全性的影响：系统回顾与荟萃分析

方法检索了2000年1月至2022年12月期间在MEDLINE、EMBASE、Web of Science和EBM Reviews上对患有慢性失眠症的成人进行的催眠药与安慰剂比较的随机临床试验。疗效结果包括所有参与者自我评估的睡眠质量问卷。安全性结果包括可接受性和耐受性。结果我们分别纳入了17项和53项临床试验，≥65岁组和65岁组分别有3688名和14720名参与者。睡眠质量结果的SMD在≥65岁组为-0.36[置信区间（CI）95%：0.45；-0.26]，而在<65岁组为-0.51[95%CI：0.61；-0.41]（P = 0.02）。不同药物类别之间的疗效存在差异。耐受性结果的总体SMD为-0.25 [95%CI: 0.34; -0.16]，安慰剂组更优（p = 0.001）。≥65岁组的SMD为-0.07 [95%CI: 0.21; 0.08]，而65岁组为-0.31 [95%CI: 0.41; -0.21]（p = 0.01）。结论我们发现，某些类别的催眠药对老年人的疗效可能较差。我们鼓励作者在其出版物中详细介绍多病和多重用药情况。

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来源期刊

Sleep medicine 医学-临床神经学

CiteScore

8.40

自引率

6.20%

发文量

1060

审稿时长

49 days

期刊介绍： Sleep Medicine aims to be a journal no one involved in clinical sleep medicine can do without. A journal primarily focussing on the human aspects of sleep, integrating the various disciplines that are involved in sleep medicine: neurology, clinical neurophysiology, internal medicine (particularly pulmonology and cardiology), psychology, psychiatry, sleep technology, pediatrics, neurosurgery, otorhinolaryngology, and dentistry. The journal publishes the following types of articles: Reviews (also intended as a way to bridge the gap between basic sleep research and clinical relevance); Original Research Articles; Full-length articles; Brief communications; Controversies; Case reports; Letters to the Editor; Journal search and commentaries; Book reviews; Meeting announcements; Listing of relevant organisations plus web sites.