Abstract | CONTEXT: Although insomnia is a frequent health complaint that is often treated with drugs, little is known about differences in treatment efficacy of various drug classes on objective versus subjective outcome measures. OBJECTIVE: Our aim was to compare treatment efficacy of classical benzodiazepines, benzodiazepine receptor agonists ( zopiclone, zolpidem and zaleplon), antidepressants (including low-dose doxepin), neuropeptides, progesterone receptor antagonists, hormones, melatonin receptor agonists, antihistamines, antiepileptics, and narcotics addressing primary insomnia. DATA SOURCES: We conducted a comprehensive literature search (up to 5 April 2013) using PubMed, Cochrane Clinical Trials, PQDT OPEN, OpenGREY, ISI Web of Knowledge, PsycINFO, PSYNDEX, and the WHO International Clinical Trials Registry Platform. ELIGIBILITY CRITERIA: Only polysomnographic, parallel-group, randomized controlled drug trials were included; eligibility was determined by two independent authors. DATA SYNTHESIS: We used a random effects model, based on 31 studies reporting 80 treatment conditions, covering 3,820 participants. RESULTS: Effect size estimates for the total sample of pooled drug classes suggest that there is a small-to-moderate, significant, and robust effect for objective outcomes (sleep onset latency g = -0.36, total sleep time g = 0.27) and subjective outcomes (sleep onset latency g = -0.24, total sleep time g = 0.21). Results indicate higher effect sizes for benzodiazepine receptor agonists and classical benzodiazepines compared with antidepressants (including low-dose doxepin) and for classical benzodiazepines compared with benzodiazepine receptor agonists. Benzodiazepine receptor agonists demonstrated higher effect sizes for objective outcomes. LIMITATIONS: Data on drug safety were not analyzed. CONCLUSIONS:
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Authors | Alexander Winkler, Charlotte Auer, Bettina K Doering, Winfried Rief |
Journal | CNS drugs
(CNS Drugs)
Vol. 28
Issue 9
Pg. 799-816
(Sep 2014)
ISSN: 1179-1934 [Electronic] New Zealand |
PMID | 25168785
(Publication Type: Journal Article, Meta-Analysis, Research Support, Non-U.S. Gov't)
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Topics |
- Humans
- Polysomnography
- Randomized Controlled Trials as Topic
- Sleep Initiation and Maintenance Disorders
(drug therapy, physiopathology)
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