Evidence map›Paper›PMID 31838549›Full record

SynthesisEuropean journal of clinical pharmacology2020

Efficacy and safety of non-benzodiazepine and non-Z-drug hypnotic medication for insomnia in older people: a systematic literature review.

Judith Sys, Simon Van Cleynenbreugel, Mieke Deschodt, Lorenz Van der Linden, Jos Tournoy

Abstract readSystematic Review
PubMed Publisher
In one paragraph

Synthesis in European journal of clinical pharmacology, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 19 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
19citing papers in PubMed, 2 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

19 citing papers in PubMed, 2 syntheses or guidelines pooled it.

  1. Pooled it
  2. Pooled it
  3. Trial
  4. Trial
  5. Trial
  6. Article
  7. Article
  8. Article
  9. Article
  10. Review
  11. Article
  12. The Function of Sleep and the Treatment of Primary Insomnia.Deutsches Arzteblatt international · 2023
    Review
  13. Optimizing treatment for older adults with depression.Therapeutic advances in psychopharmacology · 2023
    Review
  14. Article
  15. Article
  16. Article
  17. Article
  18. Article
  19. Pharmacological Management of Insomnia.Neurotherapeutics : the journal of the American Society for Experimental NeuroTherapeutics · 2021
    Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

5 authors.

Judith SysDepartment of Geriatric Medicine, University Hospitals Leuven, Herestraat 49, Leuven, 3000, Belgium.ORCID http://orcid.org/0000-0001-7356-880X
Simon Van CleynenbreugelDepartment of Geriatric Medicine, University Hospitals Leuven, Herestraat 49, Leuven, 3000, Belgium.
Mieke DeschodtDepartment of Chronic Diseases, Metabolism and Ageing, KU Leuven, Herestraat 49, Leuven, 3000, Belgium.
Lorenz Van der LindenPharmacy Department, University Hospitals Leuven, Herestraat 49, Leuven, 3000, Belgium.
Jos TournoyDepartment of Geriatric Medicine, University Hospitals Leuven, Herestraat 49, Leuven, 3000, Belgium. jos.tournoy@uzleuven.be.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

purposeInsomnia is highly prevalent in older persons and significantly impacts quality of life, functional abilities, and health status. It is frequently treated with benzodiazepines or Z-drugs. Due to adverse events, an increased use of alternative sedative medications has been observed in older adults. We aimed to study the efficacy and safety of alternative sedative medications for treating insomnia in older people, excluding benzodiazepines and Z-drugs.

methodsWe conducted a systematic search of MEDLINE (PubMed), EMBASE, and the Cochrane Central register of Controlled Trials databases. We included randomized controlled trials and prospective and retrospective quasi-experimental studies, conducted in patients older than 65 years, without psychiatric or neurological comorbidities.

resultsThe systematic search yielded 9483 articles, of which 24 were included in this review, describing nine different sleep medications in total. No clear beneficial impact on sleep could be demonstrated in studies investigating the impact of melatonin (n = 10), paroxetine (n = 1), diphenhydramine (n = 1), tiagabine (n = 2), and valerian (n = 1). Ramelteon slightly improved sleep latency (n = 4), while doxepin was found to provide a sustained sleep improvement with a safety profile that was comparable to placebo (n = 3). Suvorexant showed an improved sleep maintenance with only mild side effects (n = 1). One study detected increased adverse effects of trazodone after 3 months but did not evaluate the effect on sleep.

conclusionsThe overall level of evidence was limited, making it difficult to draw robust conclusions. Preliminary evidence points towards suvorexant, doxepin, and possibly ramelteon as effective and safe pharmacological alternatives for treating insomnia in older adults.

Indexed as

AgedBenzodiazepinesHumansHypnotics and SedativesProspective StudiesQuality of LifeRandomized Controlled Trials as TopicRetrospective StudiesSleepSleep Initiation and Maintenance DisordersBenzodiazepinesHypnotics and SedativesAgedAntidepressantHypnotics and sedativesInsomniaOlder adultsSleep

Identifiers

PMID31838549

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.