SynthesisBMC geriatrics2022
Efficacy and safety of Z-substances in the management of insomnia in older adults: a systematic review for the development of recommendations to reduce potentially inappropriate prescribing.
Synthesis in BMC geriatrics, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 28 papers, 2 of them syntheses that pooled 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.
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.
Who cites it
28 citing papers in PubMed, 2 syntheses or guidelines pooled it, 56 citations in OpenAlex.
- Prevalence of Benzodiazepine, Z-Drug and Melatonin Use in Australian Residential Aged Care Facilities: A Systematic Review and Meta-Analysis.Australasian journal on ageing · 2026Pooled it
- Effects of Agomelatine on Sleep Across Populations: A Systematic Review and Meta-Analysis.Journal of sleep research · 2026Pooled it
- A brief intervention to discontinue inappropriate z-hypnotics use by older patients in primary care: a randomised controlled trial.BMC primary care · 2026Trial
- Comparative Effects of Two Acupuncture Protocols in the Management of Chronic Insomnia: A Randomized Controlled Trial.Nature and science of sleep · 2025Trial
- Differential Dose-Response Behavioural Profiles of Diazepam, Zolpidem and Indiplon in a Two-Trial Y-Maze Paradigm in Rats.Pharmaceuticals (Basel, Switzerland) · 2026Article
- Randomised Evaluation of Sleep in Cognitive Impairment Trial (REST)-Protocol for a Feasibility Study of a Digital Cognitive Behavioural Therapy for Insomnia Intervention.International journal of environmental research and public health · 2026Article
- Microbaric oxygen therapy modulates EEG microstates and spectral power in patients with chronic insomnia disorder.BMC psychiatry · 2026Article
- Zolpidem restores sleep and decreases amyloid in a mouse model.Alzheimer's & dementia : the journal of the Alzheimer's Association · 2026Article
- Estimation of the Orexin Receptor Occupancy From Human Plasma Pharmacokinetics of Vornorexant, a Novel Dual Orexin 1/2 Receptor Antagonist for the Treatment of Insomnia.Pharmacology research & perspectives · 2026Article
- Lifetime burden of prescription medication for insomnia in middle-aged and older adults in the US: a microsimulation study.Lancet regional health. Americas · 2025Article
- Zolpidem restores sleep and slows Alzheimer's progression in a mouse model.bioRxiv : the preprint server for biology · 2025Article
- Self-reported sleep disturbance and inappropriate z-hypnotic use among older adults in general practice.Scandinavian journal of primary health care · 2025Article
- Prevalence of potentially inappropriate prescribing in community-dwelling older adults: an application of STOPP/START version 3 to The Irish Longitudinal Study on Ageing (TILDA).European geriatric medicine · 2025Article
- Development and validation of a machine-learning model for the risk of potentially inappropriate medications in elderly stroke patients.Frontiers in pharmacology · 2025Article
- Sleep disorders in cancer: interactions and intrinsic links.Frontiers in oncology · 2025Review
- Psychotropic Drug Use and Associated Factors Among Acutely Admitted Older People: A Cross-Sectional Study of a Clinical Sample.Drugs - real world outcomes · 2024Article
- A scoping review of over-the-counter products for depression, anxiety and insomnia in older people.BMC complementary medicine and therapies · 2024Article
- Neurexan Prescription Is Associated with Lower Risk of Sleep Disorder Recurrence and Depression Prevalence as Compared to Z-Drugs and Benzodiazepines: A Retrospective Database Analysis in Germany.Healthcare (Basel, Switzerland) · 2024Article
- Development of a Web Application for Simulating Plasma Drug Concentrations in Patients with Zolpidem Intoxication.Pharmaceutics · 2024Article
- Evaluation and management of insomnia in the clinical practice in Italy: a 2023 update from the Insomnia Expert Consensus Group.Journal of neurology · 2024Review
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
4 authors at 2 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundZ-drugs are usually prescribed as first line pharmacological therapy for insomnia. However, the benefits and risks of Z-drugs may differ for older adults. This systematic review investigated the available evidence on the efficacy and safety of Z-drugs in the management of insomnia in older adults.
methodsThe Cochrane database of Systematic Reviews, the Cochrane Central Register of Controlled Trials, PubMed/MEDLINE and EMBASE were searched for systematic reviews, meta-analyses, controlled interventional and observational studies using a pre-formulated search term. The target population was older adults (≥65 years old) with insomnia. Studies were included if they reported efficacy and/or safety outcomes of the use of Z-drugs for the management of insomnia compared to placebo, usual or no treatment, or other pharmacological agents.
resultsEighteen studies were included (8 interventional and 10 observational studies). In short-term interventional studies, Z-drugs were similarly or better efficacious in improving both sleep and daytime parameters than placebo or other pharmacological treatments, while showing good results on measures of safety. However, in longer-term observational studies, Z-drugs significantly increased the risk for falls and fractures in comparison to no treatment or melatonin agonists.
conclusionsAnalyzing the evidence from short-term interventional studies, Z-drugs appear effective and safe for treatment of insomnia in older adults, but they may have unfavorable side effects when used for longer periods of time. We, therefore, recommend discontinuing Z-drugs, principally because of the high risk for falls and fractures. Nonetheless, quality and quantity of evidence are low. Due to the scarcity of data, especially concerning drug dependence after longer periods of treatment and due to the significantly increased risk for falls and fractures, further studies are needed to evaluate the benefit-risk profile of Z-drugs use in older patients, particularly for long-term use.
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What OpenQuestion holds
Registered trials
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.