Effects of sedative-hypnotics on sleep quality among patients with insomnia: evidence from an observational, pre-post study in India

Abstract

Background Insomnia continues to be neglected globally, despite its high prevalence. Guidelines by the health regulatory agencies call for studies to evaluate the effect of sedative-hypnotics on sleep quality. Methods We conducted a pre-post observational study to evaluate sleep quality among 186 inpatients receiving short-term oral sedative-hypnotic therapy in a tertiary care teaching hospital in Kozhikode (Kerala), India. Using Pittsburgh Sleep Quality Index_Past-Week (PSQI_PW) questionnaire, patients were interviewed upon hospital admission and at follow up after ≥1-week of sedative-hypnotic therapy. Additionally, we interviewed 36 physicians to understand the current clinical perception about sedative-hypnotics. Results Mean (SD) age of the study patients was 59 (7.5) years. Majority (63.4%) of the patients were men. Of the various primary diagnoses for hospitalization, cardiovascular disease was the most common (22.6%, n = 49). Sedative-hypnotic therapy improved the mean (SD) PSQI_PW overall score by 6.79 points (pre: 12.70 (3.5) vs. post: 5.91 (2.8); p < 0.0001). Statistically significant improvements in sleep duration, latency, efficacy, and day dysfunction were observed. Higher proportion of study patients were prescribed benzodiazepines (73.7%) compared to zolpidem (26.3%). Patients treated with zolpidem reported higher improvements in mean overall PSQI_PW scores compared to those treated with benzodiazepines, however these differences were not statistically significant upon adjusting for age, gender and primary diagnosis for hospitalization. Qualitative interviews indicate that that physicians consider zolpidem to be safer and more efficacious. Conclusions In our study, sedative-hypnotic therapy helped improve sleep quality among the hospitalized patients. More studies evaluating the comparative efficacy and safety of zolpidem vs. benzodiazepines – including among patient groups with varying demographic and clinical characteristics – are needed. India must develop evidence-based treatment guidelines to inform the clinical practice around the use of sedative-hypnotics.

Predictors of sedative–hypnotic usage among residents of old age home in northern India

“…Comorbidities are common risk factors for benzodiazepine usage. An outpatient-based study (Satheesh et al, 2020) done in younger patients showed a prevalence of benzodiazepine abuse as 8% in India, but data in older adults are not available. A study from India (Deshpande and Nagpal, 1993) suggested that guidelines need to be developed regarding their usage to reduce their unscrupulous usage.…”

A review of available herbal medicine options for the treatment of chronic insomnia

“…Some of the most appropriate therapeutic options for chronic insomnia are summarized in Table 4. Alternative medications: Despite the effectiveness of pharmacologic treatments in the treatment of acute insomnia, some concerns are available regarding the administration of these agents, such as dependency and also their side effects [35]. Therefore, all the individuals who are affected by insomnia at any level and have concerns about the safety and effectiveness of these pharmaceutical agents, are seeking out novel alternative therapies [36].…”

Multi-Scale Permutation Entropy: A Potential Measure for the Impact of Sleep Medication on Brain Dynamics of Patients with Insomnia

“…The current evaluation of insomnia drugs mainly relies on self-reported sleep quality using questionnaires, including the Pittsburgh Sleep Quality Index [ 24 , 25 ] and Insomnia Severity Index [ 26 ]. However, sleep misperceptions and subjective–objective sleep discrepancy have long been observed in patients with insomnia, and even in the general population [ 27 , 28 , 29 ].…”