Skip to main content
Top
Published in: BMC Psychiatry 1/2021

Open Access 01-12-2021 | Insomnia | Research article

Prevalence of and factors associated with acute withdrawal symptoms after 24 weeks of eszopiclone treatment in patients with chronic insomnia: a prospective, interventional study

Authors: Yuichi Inoue, Yoshikazu Takaesu, Michinori Koebis

Published in: BMC Psychiatry | Issue 1/2021

Login to get access

Abstract

Background

Although long-term use of benzodiazepines and benzodiazepine receptor agonists (BZDs) has been associated with an increased risk of dependence, the incidence, details of clinical manifestations, and triggering factors of withdrawal symptoms associated with long-term BZD use at common clinical doses remain unclear.

Methods

In a multicenter, open-label study of 123 Japanese patients with insomnia, patients were given a common clinical dose of eszopiclone (2 mg) for 24 weeks, and then treatment was abruptly discontinued. Withdrawal symptoms were evaluated using the Benzodiazepine Hypnotics Withdrawal Symptom Scale (BHWSS). The Insomnia Severity Index (ISI) was used to rate insomnia severity during treatment and 2 weeks after discontinuation. Dependence and poor compliance during treatment without strict medication controls were evaluated with the Benzodiazepine Dependence Self Report Questionnaire short version (Bendep-SRQ SV) subscale sum scores for problematic use, preoccupation, and lack of compliance. Associations between the presence of clinically relevant withdrawal symptoms (BHWSS≥7) and demographic measures, ISI scores at Week 24, and Bendep-SRQ SV subscale sum scores were evaluated by multivariable stepwise logistic regression analyses.

Results

Seventy-six patients completed treatment and 2 weeks of withdrawal; eight (10.5%) had clinically relevant withdrawal symptoms. On multiple logistic regression analysis, Bendep-SRQ SV subscale sum scores were correlated with withdrawal symptoms (odds ratio, 1.650; 95% confidence interval, 1.105–2.464; p = 0.014). Exacerbation of post-discontinuation insomnia was not significantly different between patients who showed clinically relevant withdrawal symptoms and those who did not (p = 0.245).

Conclusions

Dependence and poor compliance may contribute to withdrawal symptoms with long-term BZD use. Providing guidance to ensure proper compliance is thought to be the best way to mitigate withdrawal symptoms.

Trial registration

UMIN000024462 (18/10/2016).
Literature
11.
go back to reference American Academy of Sleep Medicine. The International Classification of Sleep Disorders, Third Edition (ICSD-3). 2014. American Academy of Sleep Medicine. The International Classification of Sleep Disorders, Third Edition (ICSD-3). 2014.
12.
go back to reference Kobayashi M, Okajima I, Narisawa H, Kikuchi T, Matsui K, Inada K, et al. Development of a new benzodiazepine hypnotics withdrawal symptom scale. Sleep Biol Rhythms. 2018;16:63–271.CrossRef Kobayashi M, Okajima I, Narisawa H, Kikuchi T, Matsui K, Inada K, et al. Development of a new benzodiazepine hypnotics withdrawal symptom scale. Sleep Biol Rhythms. 2018;16:63–271.CrossRef
16.
go back to reference Walsh JK, Roth T. Chapter 87—pharmacologic treatment of insomnia: benzodiazepine receptor agonists. In: Kryger M, Roth T, Dement WC, editors. Principles and practice of sleep medicine (sixth edition). Philadelphia: Elsevier; 2017. p. 832–841.e4.CrossRef Walsh JK, Roth T. Chapter 87—pharmacologic treatment of insomnia: benzodiazepine receptor agonists. In: Kryger M, Roth T, Dement WC, editors. Principles and practice of sleep medicine (sixth edition). Philadelphia: Elsevier; 2017. p. 832–841.e4.CrossRef
Metadata
Title
Prevalence of and factors associated with acute withdrawal symptoms after 24 weeks of eszopiclone treatment in patients with chronic insomnia: a prospective, interventional study
Authors
Yuichi Inoue
Yoshikazu Takaesu
Michinori Koebis
Publication date
01-12-2021
Publisher
BioMed Central
Published in
BMC Psychiatry / Issue 1/2021
Electronic ISSN: 1471-244X
DOI
https://doi.org/10.1186/s12888-021-03196-0

Other articles of this Issue 1/2021

BMC Psychiatry 1/2021 Go to the issue