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CNS Drugs
Published in: CNS Drugs 9/2014

01-09-2014 | Systematic Review

Drug Treatment of Primary Insomnia: A Meta-Analysis of Polysomnographic Randomized Controlled Trials

Authors: Alexander Winkler, Charlotte Auer, Bettina K. Doering, Winfried Rief

Published in: CNS Drugs | Issue 9/2014

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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

Future studies should use objective and subjective assessment. Focusing on efficacy, clinicians should favor benzodiazepine receptor agonists and classical benzodiazepines over antidepressants (including low-dose doxepin) for primary insomnia treatment, but the additional consideration of different side effect profiles can lead to alternative treatment decisions.
Appendix
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Metadata
Title
Drug Treatment of Primary Insomnia: A Meta-Analysis of Polysomnographic Randomized Controlled Trials
Authors
Alexander Winkler
Charlotte Auer
Bettina K. Doering
Winfried Rief
Publication date
01-09-2014
Publisher
Springer International Publishing
Published in
CNS Drugs / Issue 9/2014
Print ISSN: 1172-7047
Electronic ISSN: 1179-1934
DOI
https://doi.org/10.1007/s40263-014-0198-7

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