P-486: Efficacy and safety of non-benzodiazepine and non-Z-drug hypnotic medication for insomnia in older people: a systematic literature review

摘要

Purpose: Insomnia is very prevalent in older people and significantly impacts quality of life, function and health. The condition is frequently treated with benzodiazepines and nonbenzodiazepine receptor agonists (Z-drugs), whose adverse safety profile led to an increased use of alternative sedative medications. The aim of this review is to study the efficacy and safety of alternative sedative medications for treating insomnia in older people, excluding benzodiazepines and Z-drugs. Methods: We conducted a systematic search of MEDLINE (Pubmed), EMBASE and the Cochrane Central register of Controlled Trials databases. We included randomized controlled trials, non-randomized studies with parallel groups and prospective and retrospective studies, conducted in patients older than 65 years, without psychiatric or neurological (i.e. dementia, Parkinson's disease) comorbidity. Results: The systematic search resulted in 9114 articles, of which 24 were included in this review, describing nine different sleep medications. Melatonin (n = 10 studies), paroxetine (n = 1 study), diphenhydramine (n = 1 study), tiagabine (n = 2 studies) and valerian (n = 1 study) were shown to have no effect on sleep. Four studies with ramelteon showed a small improvement in sleep latency. One study with suvorexant showed an improved sleep maintenance with only mild side effects. Three studies on doxepin revealed a sustained improvement in sleep and a safety profile comparable to placebo. One study detected increased adverse effects of trazodone after 3 months, but did not evaluate the effect on sleep. Conclusions: On basis of our systematic review, ramelteon, suvorexant and doxepin seem to bare better potential as effective and safe pharmacological approaches for treating insomnia in older persons.