8/12/2023 0 Comments Insomnia definition amaIt is defined as a dissatisfaction with the quantity or quality of sleep and is associated with difficulties initiating or maintaining sleep as well as with early-morning waking with an inability to return to sleep. Insomnia is a major healthcare problem in the Western world. 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. Nonetheless, quality and quantity of evidence are low. We, therefore, recommend discontinuing Z-drugs, principally because of the high risk for falls and fractures. ConclusionsĪnalyzing 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. However, in longer-term observational studies, Z-drugs significantly increased the risk for falls and fractures in comparison to no treatment or melatonin agonists. 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. ResultsĮighteen studies were included (8 interventional and 10 observational studies). 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. The target population was older adults (≥65 years old) with insomnia. The 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. This systematic review investigated the available evidence on the efficacy and safety of Z-drugs in the management of insomnia in older adults. However, the benefits and risks of Z-drugs may differ for older adults. Z-drugs are usually prescribed as first line pharmacological therapy for insomnia.
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