Bourgeois Jolyce, Elseviers Monique M, Van Bortel Luc, Petrovic Mirko, Vander Stichele Robert H
Heymans Institute of Pharmacology, Ghent University, De Pintelaan 185 (1 block B), 9000, Ghent, Belgium,
Drugs Aging. 2014 Sep;31(9):677-82. doi: 10.1007/s40266-014-0203-3.
Chronic use of benzodiazepines and z-drugs (BZD/Zs), the most commonly used symptomatic treatment for sleep problems, is discouraged because of the unproven long-term effectiveness. In this study, we evaluated 1-year evolution of subjective sleep quality of chronic BZD/Z users compared with nonusers.
All cognitively competent residents from ten Belgian nursing homes were screened and compiled in a group of chronic BZD/Z users or nonusers, based on the medication chart. We collected demographic, functional and psychometric characteristics (depressive symptoms with the 8-item Geriatric Depression Scale), sleep parameters (with the Pittsburgh Sleep Quality Index-PSQI) and medication use. We analysed evolution of sleep quality with nonparametric statistics. Associations with worsening of sleep quality were analysed with linear regression.
We collected data of 131 BZD/Z users and 95 nonusers. The mean age in both groups was 85 years and 77 % was female. Over a period of 1 year, the PSQI score evolved from 5.2 to 5.8 (p = 0.035) in the BZD/Z users, and from 4.3 to 4.7 (p = 0.078) in the nonusers. Though the mean deterioration in 1 year did not differ significantly between both groups, the BZD/Z users had a significantly worse sleep quality compared with nonusers at both time points. Depressive symptoms were significantly associated with worsening sleep quality (β = -0.243, p < 0.001).
Sleep quality in chronic BZD/Z users significantly decreased over 1 year and was significantly worse than in nonusers at the end of this period. This study suggests that using BZD/Zs chronically does not maintain or improve sleep quality. Depressive symptoms are an important factor in the deterioration of sleep quality.
长期使用苯二氮䓬类药物和Z类药物（BZD/Zs）是治疗睡眠问题最常用的对症疗法，但由于其长期疗效未经证实，故不提倡使用。在本研究中，我们评估了慢性BZD/Z使用者与非使用者主观睡眠质量的1年变化情况。
根据用药记录，对来自比利时十家养老院的所有认知功能正常的居民进行筛查，并将其分为慢性BZD/Z使用者组或非使用者组。我们收集了人口统计学、功能和心理测量学特征（采用8项老年抑郁量表评估抑郁症状）、睡眠参数（采用匹兹堡睡眠质量指数-PSQI）和用药情况。我们采用非参数统计分析睡眠质量的变化。采用线性回归分析与睡眠质量恶化的相关性。
我们收集了131名BZD/Z使用者和95名非使用者的数据。两组的平均年龄均为85岁，77%为女性。在1年的时间里，BZD/Z使用者的PSQI评分从5.2升至5.8（p = 0.035），非使用者从4.3升至4.7（p = 0.078）。虽然两组1年的平均恶化程度无显著差异，但在两个时间点上，BZD/Z使用者的睡眠质量均显著差于非使用者。抑郁症状与睡眠质量恶化显著相关（β = -0.243，p < 0.001）。
慢性BZD/Z使用者的睡眠质量在1年中显著下降，且在此期间结束时显著差于非使用者。本研究表明，长期使用BZD/Zs并不能维持或改善睡眠质量。抑郁症状是睡眠质量恶化的一个重要因素。
