Department of Family Medicine, University of Turku, Turku, Finland.
Department of Clinical Pharmacology, University of Helsinki, and HUSLAB, Helsinki University Hospital, Helsinki, Finland.
Basic Clin Pharmacol Toxicol. 2019 Mar;124(3):330-340. doi: 10.1111/bcpt.13144. Epub 2018 Dec 3.
Long-term use of benzodiazepines or benzodiazepine receptor agonists is widespread, although guidelines recommend short-term use. Only few controlled studies have characterized the effect of discontinuation of their chronic use on sleep and quality of life. We studied perceived sleep and quality of life in 92 older (age 55-91 years) outpatients with primary insomnia before and after withdrawal from long-term use of zopiclone, zolpidem or temazepam (BZDA). BZDA was withdrawn during 1 month, during which the participants received psychosocial support and blindly melatonin or placebo. A questionnaire was used to study perceived sleep and quality of life before withdrawal, and 1 month and 6 months later. 89 participants completed the 6-month follow-up. As melatonin did not improve withdrawal, all participants were pooled and then separated based solely on the withdrawal results at 6 months (34 Withdrawers. 55 Nonwithdrawers) for this secondary analysis. At 6 months, the Withdrawers had significantly (P < 0.05) shorter sleep-onset latency and less difficulty in initiating sleep than at baseline and when compared to Nonwithdrawers. Compared to baseline, both Withdrawers and Nonwithdrawers had at 6 months significantly (P < 0.05) less fatigue during the morning and daytime. Stress was alleviated more in Withdrawers than in Nonwithdrawers (P < 0.05). Satisfaction with life and expected health 1 year later improved (P < 0.05) in Withdrawers. In conclusion, sleep disturbances, daytime fatigue and impaired quality of life may resolve within 6 months of BZDA withdrawal. These results encourage withdrawal from chronic use of benzodiazepine-type hypnotics, particularly in older subjects.
长期使用苯二氮䓬类药物或苯二氮䓬受体激动剂较为普遍，尽管指南建议短期使用。只有少数对照研究描述了长期使用苯二氮䓬类药物停药对睡眠和生活质量的影响。我们研究了 92 例原发性失眠老年（55-91 岁）门诊患者在停用佐匹克隆、唑吡坦或替马西泮（BZDA）长期治疗前后的睡眠和生活质量感知。BZDA 在 1 个月内停药，在此期间参与者接受心理社会支持和盲法褪黑素或安慰剂治疗。使用问卷在停药前、1 个月和 6 个月后评估睡眠和生活质量感知。89 例患者完成了 6 个月随访。由于褪黑素未改善停药结果，所有参与者被汇总，然后仅根据 6 个月的停药结果（34 例停药者和 55 例未停药者）进行二次分析。在 6 个月时，与基线和未停药者相比，停药者的入睡潜伏期显著缩短（P < 0.05），入睡困难明显减轻（P < 0.05）。与基线相比，停药者和未停药者在 6 个月时白天的疲劳感均显著减轻（P < 0.05）。停药者的压力减轻程度大于未停药者（P < 0.05）。与未停药者相比，停药者停药 1 年后的生活满意度和预期健康状况明显改善（P < 0.05）。结论：BZDA 停药后 6 个月内，睡眠障碍、日间疲劳和生活质量受损可能得到改善。这些结果鼓励老年患者从慢性使用苯二氮䓬类药物治疗转为停药。
