Department of Pharmacy Practice, National College of Pharmacy, Kozhikode, Kerala, India.
Department of Global Health, Boston University School of Public Health, Boston, MA, USA.
Health Qual Life Outcomes. 2020 Jul 6;18(1):212. doi: 10.1186/s12955-020-01379-z.
Insomnia continues to be neglected globally, despite its high prevalence. Guidelines by the health regulatory agencies call for studies to evaluate the effect of sedative-hypnotics on sleep quality.
We conducted a pre-post observational study to evaluate sleep quality among 186 inpatients receiving short-term oral sedative-hypnotic therapy in a tertiary care teaching hospital in Kozhikode (Kerala), India. Using Pittsburgh Sleep Quality Index_Past-Week (PSQI_PW) questionnaire, patients were interviewed upon hospital admission and at follow up after ≥1-week of sedative-hypnotic therapy. Additionally, we interviewed 36 physicians to understand the current clinical perception about sedative-hypnotics.
Mean (SD) age of the study patients was 59 (7.5) years. Majority (63.4%) of the patients were men. Of the various primary diagnoses for hospitalization, cardiovascular disease was the most common (22.6%, n = 49). Sedative-hypnotic therapy improved the mean (SD) PSQI_PW overall score by 6.79 points (pre: 12.70 (3.5) vs. post: 5.91 (2.8); p < 0.0001). Statistically significant improvements in sleep duration, latency, efficacy, and day dysfunction were observed. Higher proportion of study patients were prescribed benzodiazepines (73.7%) compared to zolpidem (26.3%). Patients treated with zolpidem reported higher improvements in mean overall PSQI_PW scores compared to those treated with benzodiazepines, however these differences were not statistically significant upon adjusting for age, gender and primary diagnosis for hospitalization. Qualitative interviews indicate that that physicians consider zolpidem to be safer and more efficacious.
In our study, sedative-hypnotic therapy helped improve sleep quality among the hospitalized patients. More studies evaluating the comparative efficacy and safety of zolpidem vs. benzodiazepines - including among patient groups with varying demographic and clinical characteristics - are needed. India must develop evidence-based treatment guidelines to inform the clinical practice around the use of sedative-hypnotics.
尽管失眠的患病率很高，但它在全球范围内仍未得到重视。卫生监管机构的指南呼吁开展研究，评估镇静催眠药对睡眠质量的影响。
我们在印度喀拉拉邦科奇科德的一家三级保健教学医院进行了一项前后观察性研究，评估了 186 名短期口服镇静催眠治疗住院患者的睡眠质量。使用匹兹堡睡眠质量指数过去一周（PSQI_PW）问卷，在患者入院时和镇静催眠治疗后至少 1 周时进行访谈。此外，我们还采访了 36 名医生，以了解他们目前对镇静催眠药的临床看法。
研究患者的平均（SD）年龄为 59（7.5）岁。大多数（63.4%）患者为男性。住院的各种主要诊断中，心血管疾病最常见（22.6%，n=49）。镇静催眠治疗使 PSQI_PW 总分平均（SD）改善了 6.79 分（治疗前：12.70（3.5）vs. 治疗后：5.91（2.8）；p<0.0001）。观察到睡眠时间、潜伏期、疗效和日间功能障碍均有显著改善。研究患者中，苯二氮䓬类药物（73.7%）的处方比例高于佐匹克隆（26.3%）。与接受苯二氮䓬类药物治疗的患者相比，接受佐匹克隆治疗的患者报告的 PSQI_PW 总分平均改善更大，但在调整年龄、性别和住院主要诊断后，这些差异无统计学意义。定性访谈表明，医生认为佐匹克隆更安全、更有效。
在我们的研究中，镇静催眠治疗有助于改善住院患者的睡眠质量。需要开展更多研究，评估佐匹克隆与苯二氮䓬类药物的疗效和安全性比较，包括在不同人口统计学和临床特征的患者群体中开展研究。印度必须制定基于证据的治疗指南，为镇静催眠药的临床应用提供信息。
