Roehrs Timothy, Koshorek Gail, Sibai Mohammad, Tabor Aisha, Bazan Luisa, Roth Thomas
Henry Ford Health System, Sleep Disorders and Research Center & Research Ctr Henry Ford Hospital, 2799 West Grand Blvd, CPF-3 Detroit, MI, 48202, USA.
Department of Psychiatry and Behavioral Neurosciences, School of Medicine, Wayne State University, Detroit, MI, USA.
Psychopharmacology (Berl). 2025 May 9. doi: 10.1007/s00213-025-06799-7.
The abuse liability of chronic hypnotic use remains a clinical concern.
This study assessed 1) whether there would be greater difficulty discontinuing chronic hypnotic use for people with insomnia and hyperarousal vs those with insomnia but without hyperarousal and 2) whether those seeking to discontinue chronic hypnotic use of the receptor non-specific hypnotic eszopiclone would have more difficulty than those discontinuing the receptor specific zolpidem XR.
DSM-V diagnosed insomnia participants, aged 23-61 yrs, (n = 41, 36 females), with no other sleep disorders, unstable medical or psychiatric diseases or drug dependency completed the trial. Following a screening nocturnal polysomnogram (NPSG) participants were randomized to zolpidem XR (12.5 mg), eszopiclone (3 mg), or placebo nightly for 6 months. After 6 months nightly use, over a 2-week discontinuation, they were instructed to discontinue their hypnotic use, but, if necessary, to self-administer before sleep either 1, 2, or 3 capsules, each packaged separately in envelopes labeled 1, 2, and 3, containing their assigned "blinded" medication or placebo.
Over the 14 nights 21 participants took zero (51%) capsules and among the 20 taking capsules the median total number chosen was 3. Those people with insomnia and hyperarousal vs those with insomnia but not hyperarousal had more difficulty discontinuing chronic hypnotic use (aim 1) as did those using eszopiclone vs zolpidem or placebo (aim 2).
Most subjects discontinued hypnotic use and among the few continuing to use their use declined from week one to week two of the discontinuation period.
长期使用催眠药物的滥用可能性仍是一个临床关注点。
本研究评估了1）与无高度觉醒的失眠患者相比，有失眠和高度觉醒的患者在停用长期使用的催眠药物时是否会遇到更大困难，以及2）与停用受体特异性唑吡坦缓释片的患者相比，试图停用受体非特异性催眠药物艾司佐匹克隆的患者是否会有更多困难。
年龄在23 - 61岁之间、符合《精神疾病诊断与统计手册》第五版（DSM-V）诊断标准的失眠参与者（n = 41，36名女性），无其他睡眠障碍、不稳定的内科或精神疾病或药物依赖，完成了该试验。在进行一次筛查夜间多导睡眠图（NPSG）后，参与者被随机分配至每晚服用唑吡坦缓释片（12.5毫克）、艾司佐匹克隆（3毫克）或安慰剂，为期6个月。在每晚使用6个月后，经过2周的停药期，他们被指示停止使用催眠药物，但如有必要，可在睡前自行服用1、2或3粒胶囊，每粒胶囊分别装在标有1、2和3的信封中，包含其分配的“盲法”药物或安慰剂。
在14个晚上，21名参与者服用了零粒（51%）胶囊，在20名服用胶囊的参与者中，选择的胶囊总数中位数为3。与无高度觉醒的失眠患者相比，有失眠和高度觉醒的患者在停用长期使用的催眠药物时遇到了更大困难（目标1），使用艾司佐匹克隆的患者与使用唑吡坦或安慰剂的患者相比也是如此（目标2）。
大多数受试者停止了催眠药物的使用，在少数继续使用的受试者中，其使用量在停药期的第一周到第二周有所下降。
