title: The efficacy and safety of drug treatments for chronic insomnia in adults: a meta-analysis of RCTs.
abstract: BACKGROUND
  Hypnotics have a role in the management of acute insomnia; however, the efficacy and safety of pharmacological interventions in the management of chronic insomnia is unclear.
  
  
  OBJECTIVE
  The objective of this paper is to conduct a systematic review of the efficacy and safety of drug treatments for chronic insomnia in adults.
  
  
  METHODS
  Twenty-one electronic databases were searched, up to July 2006.
  
  
  METHODS
  Randomized double-blind, placebo-controlled trials were eligible. Quality was assessed using the Jadad scale. Data were pooled using the random effects model.
  
  
  RESULTS
  One hundred and five studies were included in the review. Sleep onset latency, as measured by polysomnography, was significantly decreased for benzodiazepines (BDZ), (weighted mean difference: -10.0 minutes; 95% CI: -16.6, -3.4), non-benzodiazepines (non-BDZ) (-12.8 minutes; 95% CI: -16.9, -8.8) and antidepressants (ADP) (-7.0 minutes; 95% CI: -10.7, -3.3). Sleep onset latency assessed by sleep diaries was also improved (BDZ: -19.6 minutes; 95% CI: -23.9, -15.3; non-BDZ: -17.0 minutes; 95% CI: -20.0, -14.0; ADP: -12.2 minutes; 95% CI: -22.3, -2.2). Indirect comparisons between drug categories suggest BDZ and non-BDZ have a similar effect. All drug groups had a statistically significant higher risk of harm compared to placebo (BDZ: risk difference [RD]: 0.15; non-BDZ RD: 0.07; and ADP RD: 0.09), although the most commonly reported adverse events were minor. Indirect comparisons suggest that non-BDZ are safer than BDZ.
  
  
  CONCLUSIONS
  Benzodiazepines and non-benzodiazepines are effective treatments in the management of chronic insomnia, although they pose a risk of harm. There is also some evidence that antidepressants are effective and that they pose a risk of harm.
authors.affiliation: University of Alberta/Capital Health Evidence-Based Practice Centre, Department of Pediatrics, University of Alberta, Alberta, Canada.
authors.forename: Nina
authors.initials: N
authors.lastname: Buscemi
authors.forename: Ben
authors.initials: B
authors.lastname: Vandermeer
authors.forename: Carol
authors.initials: C
authors.lastname: Friesen
authors.forename: Liza
authors.initials: L
authors.lastname: Bialy
authors.forename: Michelle
authors.initials: M
authors.lastname: Tubman
authors.forename: Maria
authors.initials: M
authors.lastname: Ospina
authors.forename: Terry P
authors.initials: TP
authors.lastname: Klassen
authors.forename: Manisha
authors.initials: M
authors.lastname: Witmans
mesh_terms: D000328:Adult; D000368:Aged; D000928:Antidepressive Agents / Q000009:adverse effects / Q000627:therapeutic use; D001569:Benzodiazepines / Q000009:adverse effects / Q000627:therapeutic use; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000009:adverse effects / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D017286:Polysomnography / Q000379:methods; D016032:Randomized Controlled Trials as Topic / Q000379:methods; D007319:Sleep Initiation and Maintenance Disorders / Q000188:drug therapy* / Q000453:epidemiology / Q000503:physiopathology
chemical_list: D000928:Antidepressive Agents; D006993:Hypnotics and Sedatives; D001569:Benzodiazepines