title: A qualitative investigation of long-term zopiclone use and sleep quality among Vietnam war veterans with PTSD.
abstract: BACKGROUND
  Self-reported sleep difficulties are common among patients with posttraumatic stress disorder (PTSD), but the routine use of hypnosedatives over extended periods is not generally recommended.
  
  
  OBJECTIVE
  To examine the effects of the extended use of zopiclone among a cohort of patients with combat-related PTSD.
  
  
  METHODS
  We conducted a 6-month follow-up cohort study of zopiclone usage characteristics for 26 combat veterans with PTSD. Psychometric and sleep assessments were also conducted at baseline and 6 months.
  
  
  RESULTS
  The mean baseline score obtained on the tranquilizer dependence questionnaire was 20.4 +/- 13.4, below the cutoff score proposed as indicative of a high likelihood of dependence (23 points). Eight (30.7%) subjects exceeded the proposed cutoff score for dependence at baseline. Most (n = 24) subjects reported poor sleep quality at baseline. Actigraphy revealed that the mean sleep efficiency score was 71.2 +/- 13.7% at baseline. A cohort of 13 men was available for inclusion in the follow-up phase of the study. The tranquilizer dependence questionnaire score at follow-up was broadly similar to the baseline score after a further 6 months of zopiclone use (18.9 at baseline compared with 19.9 +/- 2.6 at follow-up). Individual analysis revealed that the tranquilizer dependence scale score increased for 5 subjects and decreased for 8 subjects at follow-up. Four (30.7%) subjects in the follow-up cohort exceeded the proposed cutoff score for dependence at baseline and 6 (46.1%) subjects exceeded it at follow-up. Actigraphy data were consistent across measurements for individual subjects at baseline and follow-up, with similar mean sleep efficiency scores at baseline and after 6 months of treatment with zopiclone (69.6 +/- 12.7% at baseline; 71.33 +/- 19.0% at follow-up). The proportion of relatively poor sleepers (5/13 at baseline and 4/13 at follow-up) remained essentially unchanged.
  
  
  CONCLUSIONS
  Overall, the results of this study suggest that, although the subjects in the follow-up phase of the research continued to use zopiclone on a regular basis for an extended period, the efficacy of this intervention for addressing PTSD-related sleep disturbance was low. Extended treatment with zopiclone may not necessarily be associated with increased risk for dependence. Further robust research to examine the consequences of long-term zopiclone therapy for PTSD-related sleep disturbance is warranted.
authors.affiliation: Pharmacy Department, Repatriation General Hospital, Adelaide, South Australia, Australia. chris.alderman@health.sa.gov.au
authors.forename: Christopher P
authors.initials: CP
authors.lastname: Alderman
authors.forename: Andrew L
authors.initials: AL
authors.lastname: Gilbert
mesh_terms: D001315:Australia; D053961:Azabicyclo Compounds / Q000009:adverse effects / Q000627:therapeutic use*; D015331:Cohort Studies; D003130:Combat Disorders / Q000188:drug therapy; D005500:Follow-Up Studies; D006801:Humans; D006993:Hypnotics and Sedatives / Q000009:adverse effects / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D010879:Piperazines / Q000009:adverse effects / Q000627:therapeutic use*; D007319:Sleep Initiation and Maintenance Disorders / Q000188:drug therapy* / Q000209:etiology; D013313:Stress Disorders, Post-Traumatic / Q000188:drug therapy*; D019966:Substance-Related Disorders / Q000453:epidemiology / Q000209:etiology; D013997:Time Factors; D014728:Veterans / Q000523:psychology
chemical_list: D053961:Azabicyclo Compounds; D006993:Hypnotics and Sedatives; D010879:Piperazines; C515050:zopiclone