title: Sleep quality of benzodiazepine users in nursing homes: a comparative study with nonusers.
abstract: OBJECTIVE
  We aim to describe subjective sleep quality among long-term users of benzodiazepines (BZDs) in Belgian nursing homes, to compare it to nonusers, and to investigate determinants of poor sleep quality.
  
  
  METHODS
  All mentally competent residents from 10 nursing homes were screened and compiled in a group of long-term BZD users or in a group of nonusers based on the medication chart. We collected demographic, functional, and medication characteristics and global and specific sleep parameters using the Pittsburgh Sleep Quality Index (PSQI). Linear regression was used to investigate which parameters were associated with sleep quality.
  
  
  RESULTS
  Of the 300 residents, 178 (59%) were long-term BZD users and 122 were nonusers. The 2 groups did not differ in demographic and functional characteristics (mean age, 85.5 y; range, 57-100; 75% women). The users reported significantly more difficulties with falling asleep, had more midnight awakenings, felt less rested in the morning, and had a poorer self-perceived sleep quality compared to nonusers. Sleep duration and time to fall asleep did not differ. The self-perceived sleep quality was mainly determined by difficulties during initiation of sleep. After controlling for demographic, medication, and functional characteristics, BZD use remained strongly associated with poor sleep (r=0.173; P=.003), and a study centre effect (differences among nursing homes) was observed (r=0.229; P<.001).
  
  
  CONCLUSIONS
  Our findings do not support long-term effectiveness of BZDs; long-term users slept more poorly than nonusers and were even more outspoken in users of long-acting BZDs. In future longitudinal comparative studies of sleep quality, unexplained variability needs further assessment with medical, psychologic, and institutional parameters.
authors.affiliation: Heymans Institute of Pharmacology, Ghent University, Ghent, Belgium. jolyce.bourgeois@ugent.be
authors.forename: Jolyce
authors.initials: J
authors.lastname: Bourgeois
authors.forename: Monique M
authors.initials: MM
authors.lastname: Elseviers
authors.forename: Luc
authors.initials: L
authors.lastname: Van Bortel
authors.forename: Mirko
authors.initials: M
authors.lastname: Petrovic
authors.forename: Robert H
authors.initials: RH
authors.lastname: Vander Stichele
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001569:Benzodiazepines / Q000008:administration & dosage / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009735:Nursing Homes; D012307:Risk Factors; D012720:Severity of Illness Index; D012890:Sleep / Q000187:drug effects*; D007319:Sleep Initiation and Maintenance Disorders / Q000139:chemically induced* / Q000453:epidemiology
chemical_list: D001569:Benzodiazepines
keywords: Benzodiazepines; Comparative study; Nursing homes; Older adults; Sleep medication; Sleep quality