title: One-year evolution of sleep quality in older users of benzodiazepines: a longitudinal cohort study in belgian nursing home residents.
abstract: OBJECTIVE
  Chronic use of benzodiazepines and z-drugs (BZD/Zs), the most commonly used symptomatic treatment for sleep problems, is discouraged because of the unproven long-term effectiveness. In this study, we evaluated 1-year evolution of subjective sleep quality of chronic BZD/Z users compared with nonusers.
  
  
  METHODS
  All cognitively competent residents from ten Belgian nursing homes were screened and compiled in a group of chronic BZD/Z users or nonusers, based on the medication chart. We collected demographic, functional and psychometric characteristics (depressive symptoms with the 8-item Geriatric Depression Scale), sleep parameters (with the Pittsburgh Sleep Quality Index-PSQI) and medication use. We analysed evolution of sleep quality with nonparametric statistics. Associations with worsening of sleep quality were analysed with linear regression.
  
  
  RESULTS
  We collected data of 131 BZD/Z users and 95 nonusers. The mean age in both groups was 85 years and 77 % was female. Over a period of 1 year, the PSQI score evolved from 5.2 to 5.8 (p = 0.035) in the BZD/Z users, and from 4.3 to 4.7 (p = 0.078) in the nonusers. Though the mean deterioration in 1 year did not differ significantly between both groups, the BZD/Z users had a significantly worse sleep quality compared with nonusers at both time points. Depressive symptoms were significantly associated with worsening sleep quality (β = -0.243, p < 0.001).
  
  
  CONCLUSIONS
  Sleep quality in chronic BZD/Z users significantly decreased over 1 year and was significantly worse than in nonusers at the end of this period. This study suggests that using BZD/Zs chronically does not maintain or improve sleep quality. Depressive symptoms are an important factor in the deterioration of sleep quality.
authors.affiliation: Heymans Institute of Pharmacology, Ghent University, De Pintelaan 185 (1 block B), 9000, 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; D001530:Belgium; D001569:Benzodiazepines / Q000008:administration & dosage* / Q000009:adverse effects; D015331:Cohort Studies; D003865:Major Depressive Disorder / Q000150:complications; D004334:Drug Administration Schedule; D005260:Female; D006299:Health Services for the Aged; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D009735:Nursing Homes; D011788:Quality of Life; D012893:Sleep Wake Disorders / Q000150:complications / Q000188:drug therapy* / Q000523:psychology; D011795:Surveys and Questionnaires
chemical_list: D001569:Benzodiazepines