title: The impact of eszopiclone on sleep and cognition in patients with schizophrenia and insomnia: a double-blind, randomized, placebo-controlled trial.
abstract: BACKGROUND
  Insomnia is frequent in schizophrenia and may contribute to cognitive impairment as well as overuse of weight inducing sedative antipsychotics. We investigated the effects of eszopiclone on sleep and cognition for patients with schizophrenia-related insomnia in a double-blind placebo controlled study, followed by a two-week, single-blind placebo phase.
  
  
  METHODS
  Thirty-nine clinically stable outpatients with schizophrenia or schizoaffective disorder and insomnia were randomized to either 3mg eszopiclone (n=20) or placebo (n=19). Primary outcome measure was change in Insomnia Severity Index (ISI) over 8 weeks. Secondary outcome measure was change in MATRICS Consensus Cognitive Battery (MATRICS). Sleep diaries, psychiatric symptoms, and quality of life were also monitored.
  
  
  RESULTS
  ISI significantly improved more in eszopiclone (mean=-10.7, 95% CI=-13.2; -8.2) than in placebo (mean=-6.9, 95% CI=-9.5; -4.3) with a between-group difference of -3.8 (95% CI=-7.5; -0.2). MATRICS score change did not differ between groups. On further analysis there was a significant improvement in the working memory test, letter-number span component of MATRICS (mean=9.8±9.2, z=-2.00, p=0.045) only for subjects with schizophrenia on eszopiclone. There were improvements in sleep diary items in both groups with no between-group differences. Psychiatric symptoms remained stable. Discontinuation rates were similar. Sleep remained improved during single-blind placebo phase after eszopiclone was stopped, but the working memory improvement in patients with schizophrenia was not durable.
  
  
  CONCLUSIONS
  Eszopiclone stands as a safe and effective alternative for the treatment of insomnia in patients with schizophrenia. Its effects on cognition require further study.
authors.affiliation: Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA. Electronic address: cenk.tek@yale.edu.
authors.forename: Cenk
authors.initials: C
authors.lastname: Tek
authors.affiliation: Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA.
authors.forename: Laura B
authors.initials: LB
authors.lastname: Palmese
authors.affiliation: Department of Psychiatry, Duke University School of Medicine, Durham, NC, USA.
authors.forename: Andrew D
authors.initials: AD
authors.lastname: Krystal
authors.affiliation: Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA.
authors.forename: Vinod H
authors.initials: VH
authors.lastname: Srihari
authors.affiliation: Department of Anesthesiology, University of Virginia School of Medicine, Charlottesville, VA, USA.
authors.forename: Pamela C
authors.initials: PC
authors.lastname: DeGeorge
authors.affiliation: Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA.
authors.forename: Erin L
authors.initials: EL
authors.lastname: Reutenauer
authors.affiliation: Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA.
authors.forename: Sinan
authors.initials: S
authors.lastname: Guloksuz
mesh_terms: D053961:Azabicyclo Compounds / Q000627:therapeutic use*; D003071:Cognition / Q000187:drug effects; D004311:Double-Blind Method; D000069582:Eszopiclone; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000627:therapeutic use*; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D010352:Patient Dropouts; D010879:Piperazines / Q000627:therapeutic use*; D011618:Psychotic Disorders / Q000150:complications* / Q000523:psychology; D011788:Quality of Life; D012559:Schizophrenia / Q000150:complications*; D012565:Schizophrenic Psychology; D016037:Single-Blind Method; D012890:Sleep / Q000187:drug effects; D007319:Sleep Initiation and Maintenance Disorders / Q000150:complications* / Q000188:drug therapy* / Q000523:psychology; D016896:Treatment Outcome
chemical_list: D053961:Azabicyclo Compounds; D006993:Hypnotics and Sedatives; D010879:Piperazines; D000069582:Eszopiclone
keywords: Cognition; Eszopiclone; Insomnia; Schizophrenia; Sleep; Working memory