title: Pharmacological interventions to improve sleep in hospitalised adults: a systematic review.
abstract: Patients often suffer from disturbed sleep in hospital. Poor-quality sleep in hospitalised patients has been associated with significant morbidity and pharmacological sleep aids are often prescribed. The objective of this systematic review is to evaluate the comparative efficacy and safety of pharmacological interventions used for sleep in hospitalised patients.
  
  
  
  We searched MEDLINE, Embase, the Cochrane database and grey literature for prospective studies that evaluated sleep in hospitalised adults after a pharmacological intervention.
  
  
  
  Two reviewers assessed studies for inclusion and extracted data for efficacy outcomes, including sleep efficiency, sleep latency, sleep fragmentation and objectively measured sleep stage distribution. Risk of bias was assessed and meta-analyses were planned contingent upon homogeneity of the included studies.
  
  
  
  After screening 1920 citations, 15 studies involving 861 patients were included. Medications studied included benzodiazepines, nonbenzodiazepine sedatives, melatonin, propofol and dexmedetomidine. Five studies were deemed to be of high quality. Heterogeneity and variable outcome reporting precluded meta-analysis in most cases. No consistent trends with respect to sleep efficiency, quality or interruptions were observed identifying a drug or drug class as superior to another or no treatment. Benzodiazepines appeared to be better than no treatment with respect to sleep latency, but this was not consistently demonstrated across all studies. Sleep stage distribution shows that sleep in hospital is dominated by stages N1 and N2.
  
  
  
  There is insufficient evidence to suggest that pharmacotherapy improves the quality or quantity of sleep in hospitalised patients suffering from poor sleep. No drug class or specific drug was identified as superior even when compared to placebo or no treatment. Although 15 studies were included, the quality of evidence was limited by their quality and size. Larger, better-designed trials in hospitalised adults are needed.
authors.affiliation: Department of Pharmacy and Critical Care, The Ottawa Hospital, Ottawa, Ontario, Canada The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
authors.forename: Salmaan
authors.initials: S
authors.lastname: Kanji
authors.affiliation: Department of Pharmacy, Hôpital Montfort-The Ottawa Hospital, Ottawa, Ontario, Canada.
authors.forename: Alexandru
authors.initials: A
authors.lastname: Mera
authors.affiliation: The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada School of Epidemiology, Public Health and Preventative Medicine, University of Ottawa, Ottawa, Ontario, Canada.
authors.forename: Brian
authors.initials: B
authors.lastname: Hutton
authors.affiliation: Department of Pharmacy, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Lisa
authors.initials: L
authors.lastname: Burry
authors.affiliation: Department of Critical Care, The Ottawa Hospital, Ottawa, Ontario, Canada.
authors.forename: Erin
authors.initials: E
authors.lastname: Rosenberg
authors.affiliation: The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada Department of Pharmacy, The Ottawa Hospital, Ottawa, Ontario, Canada.
authors.forename: Erika
authors.initials: E
authors.lastname: MacDonald
authors.affiliation: Department of Respirology, Thunder Bay Regional Health Sciences Centre, Northern Ontario School of Medicine, Sudbury, Ontario, Canada.
authors.forename: Vanessa
authors.initials: V
authors.lastname: Luks
mesh_terms: D019317:Evidence-Based Medicine; D006801:Humans; D006993:Hypnotics and Sedatives / Q000627:therapeutic use*; D007297:Inpatients; D008550:Melatonin / Q000627:therapeutic use*; D007319:Sleep Initiation and Maintenance Disorders / Q000188:drug therapy*
chemical_list: D006993:Hypnotics and Sedatives; D008550:Melatonin
keywords: CLINICAL PHARMACOLOGY; SLEEP MEDICINE