Abstract
BackgroundInsomnia continues to be neglected globally, despite its high prevalence. Guidelines by the health regulatory agencies call for studies to evaluate the effect of sedative-hypnotics on sleep quality.MethodsWe conducted a pre-post observational study to evaluate sleep quality among 186 inpatients receiving short-term oral sedative-hypnotic therapy in a tertiary care teaching hospital in Kozhikode (Kerala), India. Using Pittsburgh Sleep Quality Index_Past-Week (PSQI_PW) questionnaire, patients were interviewed upon hospital admission and at follow up after ≥1-week of sedative-hypnotic therapy. Additionally, we interviewed 36 physicians to understand the current clinical perception about sedative-hypnotics.ResultsMean (SD) age of the study patients was 59 (7.5) years. Majority (63.4%) of the patients were men. Of the various primary diagnoses for hospitalization, cardiovascular disease was the most common (22.6%, n = 49). Sedative-hypnotic therapy improved the mean (SD) PSQI_PW overall score by 6.79 points (pre: 12.70 (3.5) vs. post: 5.91 (2.8); p < 0.0001). Statistically significant improvements in sleep duration, latency, efficacy, and day dysfunction were observed. Higher proportion of study patients were prescribed benzodiazepines (73.7%) compared to zolpidem (26.3%). Patients treated with zolpidem reported higher improvements in mean overall PSQI_PW scores compared to those treated with benzodiazepines, however these differences were not statistically significant upon adjusting for age, gender and primary diagnosis for hospitalization. Qualitative interviews indicate that that physicians consider zolpidem to be safer and more efficacious.ConclusionsIn our study, sedative-hypnotic therapy helped improve sleep quality among the hospitalized patients. More studies evaluating the comparative efficacy and safety of zolpidem vs. benzodiazepines – including among patient groups with varying demographic and clinical characteristics – are needed. India must develop evidence-based treatment guidelines to inform the clinical practice around the use of sedative-hypnotics.
Highlights
Insomnia continues to be neglected globally, despite its high prevalence
A recent report claimed that over 90% of the Indians fail to receive adequate sleep, with up to 58% believing that their work efficiency is affected by poor sleep quality and 11% falling asleep during work
We report on the factors influencing sleep quality, the sedative-hypnotic prescribing pattern, and patient-reported adverse effects of sedativehypnotic drugs
Summary
Insomnia continues to be neglected globally, despite its high prevalence. Insomnia continues to be overlooked despite its association with life threatening comorbidities like cardiovascular diseases and diabetes. Addressing the deleterious effects of insomnia poses a challenging task, especially in India, considering patients’ attitude about the disease and the suboptimal healthcare system [1]. A global survey entitled “Better Sleep, Better Health: A global look at why we’re still falling short on sleep” – conducted across 13 countries including the USA and UK – reported a very high prevalence of poor sleep in India [1]. The prevalence of insomnia is high in North India – with over 75% patients reporting poor sleep quality upon hospital admission [6]
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