Abstract
This study investigated factors associated with long-term use of benzodiazepines (BZDs) or benzodiazepine receptor agonists (BzRAs) as hypnotics in patients with chronic insomnia. Consecutive patients (n = 140) with chronic insomnia were enrolled in this study (68 men and 72 women; mean age, 53.8±10.8 years). All patients filled out a self-assessment questionnaire asking clinical descriptive variables at the baseline of the treatment period; patients received the usual dose of a single type of BZD or BzRA. The Pittsburgh Sleep Quality Index (PSQI) and the Zung Self-Rating Depression Scale were self-assessed at the baseline, and the former was re-evaluated at the time of cessation of medication or at the end of the 6-month treatment period. The PSQI included the following sub-items: evaluating sleep quality (C1), sleep latency (C2), sleep duration (C3), habitual sleep efficiency (C4), frequency of sleep disturbance (C5), use of sleeping medication (C6), and daytime dysfunction (C7). Among the patients, 54.6% needed to continue hypnotics for a 6-month treatment period. Logistic regression analysis revealed that, among descriptive variables, only the PSQI score appeared as a significant factor associated with long-term use {odds ratio (OR) = 2.8, 95% confidence interval (CI) = 2.0–4.0}. The receiver operating curve (ROC) analysis identified that the cut-off PSQI total score at the baseline for predicting long-term use was estimated at 13.5 points (area under the curve = 0.86, 95% CI = 0.8–0.92). Among the sub-items of PSQI, the increases in C1: (OR = 8.4, 95% CI = 2.4–30.0), C3: (OR = 3.6, 95% CI = 1.1–11.5), C4: (OR = 11.1, 95% CI = 3.6–33.9), and C6: (OR = 3.4, 95% CI = 1.9–6.2) scores were associated with long-term use. This study revealed that a high PSQI score at the baseline, particularly in the sub-items relating to sleep maintenance disturbance, is predictive of long-term hypnotic treatment. Our results imply the limitation of the effectiveness of hypnotic treatment alone for chronic insomnia.
Highlights
Insomnia is a common disorder with a remarkably high prevalence [1,2,3]
The ratio of chronic insomnia patients who needed to continue BZD or benzodiazepine receptor agonists (BzRAs) medication for a 6-month treatment period reached more than half (54.6%) of the total number of patients enrolled in this study, which is similar to that previously reported [15]
As for the demographic backgrounds of the patients in this study, there were no remarkable differences in age, sex [4], duration of insomnia [15], and severity of depression [25] compared with general insomnia patients
Summary
Insomnia is a common disorder with a remarkably high prevalence [1,2,3]. It has been reported that one-fifth of the general population in Japan has symptoms associated with insomnia [4]. Chronic insomnia is known to be associated with subjective daytime fatigue, low energy, difficulties in cognitive performance, and deteriorated quality of life [5]. The disorder has been known to be a risk factor for the development of somatic diseases such as hypertension and diabetes mellitus [6,7,8]. Chronic insomnia is suspected as one of the risk factors for the development of psychiatric disorders, depression and anxiety disorders [9,10]. Establishment of a better treatment strategy for achieving sufficient improvement of the disorder is desirable
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