Insomnia From Drug Treatments

• Published in: Mayo Clinic proceedings Vol. 92; no. 1; pp. 72 - 87
• Main Authors: Doufas, Anthony G., MD, PhD, Panagiotou, Orestis A., MD, PhD, Panousis, Periklis, MD, Wong, Shane Shucheng, MD, Ioannidis, John P.A., MD, DSc
• Format: Journal Article
• Language: English
• Published: Elsevier Inc 01.01.2017
• Subjects: Internal Medicine; FDA; RCT; COMTI; NSAID; interquartile range; N-methyl- d-aspartic acid; odds ratio; number of events is not applicable because the outcome is continuous; MAOI; selective serotonin reuptake inhibitor; NMDA; tricyclic antidepressant; Physicians' Desk Reference; catechol- O-methyltransferase inhibitor; DOPA; GnRH; Food and Drug Administration; CDSR; PDR; serotonin-norepinephrine reuptake inhibitor; OR; AE; adverse event; IQR; monoamine oxidase inhibitor; drug is not listed in the PDR; randomized controlled trial; gonadotropin-releasing hormone; SSRI; NA; TCA; SNRI; γ-aminobutyric acid; GABA; dopamine; NL; Cochrane Database of Systematic Reviews; nonsteroidal anti-inflammatory drug
• ISSN: 0025-6196; 1942-5546
• DOI: 10.1016/j.mayocp.2016.09.005

Abstract Objective To determine whether drugs used to treat diverse conditions cause insomnia symptoms and whether their prescription information is concordant with this evidence. Methods We conducted a survey of meta-analyses (Cochrane Database of Systematic Reviews) and comparisons with package inserts compiled in the Physicians' Desk Reference ( PDR ). We identified randomized controlled trials (RCTs) in which any drug had been evaluated vs placebo and sleep had been assessed. We collectively referred to insomnia-related outcomes as sleep disturbance . We also searched the PDR to identify any insomnia symptoms listed for drugs with RCT evidence available. Results Seventy-four Cochrane systematic reviews corresponding to 274 RCTs assessed 88 drugs in 27 different conditions, providing evidence on 109 drug-condition pairs. Of these 88 drugs, 5 decreased sleep problems and 19 increased sleep problems; 64 drugs had no nominally statistically significant effect on sleep. Acetylcholinesterase inhibitors, dopamine agonists, and selective serotonin reuptake inhibitors were the drug classes most importantly associated with sleep disturbance. Of 35 drugs that included disturbed sleep as an adverse effect in the PDR , only 14 had RCT evidence supporting such effect, and 2 had evidence of increasing and decreasing sleep problems in RCTs, although this was not shown in the PDR . We identified weak concordance between the PDR and RCTs (weighted κ=0.31; P <.001). Conclusion The RCTs offer substantial evidence about the common effects of drugs on the risk of sleep disturbance; currently, prescription information only partially agrees with the available randomized evidence.