Glass J et al. (2005) Sedative hypnotics in older people with insomnia: meta-analysis of risks and benefits. BMJ [doi:10.1136/bmj.38623.768588.47]

Sedative hypnotics are commonly prescribed for the treatment of insomnia in the elderly, but a new meta-analysis of clinical trials on their use in this population indicates that the risks might outweigh the benefits.

Glass and colleagues analyzed the benefits and adverse events reported in 24 randomized placebo-controlled trials of sedative hypnotics, involving a total of 2,417 patients with insomnia (mean age 60 years). Patients had been treated for at least five consecutive nights with a sedative hypnotic—an antihistamine, a benzodiazepine or a benzodiazepine receptor agonist. Benefits included improvements in sleep quality or total sleep time; adverse events were categorized as cognitive, psychomotor, or morning hangover effects.

Overall, sleep quality was found to improve with the use of any sedative hypnotic compared with placebo, but the effect size (0.14) was small (P <0.005). Total sleep time also increased by a mean 25.2 min (P = 0.001). Adverse cognitive events were 4.78 times more common with the use of sedatives than with placebo (P <0.01), and psychomotor-type side effects were 2.25 times more common (not significant, P = 0.07).

The authors conclude that, although their study found that use of sedative hypnotics resulted in a statistically significant improvement in sleep outcomes in the elderly, the improvement was small and could be outweighed by the risk of adverse events in older patients who might already be at higher risk of cognitive impairment or falls.