Quality of Life in Primary Insomnia: Three-week Treatment With Zolpidem Vs. Lorazepam

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Insomnia is a condition of inadequate quality or quantity of sleep that has extremely adverse effects on daytime activities. Th e aim of this study was to compare the quality of life in patients with primary insomnia before and after a 3-week treatment with lorazepam (n=20) and zolpidem (n=21) and to compare the potential differences in dysfunctional beliefs and attitudes regarding patients’ sleep between the two groups. Th e diagnosis of primary insomnia was established using the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision criteria, and patients had to complete a specially designed sleep log every day; on scheduled visits, we also administered a Visual Analogue Scale for quality of life and a self-evaluation questionnaire about Dysfunctional Beliefs and Attitudes related to Sleep at the beginning and end of this study. In summary, the examinees in our study had significantly decreased parameters of quality of life, quite lower than expected based on previous findings in this area. However, by the end of the study, quality of life significantly improved with treatment: it improved by approximately 2/3 in the Lorazepam group and more than twice in the Zolpidem group, with a significant difference in favour of Zolpidem (p=0.047). Th is finding is most likely a consequence of its better safety profile and in part its better efficiency in terms of influence on certain domains of sleep itself, as previously discussed. Further specialized studies in this area with larger samples and a more detailed methodology are clearly warranted.

1. Lloyd GG (1995). Psychiatry. In Edwards CRW, Bouchier IAD, Haslett C, Chilvers ER, eds. Davidson’s Principles and Practice of Medicine, 978-1019. 17th ed. Edinburgh: Churchil Livingstone.

2. Lustbader AS, Morgan C, Pelayo R, Vasquez LS, Yuen K (1997). Insomnia. In Rucker LM, ed. Essentials of adult ambulatory care 607-17. Baltimore: Williams and Wilkins.

3. Ohayon MM: Prevalence of DSM-IV diagnostic criteria of insomnia: distinguishing insomnia related to mental disorders from sleep disorders. J Psychiatr Res 1997; 31: 333-46.

4. Edinger JD, Wohlgemuth WK, Radtke RA, Marsh GR, Quillian RE: Cognitive behavioral therapy for treatment of chronic primary insomnia. A randomized controlled trial. JAMA 2001; 285: 1856-64.

5. Lee-Chiong T (2008). Sleep Medicine- Essentials and Review, pp 73-133. Oxford University press.

6. Buysse JD: Chronic Insomnia. Am J Psychiatry 2008; 165(6): 678-686.

7. Pigeon RW: Diagnosis, prevalence, pathways, consequences & treatment of insomnia. Indian J Med Res 2010; 131: 321-332.

8. Đukić Dejanović SM, Milovanović D, Ravanić D. et al.(2003). Nesanice- zdravstveni i ekonomski problem savremenog društva. Medicinski fakultet Kragujevac.

9. Roth T & Ancoli-Israel S: Daytime consequences and correlates of insomnia in the United States: results of the 1991 National Sleep Foundation survey. II. Sleep 1999; 22: 354-8.

10. Simon GE & VonKorff M:Prevalence, burden, and treatment of insomnia in primary care. Am J Psychiatry 1997; 154: 1417-23.

11. Balter MB: Uhlenhuth EH. New epidemiologic findings about insomnia and its treatment. J Clin Psychiatry 1992; 53 (suppl 12): 34-9.

12. Longmore M, Wilkinson I, Torok E (2001). Oxford handbook of clinical medicine. 5th ed. Oxford: Oxford University Press.

13. Kyle SD, Morgan K, Espie CA: Insomnia and health-related quality of life. Sleep Medicine Reviews 2010; 14: 69-82.

14. Hauri PJ: Can we mix behavioral therapy with hypnotics when treating insomniacs? Sleep 1997; 20: 1111-8.

15. Ashton H: The treatment of benzodiazepine dependence. Addiction. 1994; 89(11): 1535-41.

16. Seltzer JK, Kurt TL, Knodel LC, Dean B, Burch C: Texas Medicaid Vendor Drug Program Drug Utilization Review Board. Drug utilization review of sedative/hypnotic agents in Texas Medicaid patients. J Am Pharm Assoc 2000; 40: 495-9.

17. Buysse DJ, Reynolds CF, Kupfer DJ, Thorpy MJ, Bixler E, Manfredi R et al.: Clinical diagnoses in 216 insomnia patients using the International Classification of Sleep Disorders (ICSD), DSM-IV and ICD-10 categories: a report from the APA/NIMH DSM-IV Field Trial. Sleep 1994; 17: 630-7.

18. American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision. Washington, DC, American Psychiatric Association, 2000.

19. Soldatos CR, Dikeos DG, Paparrigopoulos TJ: Athens Insomnia Scale: validation of an instrument based on ICD-10 criteria. J Psychosom Res 2000; 48: 555-60.

20. Bliwise DL, Seidel WF, Cohen SA, Bliwise NG, Dement WC: Profile of mood states changes during and after 5 weeks of nightly triazolam administration. J Clin Psychiatry 1988; 49(9): 349-55.

21. Zisapel N & Nir T: Determination of the minimal clinically significant difference on a patient visual analog sleep quality scale. J Sleep Res 2003; 12: 291-298.

22. Morin CM, Stone J, Trinkle D, Mercer J, Remsberg S: Dysfunctional beliefs and attitudes about sleep among older adults with and without insomnia complaints. Psychol Aging. 1993; 8(3): 463-7.

23. Whitehead S & Ali S: Health outcomes in economic evaluation: the QALY and utilities. Br Med Bull. 2010; 96: 5-21.

24. Slobogean GP, O’Brien PJ, Brauer CA: Single-dose versus multiple-dose antibiotic prophylaxis for the surgical treatment of closed fractures. Acta Orthop 2010; 81(2): 256-62.

25. Sakai M, Shimbo T, Omata K, Takahashi Y, SatomuraK, Kitamura T et al.: Cost-effectiveness of gargling for the prevention of upper respiratory tract infections. BMC Health Serv Res 2008; 8: 258.

26. Yen ZS, Davis MA, Chen SC, Chen WJ: A cost-effectiveness analysis of treatment strategies for acute uncomplicated pyelonephritis in women. Acad Emerg Med 2003; 10(4): 309-14.

27. Sajid MS, Tonsi A, Baig MK: Health-related quality of life measurement. Int J Health Care Qual Assur. 2008; 21(4): 365-73.

28. Mihajlović G, Jovanović-Mihajlović N, Radmanović B, Radonjić K, Djukić-Dejanović S, Janković S et al.: Quality of life of schizophrenic patients treated with haloperidol depot and injection preparation of long-lasting risperidone. Srp Arh Celok Lek. 2011; 139 (1): 36-40.

29. Testa MA & Simonson DC: Assesment of quality-of-life outcomes. N Engl J Med 1996; 334(13): 835-40.

30. Kelly F, Delahaye C, Gal M: Quality of life in insomnia - results of validation studies for a specifically designed questionnaire. JAMA 1993; 3:21-6.

31. Goldenberg F, Hindmarch I, Joyce CRB, Legal M, Partinen M, Pilate C: Zopiclone, sleep and health-related quality-of-life. Human Psychopharmacology- Clinical and Experimental 1994; 9: 245-51.

32. Manuel DG, Schultz SE, Kopec JA: GroupMeasuringthe Health Burden of Chronic Disease and Injury Using Health Adjusted Life Expectancy and the Health Utilities Index. Journal of Epidemiology and Community Health 2002; 56(11): 843-850.

33. Moksin Mićić A (2005). Kvalitet života u rubnim zonoma grodova u Evropskoj uniji i Srbiji. In Održivi razvoj i njegovo okruženje 19-33. Beograd: Institut za arhitekturu i urbanizom Srbije.

34. Arsovski S: Put od kvaliteta do kvaliteta života. Zbornik radova Festival kvaliteta 2005; 32. nacionalna konferencija o kvalitetu, Kragujevac, 2005; 1: 3-16.

35. Radojlović J & Petrović NM:Stres svuda oko nas - prevladavanje hroničnog stresa. Zdravstvena zaštita 2011; 40(2): 79-82.

36. Roberts H: Serbia and Montenegro’s state services behind rest of Europe. Lancet 2003; 361(9354): 316-7.

37. Garfield R: Economic sanctions on Yugoslavia. Lancet 2001; 358(9281): 580.

38. Torrance GW, Feeny D, Furlong W: Visual Analog Scales: Do They Have a Role in the Measurement of Preferences for Health States? Med Decis Making 2001; 21: 329-334.

39. Walsh JK, Roth T, Randazzo A, Erman M, Jamieson A, Scharf M, et al.: Eight weeks of non-nightly use of zolpidem for primary insomnia. Sleep 2000; 23: 1087-96.

40. Hajak G, Cluydts R, Declerck A, Estivill SE, Middleton A, Sonka K, et al.: Continuous versus non-nightly use of zolpidem in chronic insomnia: results of a largescale, double-blind, randomized, outpatient study. Int Clin Psychopharmacol 2002; 17: 9-17.

41. Martin SA, Aikens JE, Chervin RD: Toward cost-effectiveness analysis in the diagnosis and treatment of insomnia. Sleep Med Rev 2004; 8: 63-72.

42. Leger D, Scheuermaier K, Philip P, Paillard M, GuilleminaultC: SF-36: evaluation of quality of life in severe and mild insomniacs compared with good sleepers. Psychosom Med. 2001; 63:49-55.

43. Reynolds CF, Buysse DJ, Kupfer DJ (1995). Disordered sleep: developmental and biopsychosocial perspectives on the diagnosis and treatment of persistent insomnia. In Bloom FE, Kupfer DJ, eds. Psychopharmacology: the fourth generation of progress 1617-29. New York: Raven Press.

44. Krystal AD, Erman M, Zammit GK, Soubrane C, Roth T; ZOLONG Study Group: Long-term efficacy and safety of zolpidem extended-release 12.5 mg, administered 3 to 7 nights per week for 24 weeks, in patients with chronic primary insomnia: a 6-month, randomized, double-blind, placebo-controlled, parallel-group, multicenter study. Sleep. 2008; 31(1): 79-90.

45. Morin CM, Vallieres A, Guay B, Ivers H, Savard J, Merette C et al.: Cognitive behavioral therapy, singly and combined with medication, for persistent insomnia: a randomized controlled trial. JAMA. 2009; 301(19): 2005-15

Serbian Journal of Experimental and Clinical Research

The Journal of Faculty of Medical Sciences, University of Kragujevac

Journal Information

CiteScore 2017: 0.21

SCImago Journal Rank (SJR) 2017: 0.126
Source Normalized Impact per Paper (SNIP) 2017: 0.081


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