Table 4: Cognitive and psychomotor impairment outcomes in randomized controlled trials evaluating benzodiazepines for the
treatment of insomnia
|
Study |
Study quality* |
n |
Mean age (and SD) |
Length of treatment; d |
Benzodiazepine(s) |
Comparison group(s) |
Outcome measures |
Results |
|
Elie et al70 |
4 |
36 |
38 (11) |
31 |
Flurazepam, 30 mg |
Placebo, zopiclone, 7.5 mg |
Post-sleep questionnaire, psychomotor coordination |
Psychomotor coordination significantly impaired by flurazepam on weeks 1, 3 and 4; no impairment with zopiclone |
Hindmarch106 |
4 |
40 |
NA |
14 |
Flurazepam, 15 mg
Nitrazepam, 5 mg
Temazepam, 20 mg
Triazolam, 0.25 mg |
Placebo |
Choice reaction time, critical flicker fusion |
Significant "morning after" impairment with flurazepam for reaction time |
Judd et al72 |
1 |
107 |
38 |
14 |
Flurazepam, 15 mg Flurazepam, 30 mg |
Placebo |
DSST, reading comprehension, addition test |
Flurazepam 30 mg significantly worse compared with placebo and flurazepam 15 mg for DSST and addition; no difference for reading
comprehension |
Mamelak et al80 |
2 |
36 |
60–72 |
14 + 2 withdrawal |
Flurazepam 15 mg |
Placebo |
DSST, attention test |
Flurazepam group significantly worse than placebo |
Milter et al111 |
3 |
21 |
42 |
37 + 14 withdrawal |
Flurazepam, 30 mg
Triazolam, 0.5 mg |
Placebo |
DSST, addition test, choice reaction time, pursuit and attention tests |
Impairment significant on addition test in flurazepam group only |
Ngen and Hassan71 |
2 |
44 |
35 |
14 |
Temazepam, 20 mg |
Placebo, zopiclone, 7.5 mg |
Letter cancellation test, critical flicker fusion, choice reaction time |
Impairment significant only for temazepam on critical fusion test |
Ponciano et al75 |
3 |
26 |
30 (9) |
28 |
Flurazepam, 30 mg |
Placebo, zopiclone, 7.5 mg |
Letter cancellation test, choice reaction time, critical flicker fusion |
Significant impairment in flurazepam group for letter cancellation and choice reaction time |
Tramminen and Hansen97 |
3 |
94 |
47 |
42 |
Nitrazepam, 5 mg |
Zopiclone, 7.5 mg |
DSST |
Significant impairment for both groups. |
*Quality score based on randomization, double blinding, controlling for baseline differences and follow-up of > 80% of patients; maximum score = 5. n = number of subjects; DSST = digit symbol substitution test; NA = not available.
|