Understanding the unmet needs in insomnia treatment: a systematic literature review of real-world evidence

Campbell, Renee; Chabot, Isabelle; Rousseau, B; Bridge, Daisy; Nicol, Gillian; Meier, Genevieve

doi:10.1080/00207454.2021.1995383

Cited by 11 publications

(9 citation statements)

References 91 publications

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“…Per the Insomnia Working Group, trazodone is the most frequently prescribed medication for insomnia in the primary care setting in the United States [ 30 ]. The WUA surveys are consistent with this report, showing that this antidepressant was the top prescribed medication for insomnia among respondents; this is also consistent with other studies citing its use in patients with insomnia (18–55%) [ 25 , 26 ]. However, this use notably contradicts the recommendations of the AASM guidelines, which state that trazodone should not be used to treat insomnia, given limited efficacy data and potential risks such as serious cardiovascular side effects due to an overdose [ 14 , 31 , 32 ].…”

Section: Discussionsupporting

confidence: 90%

“…From the prescribers’ point of view, less than one-third of HCPs “always (or almost always)” or “often” prescribe these medications per WUA. As a reference, the literature demonstrates a wide range of rates of use of these medications, indicating that 20–58% of patients with insomnia in the United States are prescribed nonbenzodiazepines [ 8 , 25 , 26 , 27 ].…”

Section: Discussionmentioning

confidence: 99%

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Wake Up America: National Survey of Patients’ and Physicians’ Views and Attitudes on Insomnia Care

Benca

Bertisch

Ahuja

et al. 2023

JCM

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While both patients and physicians consider sleep to be important, sleep health may not receive appropriate consideration during patient visits with health care professionals (HCPs). We completed the first large-scale survey of people with trouble sleeping (PWTS) and physicians who treat insomnia to understand their perspectives and potential discrepancies between them. The Harris Poll conducted online surveys of adult PWTS and HCPs (primary care physicians [PCPs] and psychiatrists) in the United States from September to October 2021. Respondents included 1001 PWTS, 300 PCPs, and 152 psychiatrists. Most HCPs agreed that sleep is critical to good health, yet very few reported routinely conducting full sleep histories on their patients. Approximately 30% of PWTS reported that their PCP never asks about sleep; zero HCPs in this survey reported “never” inquiring. Few HCPs reported being “very satisfied” with current treatment options; 50% of PCPs reported their patients being satisfied. Two-thirds of PWTS did not believe current treatment options adequately improved their sleep. This survey provides evidence that both PWTS and physicians agreed on the importance of sleep, but that treatment is often perceived as ineffective. This survey identifies a need for HCPs to address insomnia management and treatment gaps.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Wake Up America: National Survey of Patients’ and Physicians’ Views and Attitudes on Insomnia Care

Benca

Bertisch

Ahuja

et al. 2023

JCM

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“…For other potential agents to correct circadian rhythms, in our previous review, we found that antipsychotics actually might be more harmful and rhythm disrupting [99]. The negative impact of selective serotonergic agents has been recognized earlier [98], and the use of benzodiazepines has contraindications [100]. We conclude that melatonergic agents have shown potential efficacy in and are the most promising agents for correcting disrupted sleep-wake and circadian rhythms.…”

Section: Discussionmentioning

confidence: 84%

Melatonergic agents influence the sleep-wake and circadian rhythms in healthy and psychiatric participants: a systematic review and meta-analysis of randomized controlled trials

Moon

Partonen

Beaulieu

et al. 2022

Neuropsychopharmacol.

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Exogenous melatonergic agents are widely used to treat insomnia and sleep disturbance. Several studies have shown that they might also modulate circadian rhythms. The purpose of this systematic review and meta-analysis was to summarize current knowledge about the effects of melatonin supplements and melatonin agonists on the sleep-wake cycle as well as on the circadian rhythm of melatonin in healthy participants and in patients with psychiatric disorders. The following electronic databases were searched: EMBASE, PubMed, Web of Science, CINAHL, and Cochrane Library. Of the 12,719 articles, we finally selected 30 studies including 1294 healthy participants and 8 studies including 687 patients with psychiatric disorders. Cochrane risk of bias tool was used to assess the risk of bias. Using meta-ANOVA, studies on healthy participants showed advancing effects of melatonergic supplements and agonists on sleep-wake cycle according to dosing time and dosage, despite the fact that the original individual melatonin rhythm was within a normal range (fixed effect model standardized mean difference [95% Confidence Interval] = −0.639[−0.968 to −0.310]). In a limited number of randomized controlled trials with psychiatric patients, the findings seemed similar to those with healthy participants, despite the psychiatric disorders and treatment related factors affecting circadian rhythms. Given the unmet clinical need for evidence-based treatments to correct circadian rhythms in psychiatric disorders, efficacy of melatonergic agents seen in healthy participants, and similarity of findings among psychiatric patients, large scale, well-designed randomized controlled trials are needed to test efficacy on circadian parameters in psychiatric disorders.

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“…35 Based on an interview with family physicians, quetiapine is being prescribed to patients who do not respond to first-line therapies, those who have multiple psychiatric diagnoses, or those with complex psychological or social histories. 35 There is some evidence that one of the important reasons for increased use of APs off-label, for example, in insomnia is the lack of available treatment options, 27,36 which may apply to offlabel use more broadly.…”

Section: Discussionmentioning

confidence: 99%

Characteristics and predictors of off‐label use of antipsychotics in general population sample

Pirhonen

Haapea

Rautio

et al. 2022

Acta Psychiatr Scand

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Objective: Increasing number of people have been prescribed antipsychotics (APs) off-label in recent decades. This study aimed to identify the characteristics and predictors of receiving prescription of antipsychotics off-label. Methods: The study sample was part of the Northern Finland Birth Cohort 1966 (n = 7071). Data included questionnaires and national register data.Information on prescribed medications was extracted from the national register. The sample was divided into three groups: Persons who had been prescribed APs off-label (n = 137), individuals with non-psychotic mental disorders without APs off label (n = 1478) and individuals who had been diagnosed with psychosis or bipolar disorder and who had been prescribed APs (n = 151). We compared sociodemographic, lifestyle and clinical characteristics between the off-label and the comparison groups using logistic regression. Results:The most common diagnoses in the off-label group were depression (n = 96, 70.1%) and anxiety (n = 55, 40.1%). Compared with individuals with non-psychotic mental disorders who were not prescribed APs off-label, individuals with prescribed off-label APs had a lower level of education, lower socioeconomic status, were less often married, had a higher level of somatic and psychiatric morbidity, were more often smokers and more often had a substance abuse disorder and heavy alcohol consumption. When comparing the off-label group to individuals with psychosis or bipolar disorder who used APs, there were less differences, though individuals with psychosis or bipolar disorder had more markers of morbidity and a lower level of education. Conclusion:Individuals who had been prescribed APs off label had a higher level of mental and somatic morbidity and poorer socioeconomic status than individuals with non-psychotic mental disorders who did not use APs.

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Understanding the unmet needs in insomnia treatment: a systematic literature review of real-world evidence

Cited by 11 publications

References 91 publications

Wake Up America: National Survey of Patients’ and Physicians’ Views and Attitudes on Insomnia Care

Wake Up America: National Survey of Patients’ and Physicians’ Views and Attitudes on Insomnia Care

Melatonergic agents influence the sleep-wake and circadian rhythms in healthy and psychiatric participants: a systematic review and meta-analysis of randomized controlled trials

Characteristics and predictors of off‐label use of antipsychotics in general population sample

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