Using benzodiazepines and Z-drugs for managing primary insomnia in adults in Saudi Arabia: an e-Delphi study to aid the development of clinical guidelines

Abstract

PurposeThis study aims to obtain consensus statements required for the development of clinical guidelines for the use of benzodiazepines (BZDs) and Z-drugs for the management of primary insomnia in adults in Saudi Arabia.MethodsThree rounds of the e-Delphi technique using a Bristol Online Survey (BOS) were conducted between May and August 2018. The Director of the Saudi Sleep Medicine Group helped recruit the country’s sleep medicine experts. Snowballing was used to forward invitation emails, information sheets, and the survey to known sleep medicine experts and physicians deemed to be interested in the field. All participants’ details were anonymised except to the researcher.ResultsFifteen experts from four different regions and specialities in Saudi Arabia participated in Round 1. Twenty-one statements originated from participants’ responses. In Round 2, there were 17 respondents and 16 of the statements obtained the required consensus of 70% or higher. Eleven experts participated in Round 3 and eight statements received 100% agreement, two received 91%, and six received 82%. Having obtained the required consensus of 80% or higher in Round 3, these 16 statements fulfilled the criteria to be included in future guidelines. The five statements that failed to attain the required consensus were rejected as inappropriate for inclusion in Saudi Arabian clinical guidelines.ConclusionsThe items that achieved the required consensus can be included in future guidelines for the use of BZDs and Z-drugs in the treatment of primary insomnia in adults to standardize best practices in sleep medicine in Saudi Arabia.

The use of hypnotics for primary insomnia in Saudi Arabia: a survey of patients’ experiences and perceptions

“…The findings of this study indicate that patients usually receive sleep medication as a first-line treatment rather than non-pharmacological treatment. This finding is consistent with a previous study by our group indicating that patients in Saudi Arabia are not receiving CBT-I [14], even though it is recommended as initial therapy by many clinical guidelines [19][20][21] and by many experts in Saudi Arabia [22]. This might be due to Saudi physicians' lack of knowledge about non-pharmacological treatment modalities for primary insomnia or their not having the time or expertise to deliver nonpharmacological treatment to patients [15].…”

Healthy sleep practices for shift workers: consensus sleep hygiene guidelines using a Delphi methodology

“…Furthermore, there is no definitive number of rounds, instead, rounds usually continue until consensus on the relevant outcome/s has been reached [ 50 ], with 2–4 rounds being most common [ 52 ]. Finally, there is no defined point at which consensus is reached in a round; however, 70% agreement on items is widely accepted as having reached consensus [ 51 ].…”