Investigating the Effects of Z-Drugs in Dementia Patients With Sleep Disturbances

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Existing data from the the UK Clinical Practice Research Datalink and 3 clinical studies of PwD were used to evaluate the association between Z-drug administration and the incidence of adverse events.
Existing data from the the UK Clinical Practice Research Datalink and 3 clinical studies of PwD were used to evaluate the association between Z-drug administration and the incidence of adverse events.

The following article is part of conference coverage from the 2018 Alzheimer's Association International Conference in Chicago, Illinois. Neurology Advisor's staff will be reporting breaking news associated with research conducted by leading experts in neurology. Check back for the latest news from AAIC 2018.

CHICAGO –  At the 2018 Alzheimer's Association International Conference, held July 22-26, 2018, in Chicago, Illinois, researchers from the UK presented the study design of a trial comparing hypnotic Z-drugs with other similar therapies for people with dementia (PwD), specifically in regard to the effect of Z-drug administration on the clinical effectiveness for managing sleep disturbances in these patients. The study design was presented by lead author Chris Fox, MD, of the University of East Anglia in Norwich, United Kingdom.

“Approximately 60% of people with dementia experience sleep disturbances including insomnia and excessive daytime sleeping,” the researchers reported. “Hypnotic Z-drugs (zolpidem, zopiclone, and zaleplon) are used to treat insomnia in the elderly but can cause adverse events [such as] falls and daytime cognitive impairment which might be particularly harmful for PwD. Given the importance of Z-drugs in offering respite from sleep disturbances for PwD and carers...it is essential we understand the benefits and harms of these medications.”

Existing data from the the UK Clinical Practice Research Datalink (CPRD) and 3 clinical studies of PwD were used to evaluate the association between Z-drug administration and the incidence of adverse events. Common adverse events assessed in the analysis included falls and fractures, infections, stroke, neuropsychiatric symptoms, and mortality.

Additionally, the researchers investigated the effect of Z-drugs on cognition, functional ability, and quality of life. Patients included in the 2-year follow-up CPRD dataset were PwD with accompanying sleep disturbances (n=6922) and patients who were prescribed Z-drugs (n=3102). In the clinical study analyses, the researchers assessed PwD (n=3,057) using Z-drugs (n=374) who were followed for up to 11 years. The researchers plan on presenting their findings at a future meeting, with particularly focus on the effects of Z-drugs compared with antipsychotics and benzodiazepines or no treatment.

The findings from this study may ultimately offer guidance for managing sleep in patients with dementia, the study researchers wrote. “Prescribers will better understand the potential harms associated with medications for PwD. Furthermore, patients and carers of people with dementia will be better able to assess the benefits and harms of specific treatments, and have greater understanding of the likely consequences of using Z-drugs,” they added. “This work could lead to improved care outcomes and quality of life, reduced hospital admissions, mortality, and institutionalization for people who have dementia with sleep disturbance and their carers.”

For more coverage of AAIC 2018, click here.

Reference

Fox C, Arthur A, Ballard C, et al. Beyond anti-psychotics: exploring efficacy and harms of Z-drugs for sleep disturbance on the progression of key dementia outcomes. Presented at: 2018 Alzheimer's Association International Conference. July 22-26, 2018; Chicago, IL. Abstract 23209.

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