Fornaro, Michele ORCID: 0000-0002-9647-0853 , Caiazza, Claudio, Rossano, Flavia, Cilmi, Flavia, De Prisco, Michele ORCID: 0000-0002-2032-1181 , Vieta, Eduard ORCID: 0000-0002-0548-0053 , Thompson, Trevor ORCID: 0000-0001-9880-782X , Solmi, Marco, Carvalho, Andre Ferrer, Iasevoli, Felice and de Bartolomeis, Andrea (2024) Residual effects of medications for sleep disorders on driving performance: a systematic review and network meta-analysis of randomized controlled trials. European Neuropsychopharmacology, 81. pp. 53-63. ISSN 0924-977X (doi:https://doi.org/10.1016/j.euroneuro.2024.01.011)

PDF (AAM) 47143_THOMPSON_Residual_effects_of_medications_for_sleep_disorders_on_driving_performance.pdf - Accepted Version Restricted to Repository staff only until 24 February 2025. Available under License Creative Commons Attribution Non-commercial No Derivatives. Download (620kB) | Request a copy

Abstract

Sleep medications often carry residual effects potentially affecting driving safety, warranting network meta-analysis (NMA). PubMed/EMBASE/TRID/Clinicaltrials.gov/WHO-ICTRP/WebOfScience were inquired for randomized controlled trials of hypnotic driving studies in persons with insomnia and healthy subjects up to 05/28/2023, considering the vehicle's standard deviation of lateral position - SDLP (Standardized Mean Difference/SMD) and driving impairment rates on the first morning (co-primary outcomes) and endpoint. Risk-of-bias, global/local inconsistencies were measured, and CINeMA was used to assess the confidence in the evidence. Of 4,805 identified records, 26 cross-over RCTs were included in the systematic review, of which 22 entered the NMA, focusing on healthy subjects only. After a single administration, most molecules paralleled the placebo, outperforming zopiclone regarding SDLP. In contrast, ramelteon 8 mg, daridorexant 100 mg, zolpidem 10 mg bedtime, zolpidem middle-of-the-night 10 mg and 20 mg, mirtazapine 15–30 mg, and triazolam 0.5 mg performed significantly worse than placebo. Lemborexant 2.5–5 mg, suvorexant 15–20 mg, and zolpidem 3.5 mg middle-of-the-night associated with lower impairment than zopiclone. Repeated administration (maximum follow-up time of ten days) caused fewer residual effects than acute ones, except for flurazepam. Heterogeneity and inconsistency were negligible. Confidence in the evidence was low/very low. Sensitivity analyses confirmed the main analyses. Most FDA-approved hypnotics overlapped placebo at in-label doses, outperforming zopiclone. Repeated administration for 15 days or less reduced residual effects, warranting further research on the matter.Funding: None.

Item Type:	Article
Uncontrolled Keywords:	hypnotic; sleep drugs; safety; driving performance
Subjects:	R Medicine > R Medicine (General) R Medicine > RC Internal medicine R Medicine > RC Internal medicine > RC0321 Neuroscience. Biological psychiatry. Neuropsychiatry
Faculty / School / Research Centre / Research Group:	Faculty of Education, Health & Human Sciences Faculty of Education, Health & Human Sciences > Institute for Lifecourse Development Faculty of Education, Health & Human Sciences > Institute for Lifecourse Development > Centre for Chronic Illness and Ageing Faculty of Education, Health & Human Sciences > School of Human Sciences (HUM)
Last Modified:	10 May 2024 13:53
URI:	http://gala.gre.ac.uk/id/eprint/47143

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