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PSYCHIATRY

A Qualitative Investigation of Long-Term Zopiclone Use and Sleep Quality Among Vietnam War Veterans with PTSD

Director, Pharmacy Department, Repatriation General Hospital, Adelaide, South Australia; Associate Professor, Quality Use of Medicines and Pharmacy Research Centre, University of South Australia, Adelaide

Andrew L Gilbert, BPharm PhD

Professor and Director, Quality Use of Medicines and Pharmacy Research Centre, University of South Australia

Reprints: Dr. Alderman, Pharmacy Department, Repatriation General Hospital, Daw Park SA 5041, Australia, fax 618 83740225, chris.alderman{at}health.sa.gov.au

BACKGROUND: Self-reported sleep difficulties are common among patients with posttraumatic stress disorder (PTSD), but the routine use of hypnosedatives over extended periods is not generally recommended.

OBJECTIVE: To examine the effects of the extended use of zopiclone among a cohort of patients with combat-related PTSD.

METHODS: We conducted a 6-month follow-up cohort study of zopiclone usage characteristics for 26 combat veterans with PTSD. Psychometric and sleep assessments were also conducted at baseline and 6 months.

RESULTS: The mean baseline score obtained on the tranquilizer dependence questionnaire was 20.4 ± 13.4, below the cutoff score proposed as indicative of a high likelihood of dependence (23 points). Eight (30.7%) subjects exceeded the proposed cutoff score for dependence at baseline. Most (n = 24) subjects reported poor sleep quality at baseline. Actigraphy revealed that the mean sleep efficiency score was 71.2 ± 13.7% at baseline. A cohort of 13 men was available for inclusion in the follow-up phase of the study. The tranquilizer dependence questionnaire score at follow-up was broadly similar to the baseline score after a further 6 months of zopiclone use (18.9 at baseline compared with 19.9 ± 2.6 at follow-up). Individual analysis revealed that the tranquilizer dependence scale score increased for 5 subjects and decreased for 8 subjects at follow-up. Four (30.7%) subjects in the follow-up cohort exceeded the proposed cutoff score for dependence at baseline and 6 (46.1%) subjects exceeded it at follow-up. Actigraphy data were consistent across measurements for individual subjects at baseline and follow-up, with similar mean sleep efficiency scores at baseline and after 6 months of treatment with zopiclone (69.6 ± 12.7% at baseline; 71.33 ± 19.0% at follow-up). The proportion of relatively poor sleepers (5/13 at baseline and 4/13 at follow-up) remained essentially unchanged.

CONCLUSIONS: Overall, the results of this study suggest that, although the subjects in the follow-up phase of the research continued to use zopiclone on a regular basis for an extended period, the efficacy of this intervention for addressing PTSD-related sleep disturbance was low. Extended treatment with zopiclone may not necessarily be associated with increased risk for dependence. Further robust research to examine the consequences of long-term zopiclone therapy for PTSD-related sleep disturbance is warranted.

Key Words: sleep, stress disorders, posttraumatic, zopiclone

Published Online, August 25, 2009. www.theannals.com, DOI 10.1345/aph.1M275