Article Text


Pharmacological interventions to improve sleep in hospitalised adults: a systematic review
  1. Salmaan Kanji1,2,
  2. Alexandru Mera3,
  3. Brian Hutton2,4,
  4. Lisa Burry5,
  5. Erin Rosenberg6,
  6. Erika MacDonald2,7,
  7. Vanessa Luks8
  1. 1Department of Pharmacy and Critical Care, The Ottawa Hospital, Ottawa, Ontario, Canada
  2. 2The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
  3. 3Department of Pharmacy, Hôpital Montfort—The Ottawa Hospital, Ottawa, Ontario, Canada
  4. 4School of Epidemiology, Public Health and Preventative Medicine, University of Ottawa, Ottawa, Ontario, Canada
  5. 5Department of Pharmacy, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
  6. 6Department of Critical Care, The Ottawa Hospital, Ottawa, Ontario, Canada
  7. 7Department of Pharmacy, The Ottawa Hospital, Ottawa, Ontario, Canada
  8. 8Department of Respirology, Thunder Bay Regional Health Sciences Centre, Northern Ontario School of Medicine, Sudbury, Ontario, Canada
  1. Correspondence to Dr Salmaan Kanji; skanji{at}


Objectives Patients often suffer from disturbed sleep in hospital. Poor-quality sleep in hospitalised patients has been associated with significant morbidity and pharmacological sleep aids are often prescribed. The objective of this systematic review is to evaluate the comparative efficacy and safety of pharmacological interventions used for sleep in hospitalised patients.

Setting/participants We searched MEDLINE, Embase, the Cochrane database and grey literature for prospective studies that evaluated sleep in hospitalised adults after a pharmacological intervention.

Primary and secondary outcome measures Two reviewers assessed studies for inclusion and extracted data for efficacy outcomes, including sleep efficiency, sleep latency, sleep fragmentation and objectively measured sleep stage distribution. Risk of bias was assessed and meta-analyses were planned contingent upon homogeneity of the included studies.

Results After screening 1920 citations, 15 studies involving 861 patients were included. Medications studied included benzodiazepines, nonbenzodiazepine sedatives, melatonin, propofol and dexmedetomidine. Five studies were deemed to be of high quality. Heterogeneity and variable outcome reporting precluded meta-analysis in most cases. No consistent trends with respect to sleep efficiency, quality or interruptions were observed identifying a drug or drug class as superior to another or no treatment. Benzodiazepines appeared to be better than no treatment with respect to sleep latency, but this was not consistently demonstrated across all studies. Sleep stage distribution shows that sleep in hospital is dominated by stages N1 and N2.

Conclusions There is insufficient evidence to suggest that pharmacotherapy improves the quality or quantity of sleep in hospitalised patients suffering from poor sleep. No drug class or specific drug was identified as superior even when compared to placebo or no treatment. Although 15 studies were included, the quality of evidence was limited by their quality and size. Larger, better-designed trials in hospitalised adults are needed.


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