Trazodone for the treatment of insomnia: a meta-analysis of randomized placebo-controlled trials

Xiao-Yan Yi; Shi-Fen Ni; Mohammad Rasoul Ghadami; Hua-Qing Meng; Ming-Yan Chen; Li Kuang; Yu-Qing Zhang; Li Zhang; Xin-Yu Zhou

doi:10.1016/j.sleep.2018.01.010

Trazodone for the treatment of insomnia: a meta-analysis of randomized placebo-controlled trials

Sleep Med. 2018 May:45:25-32. doi: 10.1016/j.sleep.2018.01.010. Epub 2018 Feb 7.

Authors

Xiao-Yan Yi¹, Shi-Fen Ni², Mohammad Rasoul Ghadami³, Hua-Qing Meng², Ming-Yan Chen⁴, Li Kuang², Yu-Qing Zhang⁵, Li Zhang¹, Xin-Yu Zhou⁶

Affiliations

¹ The First Branch, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
² Department of Psychiatry, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
³ Sleep Disorders Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran.
⁴ Department of Statistics, University of Toronto, 100 St. George Street, Toronto, Canada.
⁵ Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
⁶ Department of Psychiatry, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China. Electronic address: xinyu973@126.com.

PMID: 29680424
DOI: 10.1016/j.sleep.2018.01.010

Abstract

Objective: To assess the efficacy and tolerability of trazodone compared with placebo in patients with insomnia.

Methods: Electronic databases were searched and relevant reports were hand-screened to identify eligible trials. Only randomized placebo-controlled trials were included. Standardized mean differences (SMD) and the odds ratios (OR) were estimated using a random-effect model. Primary efficacy outcomes included sleep efficiency (SE%) and self-reported sleep quality (SQ). Secondary efficacy outcomes included sleep latency (SL), total sleep time (TST), the number of awakenings (NAs), waking time after sleep onset (WASO). Tolerability outcome was measured by the number of patients who discontinued for adverse events and acceptability outcome was measured by the number of patients who discontinued for all causes.

Results: Seven trials involving 429 patients were included. There was no significant improvement for trazodone in SE% (SMD = 0.09, 95% confidence interval (CI) -0.19 to 0.38, P = 0.53) with a non-significant heterogeneity (I² = 0%, P = 0.59). However, patients receiving trazodone perceived better SQ than those receiving the placebo (SMD = -0.41, 95% CI -0.82 to -0.00, P = 0.05) with a non-significantly moderate heterogeneity (I² = 65%, P = 0.06). As to secondary efficacy outcomes, we only found a significant reduction for trazodone in NAs (SMD = -0.51, 95%CI -0.97 to -0.05) compared to the placebo, with non-significant differences found in SL, TST, or WASO between trazodone and placebo. Moreover, no significant difference was found in the outcome of tolerability or acceptability.

Conclusions: Trazodone was effective in sleep maintenance by decreasing the number of early awakenings and it could significantly improve perceived sleep quality, although there were no significant improvements in sleep efficiency or other objective measures. Trazodone however, presented good tolerance in the short-term treatment of insomnia.

Keywords: Efficacy; Insomnia; Meta-analysis; Tolerability; Trazodone.

Publication types

Meta-Analysis
Research Support, Non-U.S. Gov't
Review

MeSH terms

Humans
Randomized Controlled Trials as Topic*
Selective Serotonin Reuptake Inhibitors / administration & dosage*
Self Report
Sleep / drug effects*
Sleep Initiation and Maintenance Disorders / drug therapy*
Trazodone / administration & dosage*

Substances

Serotonin Uptake Inhibitors
Trazodone