TABLE 1.
Studies that evaluated the effect of pharmacological treatment on sleep outcomes in alcohol use cessation or treatment
| Citation | Medication | RCT | n | Daily dose | Duration of treatment | Sleep outcome measured | Results | Effect on alcohol use |
|---|---|---|---|---|---|---|---|---|
| Antidepressants | ||||||||
| Le Bon (2003) | Trazodone | Yes | 18 | 50‐200 mg | 4 wk | PSG | Sleep efficiency increase when calculated after sleep onset | NA |
| Friedmann (2008) | Trazodone | Yes | 173 | 50‐150 mg | 12 wk | PSQI | Improved sleep quality during administration (mean change from baseline −3.02; 95% CI −3.38 to −2.67) | Reduction in abstinent days compared to placebo |
| Anticonvulsants | ||||||||
| Malcolm (2002) | Carbamazepine/ lorazepam | Yes | 136 | 200‐800 mg/2‐8 mg | 5 days | Sleep Quality VAS | Significant effect of drug group on sleep quality that favored carbamazepine (adjusted mean 62.1 vs 51.2; P = .0186) | NA |
| Malcolm (2007) | Gabapentin/ Lorazepam | Yes | 75 | 400‐1200/4‐6 mg | 4 days | BDI and ESS | Those with multiple previous withdrawals reported reduced sleep disturbances and sleepiness in gabapentin compared to lorazepam group | No difference |
| Brower (2008) | Gabapentin | Yes | 21 | 1500 mg | 6 wk | SPQ and PSG | No effect | Significantly delayed the onset to heavy drinking |
| Trevisan (2008) | Gabapentin | Yes | 57 | 1200 mg | 4 wk | PSQI | No effect | No effect |
| Anton (2009) | Gabapentin/flumazenil (IV) | Yes | 60 | Up to 1200 mg/2mg | 39 days | ISI and ESS |
Decreased insomnia symptoms in those with low withdrawal symptoms on gabapentin vs placebo (P = .015) Lower daytime sleepiness in gabapentin group vs placebo (P < .004) |
Decreased alcohol use in patients with high withdrawal symptoms |
| Anton (2011) | Gabapentin/Naltrexone | Yes | 146 | 1200 mg/50 mg | 6 wk | ISI | Gabapentin/Naltrexone group reported better sleep compared to placebo or naltrexone‐only group (P = .02 and P = .03, respectively) | Gabapentin/ Naltrexone group had improvements in drinking outcomes over naltrexone alone |
| Mason (2014) | Gabapentin | Yes | 150 | 900 or 1800 mg | 12 wk | PSQI | Significant improvement in sleep compared to placebo (P < .001) | Significantly improved rates of abstinence and no heavy drinking compared to placebo |
| Karam‐Hage (2003) | Gabapentin/ Trazodone | No | 50 | 300‐1800 mg/50‐300 mg | Up to 6 wk | SPQ | Both groups improved significantly, however, gabapentin group improved more than the trazodone group from baseline (8.8 vs 6.1, P = .023) | NA |
| Melatonin Agonists | ||||||||
| Brower (2011a) | Ramelteon | No | 5 | 8 mg | 4 wk | ISI | Significant improvement insomnia score from baseline (mean 17.6 to 9.8; Cohen's d = 1.31) | NA |
| Grosshans (2014) | Agomelatine | No | 9 | 25‐50 mg | 6 wk | PSQI | Significant improvement in insomnia score from baseline (mean 13.1 to 7.8, P < .01) | NA |
| Antipsychotics | ||||||||
| Litten (2012) | Quetiapine XR | Yes | 218 | Up to 400 mg | 12 wk | PSQI | Significant improvement in sleep compared to placebo (P = .009) | No effect |
| Chakravorty (2014) | Quetiapine XR | Yes | 20 | Up to 400 mg | 8 wk | PSG | No effect on sleep efficiency yet a reduction in wake after sleep‐onset time from baseline (P = .03) | NA |
| Other Agents | ||||||||
| Staner (2006) | Acamprosate | Yes | 24 | 1998 mg | 3 wk | PSG | Decreased wake time after sleep onset and increased stage 3 and REM sleep latency compared to placebo (P < .05) | NA |
| Perney (2012) | Acamprosate | Yes | 592 | 2000 or 3000 mg | 24 wk | SSI | Percentage of mean change over baseline was significantly improved with compared with placebo (P = .001) | NA |
| Irwin (2009) | Etanercept | Yes | 18 | 25 mg | Single dose, crossover | PSG | Significant decrease in amount and percentage of REM sleep compared to placebo | NA |
| Petrakis (2016) | Prazosin | Yes | 96 | 16 mg | 13 wk | PSQI | No effect | No effect |
Abbreviations: BDI, Beck Depression Inventory, Item 16; ESS, Epworth Sleepiness Scale; ISI, Insomnia Severity Index; IV, intravenous; n, number of evaluated subjects; NA, not applicable, not investigated; PSG, polysomnography; PSQI, Pittsburgh Sleep Quality Index; RCT, randomized clinical trial; SPQ, Sleep Problems Questionnaire; SSI, Short Sleep Index; VAS, visual analog scale; XR, extended‐release.