Doxepin is more effective than zolpidem in improving executive function in patients with insomnia disorder

• Published in: Sleep & breathing 2024-05, Vol.28 (2), p.929-934
• Main Authors: Yu, Zhenghe, Han, Li, Yan, Pan, Liu, Wenjuan, Ren, Lishan, Xu, You, Yang, Lili, Ma, Lisha, Liu, Yi, Wang, Shengdong
• Format: Article
• Language: English
• Subjects: Adult; Cognitive ability; Dentistry; Doxepin - therapeutic use; Executive function; Executive Function - drug effects; Female; Humans; Hypnotics and Sedatives - therapeutic use; Insomnia; Internal Medicine; Latency; Male; Medicine; Medicine & Public Health; Middle Aged; Neurology; Otorhinolaryngology; Patients; Pediatrics; Pneumology/Respiratory System; Polysomnography - drug effects; Psychiatrics • Original Article; Pyridines - adverse effects; Pyridines - therapeutic use; Sleep; Sleep Aids, Pharmaceutical - adverse effects; Sleep Aids, Pharmaceutical - therapeutic use; Sleep and wakefulness; Sleep disorders; Sleep Initiation and Maintenance Disorders - drug therapy; Structure-function relationships; Treatment Outcome; Zolpidem; Zolpidem - therapeutic use
• ISSN: 1520-9512; 1522-1709; 1522-1709
• DOI: 10.1007/s11325-023-02972-4

Background  Insomnia disorder is associated with an impairment in cognitive performance. Doxepin and zolpidem have been found to be effective in improving sleep. In this study, we aimed to compare the effects of doxepin and zolpidem on sleep structure and executive function in patients with insomnia disorder. Methods Patients with primary insomnia were randomly assigned to receive doxepin 6 mg/day orally or zolpidem 5–10 mg/day orally. Polysomnography (PSG) and the Pittsburgh Sleep Quality Index (PSQI) were used at baseline and after the 8-week treatment to compare clinical efficacy in the two groups. Safety was assessed using the Treatment Emergent Symptom Scale (TESS). Executive function was evaluated using the Wisconsin sorting card test (WSCT). Results Of 120 patients enrolled in the study, 60 participants were assigned to each group. A total of 109 participants (53 in the doxepin group and 56 in the zolpidem group) completed the study. After treatment, the wake after sleep onset (WASO) and total sleep time (TST) values in the doxepin group were 80.3 ± 21.4 min and 378.9 ± 21.9 min, respectively, which were significantly better than those in the zolpidem group (132.9 ± 26.5 min and 333.2 ± 24.2 min, respectively; ( P