OBJECTIVES: To evaluate sleep quality among inpatients receiving sedative-hypnotics in a tertiary care teaching hospital in Kozhikode, South India.

METHODS: This pre-post intervention, observational study enrolled 186 inpatients (aged 15-90 years) who were prescribed sedative-hypnotics for sleep problems. Patients with chronic insomnia and/or long-term sedative drug use, pregnant women, and children were excluded. Using modified Pittsburgh Sleep Quality Index (PSQI) questionnaire, patients were interviewed upon hospital admission and a follow-up interview was conducted after ≥1-week of sedative-hypnotic therapy. PSQI total scores range from 0 (normal) to 21 (worst). Changes in sleep-quality scores (paired t-test) and patient-reported adverse events (AEs) were analysed using SAS 9.4 software.

RESULTS: Overall, mean PSQI total score improved by 6.79 points after sedative-hypnotic therapy (pre: 12.70 vs post: 5.91; p<0.0001). Similar pre-post score changes (range: -6.17 to -6.59) were observed in patients administered benzodiazepines, and non-benzodiazepine had higher impact (-8.34). Patients experienced improvements in mean sleep duration (from 4.7 hours to 6.9 hours) and mean sleep latency (from 18.9 minutes to 7.9 minutes).

Among principal diagnoses associated with hospitalizations, most significant PSQI improvements were observed in case of infections (pre: 13.28 vs post 4.96; p<0.0001) and fractures (13.28 vs 4.96; p<0.0001). Patients with heart diseases benefitted the least (10.19 vs 4.81; p<0.0001). Most patients in the study received benzodiazepines (79.6%), of which alprazolam (40.3%) was most common. Only 20.4% received non-benzodiazepines. Overall 80% patients experienced abrupt awakening, mostly due to pain (12.36%) and dyspnoea (10.75%). Insomnia was most common among elderly patients (50-70 years). Sedative-hypnotic induced AEs were reported by 17.7% patients, more frequently by the elderly (72.7%).

CONCLUSIONS: Inpatients, especially elderly and those at high AE risk, experience poor sleep quality. Lack of standard guidelines for use and continuous efficacy monitoring pose a challenge. Large-scale studies are needed for improving informed use of sedative-hypnotics in India.