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This proposal will assess risks for transition from therapeutic hypnotic use to abuse in people with insomnia. The investigators will study a hypothesized at-risk sub-population, insomniacs with hyperarousal, and compare two hypnotics, a drug with mood effects, eszopiclone, versus one without mood effects, zolpidem.
Persons with DSM-V diagnosed insomnia disorder, aged 18-65 yrs, with no other sleep disorders, unstable medical or psychiatric diseases or drug dependency will be entered to the trial. Following a screening NPSG and MSLT, participants will be randomized to zolpidem XR 12.5 mg (n=60), eszopiclone 3 mg (n=60), or placebo (n=50) nightly for 6 months. After 6 months of nightly use, over a 2-week choice period, they were instructed to discontinue hypnotic use, but if necessary, to self-administer either 1, 2, or 3 capsules of their assigned "blinded" medication (zolpidem XR 6.25 mg, 6.25 mg, placebo; eszopiclone 2 mg, 1 mg, placebo as capsules 1, 2 and 3 respectively; or 3 placebos). Nightly sleep at home will be recorded by actigraphy for one week after the screening NPSG and MSLT and before treatment is initiated and actigraphy again during the two week discontinuation.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Placebo | Placebo Comparator | Intervention: Six months of nightly placebo |
|
| Zolpidem CR | Active Comparator | Intervention: Six months of zolpidem cr 12.5 mg nightly use |
|
| Eszopiclone | Active Comparator | Intervention: Six months of eszopiclone 3 mg nightly use |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| placebo | Drug | six months of nightly placebo |
| |
| Zolpidem CR |
| Measure | Description | Time Frame |
|---|---|---|
| Total Number of Capsules Taken During Discontinuation From Either Active Drug vs Placebo Over a Two Week Period | instruction to stop nightly hypnotic use over a two-week discontinuation period with option to choose of 1, 2, 3 capsules, if necessary | total number of capsules chosen in week 1 and week 2 of the discontinuation period |
| Measure | Description | Time Frame |
|---|---|---|
| Percent of Time Asleep Over Time in Bed During the Two-week Discontinuation Period | comparing the three treatment arms for nightly hypnotic efficacy using actigraphic determined sleep efficiency over the two week discontinuation period | mean nightly sleep efficiency during week 1 and week 2 of the discontinuation period |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Timothy A Roehrs, PhD | Henry Ford Health System Sleep Disorders Ctr | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| HFHS Sleep Disorders Ctr | Detroit | Michigan | 48202 | United States |
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| ID | Title | Description |
|---|---|---|
| FG000 | Placebo | Intervention: Six months of nightly placebo placebo |
| FG001 | Zolpidem CR | Intervention: Six months of zolpidem cr 12.5 mg nightly use Zolpidem CR |
| FG002 | Eszopiclone | Intervention: Six months of eszopiclone 3 mg nightly use Eszopiclone |
| Title | Milestones | Reasons Not Completed | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Overall Study |
|
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| ID | Title | Description |
|---|---|---|
| BG000 | Placebo | Intervention: Six months of nightly placebo placebo |
| BG001 | Zolpidem CR | Intervention: Six months of zolpidem cr 12.5 mg nightly use Zolpidem CR |
| Units | Counts |
|---|---|
| Participants |
|
| Title | Description | Population Description | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Denominator Units Selected | Denominators | Classes |
|---|---|---|---|---|---|---|---|---|---|
| Age, Categorical | Count of Participants |
| Type | Title | Description | Population Description | Reporting Status | Anticipated Posting Date | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Time Frame | Units Analyzed | Denominator Units Selected | Arm/Group Information | Denominators | Classes | Analyses | |||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Primary | Total Number of Capsules Taken During Discontinuation From Either Active Drug vs Placebo Over a Two Week Period | instruction to stop nightly hypnotic use over a two-week discontinuation period with option to choose of 1, 2, 3 capsules, if necessary | Posted | Mean | Standard Deviation | Total number capsules chosen | total number of capsules chosen in week 1 and week 2 of the discontinuation period |
|
6 months
reported weekly by questionnaire
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| ID | Title | Description | Deaths (Affected) | Deaths (At Risk) | Serious Events (Affected) | Serious Events (At Risk) | Other Events (Affected) | Other Events (At Risk) |
|---|---|---|---|---|---|---|---|---|
| EG000 | Placebo | Intervention: Six months of nightly placebo placebo | 0 |
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Difficulty reaching proposed enrollment target: 41 of projected 120 participants completed the study- in part due to COVID. Study is to be considered preliminary
| Title | Organization | Phone | Extension | |
|---|---|---|---|---|
| Timothy Roehrs | Henry Ford Health System | 13138026681 | troehrs1@hfhs.org |
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| Type | Includes Protocol | Includes SAP | Includes ICF | Document Label | Document Date | Document Uploaded Date | Document File Name |
|---|---|---|---|---|---|---|---|
| Prot_SAP | Yes | Yes | No | Study Protocol and Statistical Analysis Plan | Aug 3, 2015 | Aug 28, 2023 | Prot_SAP_000.pdf |
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| ID | Term |
|---|---|
| D007319 | Sleep Initiation and Maintenance Disorders |
| ID | Term |
|---|---|
| D020919 | Sleep Disorders, Intrinsic |
| D020920 | Dyssomnias |
| D012893 | Sleep Wake Disorders |
| D009422 | Nervous System Diseases |
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| ID | Term |
|---|---|
| D000069582 | Eszopiclone |
| ID | Term |
|---|---|
| D010879 | Piperazines |
| D006573 | Heterocyclic Compounds, 1-Ring |
| D006571 | Heterocyclic Compounds |
| D011719 | Pyrazines |
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| Drug |
six months of nightly zolpidem |
|
|
| Eszopiclone | Drug |
|
|
| BG002 | Eszopiclone | Intervention: Six months of eszopiclone 3 mg nightly use Eszopiclone |
| BG003 | Total | Total of all reporting groups |
| Participants |
|
| Age, Continuous | Mean | Standard Deviation | years |
|
| Sex: Female, Male | Count of Participants | Participants |
|
| Race (NIH/OMB) | Count of Participants | Participants |
|
| Region of Enrollment | Number | participants |
|
| Baseline PSG defined sleep efficiency | Mean | Standard Deviation | percent sleep per 8 hrs |
|
| Average daytime sleep latency in min | Mean | Standard Deviation | minutes |
|
| Eszopiclone |
Intervention: Six months of eszopiclone 3 mg nightly use Eszopiclone |
|
|
|
| Secondary | Percent of Time Asleep Over Time in Bed During the Two-week Discontinuation Period | comparing the three treatment arms for nightly hypnotic efficacy using actigraphic determined sleep efficiency over the two week discontinuation period | Posted | Mean | Standard Deviation | % sleep time/bedtime | mean nightly sleep efficiency during week 1 and week 2 of the discontinuation period |
|
|
|
|
| 14 |
| 0 |
| 14 |
| 0 |
| 14 |
| EG001 | Zolpidem CR | Intervention: Six months of zolpidem cr 12.5 mg nightly use Zolpidem CR | 0 | 11 | 0 | 11 | 0 | 11 |
| EG002 | Eszopiclone | Intervention: Six months of eszopiclone 3 mg nightly use Eszopiclone | 0 | 16 | 0 | 16 | 0 | 16 |
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| D001523 |
| Mental Disorders |
| D011725 |
| Pyridines |