Sleep-related adverse events of smoking cessation drugs: A network meta-analysis of randomized controlled trials

• Published in: Psychiatry research Vol. 335; p. 115874
• Main Authors: Song, Yubin, Park, Yoon-A, Lee, Da Hoon, Yee, Jeong, Gwak, Hye Sun
• Format: Journal Article
• Language: English
• Published: Ireland Elsevier B.V 01-05-2024
• Subjects: Abnormal dreams; Adverse events; Bupropion - adverse effects; Humans; Insomnia; Network Meta-Analysis; Nicotinic Agonists - adverse effects; Nightmare; Randomized Controlled Trials as Topic; Sleep; Sleep Initiation and Maintenance Disorders - drug therapy; Sleepiness; Smoking - psychology; Smoking Cessation - psychology; Smoking cessation drugs; Somnolence; Tobacco Use Cessation Devices - adverse effects; Varenicline - therapeutic use; Somnolence; Network meta-analysis; Abnormal dreams; Adverse events; Smoking cessation drugs; Insomnia; Nightmare
• ISSN: 0165-1781; 1872-7123
• DOI: 10.1016/j.psychres.2024.115874

•This is the first network meta-analysis on sleep-related side effects of smoking-cessation drugs.•Bupropion plus nicotinic acetylcholine receptor agonist (NRA) ranked first in insomnia.•NRA plus nicotine replacement therapy in abnormal dreams, NRA in nightmares, and nortriptyline in somnolence ranked first.
Smoking cessation medications have the potential to affect the functioning of the nervous system, leading to sleep disturbances. Our study aimed to compare the sleep-related side effects (such as insomnia, abnormal dreams, nightmares, and somnolence) induced by different smoking cessation medications in non-psychiatric smokers. We conducted a thorough search of five electronic databases (Cochrane, EMBASE, PubMed, PsycInfo, and Web of Science) for randomized controlled trials. This study was registered with the PROSPERO (registration number CRD42022347976). A total of 79 full-text articles, encompassing 36,731 participants, were included in our analysis. Individuals using bupropion, bupropion in combination with a nicotinic acetylcholine receptor agonist (NRA), and bupropion in conjunction with nicotine replacement therapy (NRT) exhibited a higher likelihood of experiencing insomnia compared to those using NRT alone. Bupropion plus NRA had the highest ranking on the surface under the cumulative ranking curve (SUCRA) for insomnia risk, while placebo had the lowest ranking. Additionally, NRA plus NRT ranked first for abnormal dream outcomes, NRA alone for nightmares, and nortriptyline for somnolence, based on the SUCRA results. Healthcare providers should exercise caution when prescribing smoking cessation drugs, particularly in consideration of their potential sleep-related side effects.