Étude du changement de l’architecture du sommeil chez la personne âgée après un sevrage aux benzodiazépines couplé à la thérapie cognitivo-comportementale pour insomnie
Background: Benzodiazepines (BZD) and related drugs are consumed chronically by a large part of the elderly population with chronic insomnia. However, this use in this population is criticized for the risk of associated side effects. Cognitive behavioral therapy for insomnia (CBT-I) is the first-line treatment for insomnia because of its efficacy and safety.  Objective: The objective of this project is to assess changes in sleep quality, macroarchitecture and sleep microarchitecture after withdrawal from BZD in the elderly with chronic insomnia. Then, we study the effect of CBT-I coupled with withdrawal on the same variables of interest. We hypothesize that weaning will be accompanied by an improvement in the subjective sleep quality  (decrease in Insomnia Severity Index (ISI) and increase in sleep efficiency (SE)) and a modification of certain distinct variables: sleep spindle and stage N3 (increase in the percentage at stage N3 and decrease in the density of sleep spindles). In addition, we hypothesize that these changes will be more pronounced with CBT-I coupled with weaning.    Methods: 41 participants (mean age: 69.39 ± 6.88 years) were randomized into 2 groups; stratified for age, duration and dose of BZD and relatives consumed: the weaning+CBT-I group (N = 23) and the weaning group (N = 18). All participants complete a 16-week weaning plan with follow-up, and at the same time, only the therapy group receives CBT-I. Data acquisition is carried out before and after weaning from questionnaire (ISI), sleep diary (SE) over a period of 14 days, and by polysomnographic recordings (stage N3 and density of sleep spindles).   Results: 60.98% of participants (weaning+CBT-I group: 60.87%; weaning group: 61.11%) succeeded in completely stopping their medication after withdrawal. A decrease in ISI (F(1.40) = 4.36, p = 0.04) and in sleep spindle density (F(1.36) = 7.18, p = 0.01) was observed after weaning. Finally, CBT-I coupled with weaning showed a greater increase in SE (Sleep Diary; F(1.35) = 6.75, p = 0.01) compared to the control group.  Conclusion: The weaning plan with follow-up makes it possible to obtain complete weaning in a majority of participants, without any significant worsening of their quality of sleep being observed. The addition of CBT-I during withdrawal from BZD and related products resulted in a greater improvement in self-reported sleep quality (Sleep Diary: SE).
Benzodiazepines Withdrawal CBT-I Sleep architecture Elderly