Hypnotic-Induced Fall Risk Upon Awakening: A Network Meta-Analysis of Postural Stability Outcomes.
Flavia Rossano, Claudio Caiazza, Claudia Toni et al.
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In 30 seconds
This systematic review and frequentist random-effects network meta-analysis compared morning postural stability after hypnotic use, using randomized controlled trials that assessed static body sway or dynamic walking balance. Of 4,459 records identified, 23 studies were included. Most hypnotics at in-label doses did not significantly affect morning balance versus placebo. Exceptions included zopiclone 7.5 mg and, in analyses including older adults, zolpidem 6.5 mg extended-release (SMD = 0.39, 95% C.I.[0.01;0.76]). Confidence in the evidence was mainly low or very low.
Key findings
- Most regulatory-approved hypnotics at in-label doses showed no significant morning postural-stability impairment versus placebo.
- Zolpidem 6.5 mg extended-release was associated with worse balance in the subset including older adults (SMD = 0.39, 95% C.I.[0.01;0.76]).
- At middle-of-the-night assessments, reported SMDs were 0.98 for zopiclone 7.5 mg, 1.14 for zolpidem 6.5 mg extended-release, and 1.60 for zolpidem 10 mg.
- Confidence in the evidence was mainly low or very low.
Why it matters
Postural instability after hypnotic use may be relevant to falls, particularly when people awaken during the night or have heightened baseline fall risk. The findings suggest that balance effects are not uniform across drugs, doses, and assessment times. However, the generally low or very-low confidence means these estimates should be interpreted cautiously rather than as definitive comparative safety rankings.
What to keep in mind
Confidence in the evidence was mainly low or very low, and the review identified a need for further research on dynamic balance.