Physicians' attitudes toward hypnotics for insomnia: A questionnaire-based study.

ABSTRACT

Introduction: Benzodiazepines and non-benzodiazepines are still widely prescribed despite safety concerns and the introduction of novel hypnotics (orexin receptor antagonists [ORA] and melatonin receptor agonists [MRA]), which may be influenced by physicians' attitudes toward hypnotics. Methods: A questionnaire survey was administered to 962 physicians between October 2021 and February 2022, investigating frequently prescribed hypnotics and the reasons for their selection. Results: ORA were the most frequently prescribed at 84.3%, followed by non-benzodiazepines (75.4%), MRA (57.1%), and benzodiazepines (54.3%). Compared to non-frequent prescribers of hypnotics, a logistic regression analysis showed that frequent ORA prescribers were more concerned with efficacy (odds ratio [OR] 1.60, 95% confidence interval [CI] 1.01-2.54, p = 0.044) and safety (OR 4.52, 95% CI 2.99-6.84, p < 0.001), frequent MRA prescribers were more concerned with safety (OR 2.48, 95% CI 1.77-3.46, p < 0.001), frequent non-benzodiazepine prescribers were more concerned with efficacy (OR 4.19, 95% CI 2.91-6.04, p < 0.001), and frequent benzodiazepine prescribers were more concerned with efficacy (OR 4.19, 95% CI 2.91-6.04, p < 0.001) but less concerned with safety (OR 0.25, 95% CI 0.16-0.39, p < 0.001). Discussion: This study suggested that physicians believed ORA to be an effective and safe hypnotic and were compelled to prescribe benzodiazepine and non-benzodiazepine frequently, choosing efficacy over safety.