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Computerized Dynamic Posturography for Postural Control Assessment in Patients with Intermittent Claudication
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Hypnotic-Induced Fall Risk Upon Awakening: A Network Meta-Analysis of Postural Stability Outcomes.

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Summary

Most hypnotic medications do not significantly impair morning postural stability at prescribed doses. However, certain hypnotics like zopiclone and zolpidem may affect balance, especially in older adults or at higher doses.

Keywords:
benzodiazepinesfall riskhypnoticsorexin receptor antagonistspostural stabilityz‐drugs

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Area of Science:

  • Pharmacology
  • Geriatrics
  • Neurology

Background:

  • Chronic insomnia affects 10% of adults, leading to widespread hypnotic medication use.
  • Potential residual effects of hypnotics upon awakening may impair postural stability and increase fall risk.
  • Understanding the impact of hypnotics on balance is crucial for patient safety, particularly in vulnerable populations.

Purpose of the Study:

  • To systematically compare the effects of various hypnotic medications on postural stability upon awakening using a network meta-analysis (NMA).
  • To identify specific hypnotics or dosages that may pose a risk to balance and increase fall risk.
  • To provide evidence-based recommendations for hypnotic prescribing to minimize adverse effects on postural control.

Main Methods:

  • A systematic review and frequentist random-effects network meta-analysis (NMA) were conducted following PRISMA guidelines.
  • Searched major databases (PubMed, EMBASE, ClinicalTrials.gov, WHO-ICTRP) for relevant randomized controlled trials (RCTs) up to October 2025.
  • Included studies assessed static (body sway) and dynamic (walking test) balance, with risk-of-bias and confidence in evidence evaluated using RoB2 and CINeMA.

Main Results:

  • Most in-label doses of hypnotics showed no significant impact on morning postural stability compared to placebo.
  • Zopiclone 7.5 mg and extended-release zolpidem (6.5 mg and 10 mg) demonstrated potential negative effects on balance, particularly during middle-of-the-night awakenings or in older adults.
  • Confidence in the evidence for most findings was rated as low or very-low.

Conclusions:

  • Regulatory-approved hypnotics generally do not significantly impair postural balance at standard, in-label doses.
  • Caution is advised with longer-acting hypnotics, higher doses, and in individuals at high risk of falls, such as older adults.
  • Lower doses and shorter half-life hypnotics are preferable when treatment is necessary, emphasizing the need for further research on dynamic balance and fall prevention.