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Frontiers in sleep
By Wang D, Wang X, Wang W and 1 others.
Chronic insomnia with anxiety symptoms is frequently accompanied by sustained hypnotic or sedative medication use. Evidence regarding procedure-based adjuncts to structured medication reduction remains limited.
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To evaluate whether participation in a stellate ganglion block (SGB)-based care pathway, compared with contemporaneous routine care without SGB, was associated with hypnotic or sedative medication reduction at 1 month.
This single-center retrospective cohort study screened 420 records from 1 January 2022 to 31 December 2025 and included 160 adults with chronic insomnia, anxiety symptoms, and baseline hypnotic or sedative use. Eighty patients received a standardized four-session SGB-based pathway and 80 routine-care controls were selected by outcome-blinded, 1:1 calendar-time risk-set sampling without replacement. The pragmatic 1 month composite outcome was achievement of at least one of the following: a ≥50% reduction in the exploratory operational medication-burden score, transition from combination therapy to monotherapy, or complete discontinuation maintained for ≥2 weeks. Components and class-specific benzodiazepine and Z-drug outcomes were analyzed separately. The primary adjusted model was restricted to age, sex, baseline operational burden, and baseline medication count. Robust Poisson, Firth logistic, marginal standardization, bootstrap, propensity-score matching, overlap weighting, and trimmed stabilized inverse probability weighting were used.
The composite outcome occurred in 32/80 patients (40.0%) in the SGB-based pathway group and 12/80 (15.0%) under routine care (crude risk difference, 25.0 percentage points; 95% CI, 11.7-38.3; crude RR, 2.67; 95% CI, 1.48-4.79). The core robust Poisson model yielded an adjusted RR of 2.43 (95% CI, 1.32-4.46), and marginal standardization yielded adjusted risks of 38.0% vs. 16.7% and an adjusted risk difference of 21.3 percentage points (95% CI, 8.9-32.3). The association was primarily driven by ≥50% operational-burden reduction (33.8% vs. 11.2%; adjusted RR, 2.77; 95% CI, 1.34-5.75). Transition to monotherapy and complete discontinuation were numerically more frequent but imprecisely estimated. Class-specific analyses supported an association with ≥50% benzodiazepine dose reduction; Z-drug analyses were directionally similar but less precise. Three month maintained response remained more frequent after conservative and censoring-weighted analyses. Fifteen of 80 SGB-treated patients had a recorded procedure-related event; no serious event was recorded.
Participation in an SGB-based care pathway was associated with a higher probability of short-term medication reduction, particularly substantial dose reduction, but evidence for complete discontinuation was inconclusive. Because treatment allocation and co-interventions were nonrandomized, the results do not establish an independent causal effect of SGB.
Published in Frontiers in sleep. The abstract is shown as published and remains the work of its authors; read the full article at the source.
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