Key result
Z-hypnotics link to fewer adverse cardiovascular events than benzodiazepines for treating insomnia in cardiac patients.
Why the study?
Insomnia is a common sleep disorder with important cardiovascular consequences, and the comparative clinical implications of benzodiazepines versus Z-hypnotics in cardiac patients are not well summarized.
Do Z-hypnotics have a more favorable cardiovascular safety profile compared to benzodiazepines in cardiac patients with insomnia?
Do Z-hypnotics have a more favorable cardiovascular safety profile compared to benzodiazepines in cardiac patients with insomnia?
Insomnia is a significant cardiovascular risk factor, and when pharmacological treatment is necessary for cardiac patients, Z-hypnotics (such as zopiclone) represent a safer alternative to benzodiazepines.
Z-hypnotics may be preferable to benzodiazepines for insomnia in cardiac patients; leaves open confirmation via randomized trials.
Introduction/Objective: Insomnia is a common sleep disorder that extends beyond the subjective feeling of poor sleep and represents a state of persistent physiological hyperarousal with important cardiovascular consequences. This review aimed to summarize the pathophysiological links between insomnia and cardiovascular disease and to compare the clinical implications of benzodiazepines and Z-hypnotics in the treatment of insomnia in cardiac patients. Methods: Using a descriptive-comparative approach, we analyzed review articles, meta-analyses, cohort studies, and observational studies addressing the relationship between insomnia, cardiovascular outcomes, and pharmacological treatment, with particular focus on differences between benzodiazepines and Z-hypnotics in cardiac patients. Results: The available evidence indicates that insomnia, through autonomic, neuroendocrine, inflammatory, and metabolic dysregulation, contributes to the development of hypertension, atrial fibrillation, and heart failure, with the greatest risk observed in insomnia with objectively short sleep duration. Longitudinal studies further suggest that persistent insomnia symptoms are associated with greater cardiovascular burden. In therapeutic terms, benzodiazepines in cardiac patients are associated with higher rates of adverse events, including heart failure rehospitalization, sudden cardiac arrest, and cardiovascular mortality, whereas available data on Z-hypnotics suggest a more favorable or neutral profile. Conclusion: Insomnia is a clinically important yet often overlooked cardiovascular risk factor. In cardiac patients, its recognition and treatment should be part of a comprehensive clinical approach, prioritizing non-pharmacological measures and carefully selected pharmacotherapy. When drug treatment is necessary, Z-hypnotics may be considered a more favorable alternative to benzodiazepines, with zopiclone standing out because of its pharmacological and clinical characteristics.
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Otašević et al. (2026) conducted a review in Insomnia and cardiovascular disease. Benzodiazepines and Z-hypnotics was evaluated. Insomnia contributes to cardiovascular disease development, and Z-hypnotics may be a more favorable alternative to benzodiazepines for treatment in cardiac patients due to fewer adverse cardiovascular events.
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