Post-Coronary Artery Bypass Graft Surgery Insomnia: Quetiapine vs Alprazolam

Given that insomnia is common and not always easily handled after coronary artery bypass graft surgery (CABG), this study was conducted to compare the efficacy of quetiapine and alprazolam in post-CABG insomnia.
 
In this clinical trial, 90 patients undergoing CABG were selected and randomly divided into 2 groups of 45 patients. The first group received 12.5 mg of oral quetiapine and the second group received 0.5 mg of alprazolam before bedtime (at 10 PM). The patients’ insomnia was evaluated and compared using the Insomnia Severity Index (ISI) questionnaire on 3 occasions: 1 month before surgery and then 3 days and 14 days after surgery.
 
The mean score of insomnia 1 month before surgery and 3 days after surgery had no statistically significant difference in both groups (P =0.89 and P =0.55, respectively). The mean score of insomnia on the 14th postoperative day, which was at the end of the 10-day treatment period, was 15.33 ± 3.87 in the alprazolam group and 13.33 ± 4.71 in the quetiapine group (P >0.05 and P =0.043, respectively). In the quetiapine group, 2 patients experienced drowsiness on the following day and 1 patient developed pruritus; none of them experienced restless leg syndrome or dystonia. Nine patients in the quetiapine group and 3 patients in the alprazolam group had drug noncompliance.
 
Despite more drug noncompliance, very low-dose quetiapine was more effective than alprazolam in improving the sleep quality of our early postoperative CABG patients.  (Iranian Heart Journal 2021; 22(3): 74-80)