{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T19:01:54Z","timestamp":1790622114938,"version":"4.1.0"},"reference-count":65,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2026,4,7]],"date-time":"2026-04-07T00:00:00Z","timestamp":1775520000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,4,7]],"date-time":"2026-04-07T00:00:00Z","timestamp":1775520000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Journal of Sleep Research"],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>Chronic insomnia affects 10% of adults, with hypnotic medications widely prescribed. Residual pharmacological effects upon awakening may affect postural stability, increasing fall risk. We used a Network Meta\u2010Analysis (NMA) framework to compare the influence of hypnotic medications on posture upon awakening. A systematic review and frequentist random\u2010effects NMA was conducted following the PRISMA guidelines and a pre\u2010determined protocol. We searched PubMed, EMBASE, ClinicalTrials.gov, WHO\u2010ICTRP for randomized controlled trials until 10\/21\/2025, documenting the effects of hypnotics on static (body sway) and dynamic (walking test) balance. Risk\u2010of\u2010bias and confidence in evidence were assessed with RoB2 and CINeMA. Of 4459 identified records, 23 studies were included in the review. Most in\u2010label doses of hypnotics showed no significant impact on postural stability in the morning compared to placebo, except zopiclone 7.5\u2009mg both at bedtime (Standardized Mean Difference\u2014SMD\u2009=\u20090.22, 95% C.I.[0.22;0.1.24]) and middle\u2010of\u2010the\u2010night awakening (SMD\u2009=\u20094.45, 95% C.I.[3.54;5.36]), while zolpidem 6.5\u2009mg extended\u2010release proved worse in the subset including older adults (SMD\u2009=\u20090.39, 95% C.I.[0.01;0.76]). Same applied to middle\u2010of\u2010the\u2010night evaluations for zopiclone 7.5\u2009mg (SMD\u2009=\u20090.98, 95% C.I.[0.07;1.90]), zolpidem 6.5\u2009mg extended\u2010release (SMD\u2009=\u20091.14, 95% C.I.[0.30;1.98]), and zolpidem 10\u2009mg (SMD\u2009=\u20091.60, 95% C.I.[0.63;2.58]). Confidence in the evidence was mainly low\/very\u2010low. Most regulatory\u2010approved hypnotics did not significantly impair postural balance at in\u2010label doses. However, caution is warranted for longer\u2010acting and high\u2010doses, particularly in high fall\u2010risk individuals, including older adults. Given the age\u2010related decline in postural reflexes and heightened sensitivity to CNS depressants, lower doses and shorter half\u2010life drugs should be preferred whenever hypnotic therapy is necessary. Future research is needed to explore dynamic balance further to optimize prescribing guidelines for fall prevention in vulnerable populations.<\/jats:p>","DOI":"10.1111\/jsr.70337","type":"journal-article","created":{"date-parts":[[2026,4,8]],"date-time":"2026-04-08T00:24:55Z","timestamp":1775607895000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Hypnotic\u2010Induced Fall Risk Upon Awakening: A Network Meta\u2010Analysis of Postural Stability Outcomes"],"prefix":"10.1111","volume":"35","author":[{"given":"Flavia","family":"Rossano","sequence":"first","affiliation":[{"name":"Azienda Sanitaria Locale Napoli 1 Centro Unit\u00e0 Operativa Centro di Salute Mentale 24\/73 e 31  Naples Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6275-0657","authenticated-orcid":false,"given":"Claudio","family":"Caiazza","sequence":"additional","affiliation":[{"name":"Azienda Sanitaria Locale Napoli 3 Sud Unit\u00e0 Operativa Centro di Salute Mentale 55\u201057  Naples Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claudia","family":"Toni","sequence":"additional","affiliation":[{"name":"Department of Psychiatry University of Campania \u201cL. Vanvitelli\u201d  Naples Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gaia","family":"Sampogna","sequence":"additional","affiliation":[{"name":"Department of Psychiatry University of Campania \u201cL. Vanvitelli\u201d  Naples Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Valeria","family":"Del Vecchio","sequence":"additional","affiliation":[{"name":"Department of Psychiatry University of Campania \u201cL. Vanvitelli\u201d  Naples Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1676-629X","authenticated-orcid":false,"given":"Laura","family":"Palagini","sequence":"additional","affiliation":[{"name":"Azienda Ospedaliero\u2010Universitaria Pisana AUOP  Pisa Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Fiorillo","sequence":"additional","affiliation":[{"name":"Department of Psychiatry University of Campania \u201cL. Vanvitelli\u201d  Naples Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,4,7]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.2165\/00002512-200522090-00004"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00228-003-0591-5"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/0924-9338(96)80094-0"},{"key":"e_1_2_11_5_1","unstructured":"Appeadu M. K. andB.Bordoni.2025.\u201cFalls and Fall Prevention in Older Adults. StatPearls. Treasure Island (FL) Ineligible Companies. 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