{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T05:00:00Z","timestamp":1790312400637,"version":"4.1.0"},"reference-count":33,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T00:00:00Z","timestamp":1790294400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Sleep"],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>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 \u226550% reduction in the exploratory operational medication-burden score, transition from combination therapy to monotherapy, or complete discontinuation maintained for \u22652 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>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\u201338.3; crude RR, 2.67; 95% CI, 1.48\u20134.79). The core robust Poisson model yielded an adjusted RR of 2.43 (95% CI, 1.32\u20134.46), 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\u201332.3). The association was primarily driven by \u226550% operational-burden reduction (33.8% vs. 11.2%; adjusted RR, 2.77; 95% CI, 1.34\u20135.75). Transition to monotherapy and complete discontinuation were numerically more frequent but imprecisely estimated. Class-specific analyses supported an association with \u226550% 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/frsle.2026.1923070","type":"journal-article","created":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T04:27:13Z","timestamp":1790310433000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Association of a stellate ganglion block-based care pathway with hypnotic medication reduction in chronic insomnia with anxiety symptoms: a real-world retrospective cohort study"],"prefix":"10.3389","volume":"5","author":[{"given":"Dongze","family":"Wang","sequence":"first","affiliation":[{"name":"Department of Neurology, The First Hospital of Hebei Medical University","place":["Shijiazhuang, Hebei, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaohan","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Neurology, The First Hospital of Hebei Medical University","place":["Shijiazhuang, Hebei, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wenyuan","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Neurology, The First Hospital of Hebei Medical University","place":["Shijiazhuang, Hebei, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yanyong","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Neurology, The First Hospital of Hebei Medical University","place":["Shijiazhuang, Hebei, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,9,25]]},"reference":[{"key":"B1","year":"2025","journal-title":"Joint Clinical Practice Guideline on Benzodiazepine Tapering"},{"key":"B2","doi-asserted-by":"publisher","first-page":"399","DOI":"10.1080\/00273171.2011.568786","article-title":"An introduction to propensity score methods for reducing the effects of confounding in observational studies","volume":"46","author":"Austin","year":"2011","journal-title":"Multivariate Behav. Res."},{"key":"B3","doi-asserted-by":"publisher","first-page":"10","DOI":"10.1016\/j.jad.2011.01.011","article-title":"Insomnia as a predictor of depression: a meta-analytic evaluation of longitudinal epidemiological studies","volume":"135","author":"Baglioni","year":"2011","journal-title":"J. Affect. Disord."},{"key":"B4","doi-asserted-by":"publisher","first-page":"1149","DOI":"10.1093\/aje\/kwj149","article-title":"Variable selection for propensity score models","volume":"163","author":"Brookhart","year":"2006","journal-title":"Am. J. Epidemiol."},{"key":"B5","volume-title":"N05CF Benzodiazepine-Related Drugs","year":"2026"},{"key":"B6","doi-asserted-by":"publisher","first-page":"2409","DOI":"10.1002\/sim.1047","article-title":"Solution to the problem of separation in logistic regression","volume":"21","author":"Heinze","year":"2002","journal-title":"Stat. Med."},{"key":"B7","doi-asserted-by":"publisher","first-page":"1389","DOI":"10.1016\/j.ncl.2012.08.018","article-title":"Psychiatric disorders and sleep","volume":"30","author":"Krystal","year":"2012","journal-title":"Neurol. Clin."},{"key":"B8","doi-asserted-by":"publisher","first-page":"2086","DOI":"10.1111\/j.1360-0443.2011.03563.x","article-title":"Benzodiazepines revisited\u2013will we ever learn?","volume":"106","author":"Lader","year":"2011","journal-title":"Addiction"},{"key":"B9","doi-asserted-by":"publisher","first-page":"1179","DOI":"10.1378\/chest.14-1617","article-title":"The pathophysiology of insomnia","volume":"147","author":"Levenson","year":"2015","journal-title":"Chest"},{"key":"B10","doi-asserted-by":"publisher","first-page":"390","DOI":"10.1080\/01621459.2016.1260466","article-title":"Balancing covariates via propensity score weighting","volume":"113","author":"Li","year":"2018","journal-title":"J. Am. Stat. Assoc."},{"key":"B11","doi-asserted-by":"publisher","first-page":"2131","DOI":"10.2147\/NSS.S551748","article-title":"Ultrasound-guided stellate ganglion block with cervicotemporal myofascial trigger point acupuncture for insomnia with comorbid anxiety and depression: a retrospective observational study","volume":"17","author":"Li","year":"2025","journal-title":"Nat. Sci. Sleep"},{"key":"B12","doi-asserted-by":"publisher","first-page":"1554841","DOI":"10.3389\/fneur.2025.1554841","article-title":"Efficacy and exploratory analysis of potential mechanisms of stellate ganglion block in alleviating sleep disturbance in generalized anxiety disorder: a randomized controlled trial excluding comorbid depression","volume":"16","author":"Liu","year":"2025","journal-title":"Front. Neurol"},{"key":"B13","doi-asserted-by":"publisher","first-page":"332","DOI":"10.1176\/appi.ajp.161.2.332","article-title":"Randomized clinical trial of supervised tapering and cognitive behavior therapy to facilitate benzodiazepine discontinuation in older adults with chronic insomnia","volume":"161","author":"Morin","year":"2004","journal-title":"Am. J. Psychiatry"},{"key":"B14","doi-asserted-by":"publisher","first-page":"1129","DOI":"10.1016\/S0140-6736(11)60750-2","article-title":"Chronic insomnia","volume":"379","author":"Morin","year":"2012","journal-title":"Lancet"},{"key":"B15","doi-asserted-by":"publisher","first-page":"188","DOI":"10.3390\/brainsci15020188","article-title":"Three-month durability of bilateral two-level stellate ganglion blocks in patients with generalized anxiety disorder: a retrospective analysis","volume":"15","author":"Mulvaney","year":"2025","journal-title":"Brain Sci."},{"key":"B16","doi-asserted-by":"publisher","first-page":"424","DOI":"10.1007\/s11916-014-0424-5","article-title":"Ultrasound-guided stellate ganglion block: safety and efficacy","volume":"18","author":"Narouze","year":"2014","journal-title":"Curr. Pain Headache Rep."},{"key":"B17","first-page":"339","article-title":"Deprescribing benzodiazepine receptor agonists: evidence-based clinical practice guideline","volume":"64","author":"Pottie","year":"2018","journal-title":"Can. Fam. Physician"},{"key":"B18","doi-asserted-by":"publisher","first-page":"125","DOI":"10.7326\/M15-2175","article-title":"Management of chronic insomnia disorder in adults: a clinical practice guideline from the American College of Physicians","volume":"165","author":"Qaseem","year":"2016","journal-title":"Ann. Intern. Med."},{"key":"B19","doi-asserted-by":"publisher","first-page":"130","DOI":"10.1001\/jamapsychiatry.2019.3474","article-title":"Effect of stellate ganglion block treatment on posttraumatic stress disorder symptoms: a randomized clinical trial","volume":"77","author":"Rae Olmsted","year":"2020","journal-title":"JAMA Psychiatry"},{"key":"B20","doi-asserted-by":"publisher","first-page":"4831","DOI":"10.2147\/CMAR.S173511","article-title":"Comparison of the effects of stellate ganglion block and paroxetine on hot flashes and sleep disturbance in breast cancer survivors","volume":"10","author":"Rahimzadeh","year":"2018","journal-title":"Cancer Manag. Res."},{"key":"B21","doi-asserted-by":"publisher","first-page":"675","DOI":"10.1111\/jsr.12594","article-title":"European guideline for the diagnosis and treatment of insomnia","volume":"26","author":"Riemann","year":"2017","journal-title":"J. Sleep Res."},{"key":"B22","doi-asserted-by":"publisher","first-page":"307","DOI":"10.5664\/jcsm.6470","article-title":"Clinical practice guideline for the pharmacologic treatment of chronic insomnia in adults: an American Academy of Sleep Medicine clinical practice guideline","volume":"13","author":"Sateia","year":"2017","journal-title":"J. Clin. Sleep Med."},{"key":"B23","article-title":"Oral Benzodiazepines and Choosing Equivalent Doses","year":"2026"},{"key":"B24","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1214\/09-STS313","article-title":"Matching methods for causal inference: a review and a look forward","volume":"25","author":"Stuart","year":"2010","journal-title":"Stat. Sci."},{"key":"B25","doi-asserted-by":"publisher","first-page":"890","DOI":"10.1001\/jamainternmed.2014.949","article-title":"Reduction of inappropriate benzodiazepine prescriptions among older adults through direct patient education: the EMPOWER cluster randomized trial","volume":"174","author":"Tannenbaum","year":"2014","journal-title":"JAMA Intern. Med."},{"key":"B26","doi-asserted-by":"publisher","first-page":"1457","DOI":"10.1093\/sleep\/28.11.1457","article-title":"Epidemiology of insomnia, depression, and anxiety","volume":"28","author":"Taylor","year":"2005","journal-title":"Sleep"},{"key":"B27","doi-asserted-by":"publisher","first-page":"3787","DOI":"10.1210\/jcem.86.8.7778","article-title":"Chronic insomnia is associated with nyctohemeral activation of the hypothalamic-pituitary-adrenal axis: clinical implications","volume":"86","author":"Vgontzas","year":"2001","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"B28","doi-asserted-by":"publisher","first-page":"e296","DOI":"10.1371\/journal.pmed.0040296","article-title":"The strengthening the reporting of observational studies in Epidemiology statement: guidelines for reporting observational studies","volume":"4","author":"von Elm","year":"2007","journal-title":"PLoS Med."},{"key":"B29","doi-asserted-by":"publisher","first-page":"240","DOI":"10.1186\/s12883-026-04781-0","article-title":"Effect of high-frequency stellate ganglion block on sleep and affective symptoms in insomnia disorder: a prospective pilot study","volume":"26","author":"Wang","year":"2026","journal-title":"BMC Neurol."},{"key":"B30","volume-title":"Defined Daily Dose (DDD): ATC\/DDD Toolkit","year":"2026"},{"key":"B31","doi-asserted-by":"publisher","first-page":"1753003","DOI":"10.3389\/fpsyt.2026.1753003","article-title":"A novel application of stellate ganglion block to improve sleep: a systematic review and meta-analysis","volume":"17","author":"Wu","year":"2026","journal-title":"Front. Psychiatry"},{"key":"B32","doi-asserted-by":"publisher","first-page":"491","DOI":"10.1007\/s40122-022-00473-y","article-title":"Stellate ganglion block improves postoperative sleep quality and analgesia in patients with breast cancer: a randomized controlled trial","volume":"12","author":"Yang","year":"2023","journal-title":"Pain Ther"},{"key":"B33","doi-asserted-by":"publisher","first-page":"702","DOI":"10.1093\/aje\/kwh090","article-title":"Modified Poisson regression approach to prospective studies with binary data","volume":"159","author":"Zou","year":"2004","journal-title":"Am. J. Epidemiol."}],"container-title":["Frontiers in Sleep"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/frsle.2026.1923070\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T04:27:14Z","timestamp":1790310434000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/frsle.2026.1923070\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,25]]},"references-count":33,"alternative-id":["10.3389\/frsle.2026.1923070"],"URL":"https:\/\/doi.org\/10.3389\/frsle.2026.1923070","relation":{},"ISSN":["2813-2890"],"issn-type":[{"value":"2813-2890","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,25]]},"article-number":"1923070"}}