Supplementary file 1_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.docx

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.</p>Results<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, 11.7–38.3; 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.</p>Conclusion<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.</p>