A Randomized Trial of Temazepam versus Acetazolamide in High Altitude Sleep Disturbance

Abstract

. A randomized trial of temazepam versus acetazolamide in high-altitude sleep disturbance. High Alt Med Biol 14: [234][235][236][237][238][239] 2013.-This study is the first comparative trial of sleep medications at high altitude. We performed a randomized, double-blind trial of temazepam and acetazolamide at an altitude of 3540 meters. 34 healthy trekkers with self-reports of highaltitude sleep disturbance were randomized to temazepam 7.5 mg or acetazolamide 125 mg taken at bedtime for one night. The primary outcome was sleep quality on a 100 mm visual analog scale. Additional measurements were obtained with actigraphy; pulse oximetry; and questionnaire evaluation of sleep, daytime drowsiness, daytime sleepiness, and acute mountain sickness. Sixteen subjects were randomized to temazepam and 18 to acetazolamide. Sleep quality on the 100 mm visual analog scale was higher for temazepam (59.6, SD 20.1) than acetazolamide (46.2, SD 20.2; p = 0.048). Temazepam also demonstrated higher subjective sleep quality on the Groningen Sleep Quality Scale (3.5 vs. 6.8, p = 0.009) and sleep depth visual analog scale (60.3 vs. 41.4, p = 0.028). The acetazolamide group reported significantly more awakenings to urinate (1.8 vs. 0.5, p = 0.007). No difference was found with regards to mean nocturnal oxygen saturation (84.1 vs. 84.4, p = 0.57), proportion of the night spent in periodic breathing, relative desaturations, sleep onset latency, awakenings, wake after sleep onset, sleep efficiency, Stanford Sleepiness Scale scores, daytime drowsiness, or change in self-reported Lake Louise Acute Mountain Sickness scores. We conclude that, at current recommended dosing, treatment of high-altitude sleep disturbance with temazepam is associated with increased subjective sleep quality compared to acetazolamide.

Going to Altitude with a Preexisting Psychiatric Condition

“…Several factors can negatively influence a preexisting mood disorder at HA: (1) Disturbances in the sleep–wake cycle at HA (Tanner et al, 2013) can precipitate mood changes and acute episodes of a mood disorder (Perlman et al, 2006) more so in women than men (Saunders et al, 2015). On the contrary, sleep disturbance can be a prodromal symptom of bipolar and possibly also unipolar episodes (Jackson et al, 2003).…”

Losartan may attenuate altitude-related sleep disturbance

“…One possibility is that the scores were near maximal for most participants on night 3, with a mean score of 9.9 (SD 1.7) out of 14. This was significantly higher than other studies using the GSQS as an outcome, potentially creating an artificial ceiling which failed to reflect between-group variability 22 25. Second is the fact that disagreement between objective and subjective markers is a common phenomenon in sleep research 33.…”

“…The main finding of the study was that angiotensin II blockade appears to reduce the impact of high-altitude exposure on sleep physiology, as measured using actigraphy-derived sleep efficiency scoring. The finding of a decline in objective measures of sleep performance after an increase in sleeping altitude is common in the literature, but this was only replicated in the placebo group 4 7 25. The group taking daily 100 mg losartan capsules did not experience the sharp drop seen in sleep efficiency experienced by the placebo group after the increase in altitude on night 3, nor was there any relationship between sleep efficiency and altitude changes overall.…”

Comparing the Effects of Melatonin and Zolpidem on Sleep Quality, Depression, and Anxiety in Patients With Colorectal Cancer Undergoing Chemotherapy

“…The participants were asked to write their demographic information, including name, age, gender, marital status, race, education, access number, disease, type of cancer treatment in the beginning. The translated (Farsi) Groningen Sleep Quality Scale (GSQS), Pittsburgh sleep quality index (PSQI), Hamilton Rating Scale for Depression (HRSD), and Hamilton Anxiety Rating Scale (HARS) were used according to previously published paper (Jafarian, Gorouhi, Taghva, & Lotfi, 2008;Mousavi Malek, Zakerimoghadam, Esmaeili, & Kazemnejad, 2018;Tanner et al, 2013). To assess the appropriation of translated entries, a consultation was done with a bilingual neurologist and psychiatrist, who confirmed the validity of the translated questionnaires.…”