Effect of zolpidem during sleep on ventilation and cardiovascular variables in normal subjects

Abstract

A double-blind study comparing the effect of zolpidem 10 mg, and placebo, on sleep architecture, nocturnal ventilation, cardiovascular parameters (heart rate, systolic, diastolic and mean blood pressures) was carried out. Ten healthy middle-aged males took part in the study. No significant differences were found between zolpidem and placebo in relation to sleep architecture. Mean respiratory disturbance index (RDI) and SaO2 values (mean SaO2, time spent with SaO2 < 90%) were similar under both conditions. The diastolic and mean blood pressure readings taken from REM periods which occurred during the first third of the night were significantly higher with zolpidem. No changes in systolic blood pressure or heart rate were found with zolpidem in comparison to placebo.

Zolpidem reduces the blood oxygen level-dependent signal during visual system stimulation

“…In addition, previous work has shown that during early sleep there is an increase in CBF in visual association cortices (Kjaer et al, 2002) and an increase in the occipital cortex with zolpidem specifically (Finelli et al, 2000), both of which are contrary to the present results. Furthermore, in agreement with other studies demonstrating that zolpidem has little to no effect on blood pressure, heart rate, or respiration (Evans et al, 1990; Licata et al, 2008; McCann et al, 1993), physiological activity (heart rate and oxygen saturation) did not change with any dose of zolpidem relative to placebo. Thus respiration was unchanged, further suggesting that sleep did not occur.…”

Sleep-related vagotonic effect of zolpidem in rats

“…Not only zolpidem but also other hypnotics with possible effects on sleep-related autonomic functions have rarely been evaluated. Some studies indicated that zolpidem had little effect on heart rate and blood pressure in healthy rats (Mailliet et al 2001) and humans (Mccann et al 1993). The present study, however, revealed that a large dose (30 mg/kg) of zolpidem produced significant suppression of heart period and cardiac vagal activity.…”

“…Unlike traditional hypnotics, it causes only minor effects on sleep patterns and has fewer undesirable effects (Declerck et al 1992). As previously reported, zolpidem rarely caused adverse effects on the cardiovascular system, such as hypotension or tachycardia in animals, healthy humans, and even hemodynamically compromised subjects such as the elderly and astronauts (Mccann et al 1993;Ganzoni et al 1995;Mailliet et al 2001;Shi et al 2003). Reports on the effects of zolpidem on sleep-related autonomic functions, however, are still lacking.…”

Effect of melatonin on nocturnal blood pressure: meta-analysis of randomized controlled trials

“…Thus, benzodiazepine and benzodiazepine-like hypnotics that treat insomnia effectively do not improve hypertension. In fact, zolpidem, which is the most widely prescribed hypnotic drug, does not lower and may even increase nocturnal blood pressure 35,36. Furthermore, the effect of zolpidem on blood pressure is seen in the early morning hours, at the time when blood pressure elevation has been implicated as a risk for cardiovascular events 37…”