Effects of Zolpidem and Zaleplon on Sleep, Respiratory Patterns and Performance at a Simulated Altitude of 4,000 m

Beaumont, Maurice; Batejat, D.; Coste, Olivier; Beers, Pascal Van; Colas, Anthony; Clère, Jean-Michel; Piérard, Christophe

doi:10.1159/000076723

Cited by 40 publications

(22 citation statements)

References 25 publications

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“…Both chamber and field studies have demonstrated improvements in sleep quality and sleep architecture, including increased slow-wave, stage 4 sleep and total sleep time, although the latter result was not consistent across studies (Beaumont et al, 1996;Beaumont et al, 2004;Beaumont et al, 2007). At present, there is no evidence that either agent decreases periodic breathing.…”

Section: Gamma Aminobutyric Acid (Gaba) Receptor Agentsmentioning

confidence: 84%

“…Aside from the studies comparing zolpidem and zaleplon, there have been no head-to-head comparisons of acetazolamide, temazepam and the non-benzodiazepine hypnotics. In the studies of zolpidem and zaleplon, there were small differences favoring zolpidem but it is unclear if these differences are of clinical significance (Beaumont et al, 2004;Beaumont et al, 2007). Comparison between existing studies is also limited by large methodological differences between the studies, including the altitudes at which the studies were conducted, differences in ascent profile and the duration of stay at altitude prior to the initiation of study protocols.…”

Section: Which Medication Is the Most Effective Sleep Aid At Altitude?mentioning

confidence: 99%

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Which Medications Are Safe and Effective for Improving Sleep at High Altitude?

Luks

2008

High Altitude Medicine & Biology

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Given the well-established problems with sleep at high altitude, it is not uncommon for people planning trips to the mountains to seek advice from clinicians regarding pharmacologic options for improving sleep during their trip. This review article considers the various medications that have been studied for this purpose at high altitude with an emphasis on both their efficacy and safety. The available data support the use of either acetazolamide, temazepam, zolpidem or zaleplon in this environment. Other agents commonly used at sea-level such as eszopiclone and diphenhydramine have not been studied at high altitude but are likely safe to use given their mechanism of action and known side effects. Limited evidence suggests diazepam may cause hypoventilation at high altitude and its use in this environment should be discouraged. Insufficient data exist to determine which agent is most effective at altitude nor do we know whether combination therapy with acetazolamide and a hypnotic agent offers any benefits over monotherapy.

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Section: Gamma Aminobutyric Acid (Gaba) Receptor Agentsmentioning

confidence: 84%

Section: Which Medication Is the Most Effective Sleep Aid At Altitude?mentioning

confidence: 99%

Which Medications Are Safe and Effective for Improving Sleep at High Altitude?

Luks

2008

High Altitude Medicine & Biology

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“…The efficacy and safety of zolpidem and zaleplon in treating sleep disturbances at high altitude had been confirmed by several well-designed clinic trials [57][58][59][60]. A recent meta-analysis of randomized placebo-controlled trials revealed that zaleplon and zolpidem improved the total sleep time, sleep efficiency, and stage 4 sleep duration, whereas they decreased the wake-after-sleep onset without impairing ventilation [61] (data are shown in Figure 6).…”

Section: Non-benzodiazepinesmentioning

confidence: 79%

Sleep Disorder at High Altitude

Kong¹

2021

Updates in Sleep Neurology and Obstructive Sleep Apnea

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In this chapter, we discuss the occurrence, mechanism, clinical manifestations, outcomes, and managements of a commonly encountered sleep disorder of someone traveling in high altitude for working and sightseeing. Humans ascending to altitudes above 2500 m usually suffer from substantial disturbances in sleep quality as difficulty in sleep onset, frequent awakenings, respiratory disturbance, and a feeling of drowsiness on the next day. Data obtained from polysomnographic studies demonstrated several variations of sleep architecture in those healthy subjects ascending to high altitude during sleep, including periodic breathing and decreased non-rapid eye movement deep sleep stage 3 and 4 (in new nomenclature N3), which were usually accompanied by and the lowered arterial O 2 and restricted ventilation. Hypoxia is most severe during sleep and in correspondence to periodic breathing and sleep disturbance at high altitude. Poor sleep quality impairs cognition and executive abilities at high altitude though it may largely be improved after full time of acclimatization. Evidence-based choices for clinicians to treat sleep disorder at high altitude are relatively scarce at present. Supplemental oxygen and dietary nitrate are effective in alleviating nocturnal hypoxia. There is strong evidence supporting the efficacy and safety of acetazolamide and nonbenzodiazepines in minimizing periodic breathing and improving sleep quality at high altitude.

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“…This negative change in sleep architecture results in a decreased physical and mental well-being, which can manifest as impaired cognitive functioning (May et al,1987;Kong et al, 2011) and poor daytime performance (Wickramasinghe et al, 1999). The alterations in sleep architecture may be due to a number of different sleep parameter changes including a shortened stage 3 + 4 of non-rapid eye movement (non-REM) sleep, decreased oxygen saturation, prolonged wake after sleep onset (WASO) (Beaumont et al,2004;2007), an increased number of awakenings, prolonged sleep onset latency (Panjwani et al,2007), and shortened time in rapid eye movement (REM) sleep (Przybylowski et al,2003).…”

Section: Introductionmentioning

confidence: 99%

Sleep Architecture in Partially Acclimatized Lowlanders and Native Tibetans at 3800 Meter Altitude: What Are the Differences?

Kong

Liu

et al. 2015

High Altitude Medicine & Biology

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It is not well known whether high altitude acclimatization could help lowlanders improve their sleep architecture as well as Native Tibetans. In order to address this, we investigated the structural differences in sleep between Native Tibetans and partially acclimatized lowlanders and examined the association between sleep architecture and subjective sleep quality. Partially acclimatized soldiers from lowlands and Native Tibetan soldiers stationed at Shangri-La (3800 m) were surveyed using the Pittsburgh Sleep Quality Index (PSQI), Hamilton Anxiety Scale (HAMA), and Hamilton Depression Rating Scale (HAMD). The sleep architecture of those without anxiety (as determined by HAMA>14) and/or depression (HAMD>20) was analyzed using polysomnography and the results were compared between the two groups. One hundred sixty-five male soldiers, including 55 Native Tibetans, were included in the study. After partial acclimatization, lowlanders still exhibited differences in sleep architecture as compared to Native Tibetans, as indicated by a higher PSQI score (8.14±2.37 vs. 3.90±2.85, p<0.001), shorter non-rapid eye movement (non-REM) sleep (458.68±112.63 vs. 501±37.82 min, P=0.03), lower nocturnal arterial oxygen saturation (Spo2; mean 91.39±1.24 vs. 92.71±2.12%, p=0.03), and increased times of Spo2 reduction from 89% to 85% (median 48 vs.17, p=0.04) than Native Tibetans. Sleep onset latency (β=0.08, 95%CI: 0.01 to 0.15), non-REM latency (β=0.011, 95%CI 0.001 to 0.02), mean Spo2 (β=-0.79, 95%CI: -1.35 to -0.23) and time in stage 3+4 sleep (β=-0.014, 95%CI: -0.001 to -0.028) were slightly associated with the PSQI score. Partially acclimatized lowlanders experienced less time in non-REM sleep and had lower arterial oxygen saturation than Native Tibetans at an altitude of 3800 m. The main independent contributors to poor sleep quality are hypoxemia, difficulty in sleep induction, and time in deep sleep.

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Effects of Zolpidem and Zaleplon on Sleep, Respiratory Patterns and Performance at a Simulated Altitude of 4,000 m

Cited by 40 publications

References 25 publications

Which Medications Are Safe and Effective for Improving Sleep at High Altitude?

Which Medications Are Safe and Effective for Improving Sleep at High Altitude?

Sleep Disorder at High Altitude

Sleep Architecture in Partially Acclimatized Lowlanders and Native Tibetans at 3800 Meter Altitude: What Are the Differences?

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