Effects of zolpidem on sleep architecture, night time ventilation, daytime vigilance and performance in heavy snorers.

Quera-Salva, Maria-Antonia; McCann, C C; J, Boudet; Frisk, Mio Kobayashi; Borderies, Pascal; Meyer, Peter

doi:10.1111/j.1365-2125.1994.tb04301.x

Cited by 34 publications

(17 citation statements)

References 32 publications

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“…Recent studies also suggest that increasing the threshold for arousal with certain hypnotics can stabilise breathing in OSA, especially for the ~30% of patients who have a low respiratory arousal threshold trait (Carberry et al., ; Carter et al., ; Eckert, Malhotra, Wellman, & White, ; Eckert & Younes, ; Eckert et al., ). Nonetheless, uncertainty regarding the effects of common hypnotics on OSA severity remains, with some studies showing reductions in apnea–hypopnea index (AHI) by ~25%–50% without worsening hypoxemia (Eckert et al., ; Edwards et al., ; Smales et al., ), while others show no change in AHI (Camacho & Morin, ; Carter et al., ; Eckert et al., ; Hoijer et al., ; Quera‐Salva et al., ) or, at high doses and in severe OSA, worse hypoxemia (Berry, Kouchi, Bower, Prosise, & Light, ; Cirignotta et al., ).…”

Section: Introductionmentioning

confidence: 99%

“…. Nonetheless, uncertainty regarding the effects of common hypnotics on OSA severity remains, with some studies showing reductions in apnea-hypopnea index (AHI) by ~25%-50% without worsening hypoxemia (Eckert et al, 2011;Edwards et al, 2016;Smales et al, 2015), while others show no change in AHI (Camacho & Morin, 1995;Carter et al, 2016;Hoijer et al, 1994;Quera-Salva et al, 1994) or, at high doses and in severe OSA, worse hypoxemia (Berry, Kouchi, Bower, Prosise, & Light, 1995;Cirignotta et al, 1988).…”

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The effects of zolpidem in obstructive sleep apnea – An open‐label pilot study

Carberry

Grunstein

Eckert

2019

Journal of Sleep Research

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New knowledge on hypnotics and their effects on the phenotypic causes of obstructive sleep apnea indicate that zolpidem has therapeutic potential for certain patients. Specifically, zolpidem increases the threshold for arousal threshold and pharyngeal dilator muscle responsiveness. However, the effects of a standard dose of zolpidem (10 mg) on obstructive sleep apnea severity and symptoms have not been investigated. In an open‐label pilot study, 12 unselected people with obstructive sleep apnea were recruited following a diagnostic in‐laboratory sleep study. Participants then returned for a single‐night sleep study in which 10 mg of zolpidem was given just prior to sleep. Tolerability, next‐day sleepiness and the effects of zolpidem on polysomnography variables were assessed. Zolpidem was well tolerated and significantly improved the sleep efficiency compared with the no‐drug night (77 ± 12% versus 84 ± 9%, p = 0.005). Individual responses on obstructive sleep apnea severity to zolpidem in this unselected obstructive sleep apnea patient population were variable with no overall systematic difference in apnea–hypopnea index (29 ± 18.2 events per hr versus 33 ± 28 events per hr, p = 0.45) or other key respiratory parameters (e.g. event duration or hypoxemia). Next‐day sleepiness assessed via the Karolinska Sleepiness Scale was not different between visits (4 ± 1 versus 4 ± 2, p = 0.85). These findings provide the first insight into the effects of a standard dose of zolpidem in obstructive sleep apnea, and highlight its tolerability and potential to improve sleep quality. The variable effects on obstructive sleep apnea severity observed in this pilot also underscore the need for larger trials that incorporate phenotypic characterisation (e.g. arousal threshold, Pcrit and muscle responsiveness) to understand inter‐individual heterogeneity and the therapeutic potential of zolpidem for certain people with obstructive sleep apnea.

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Section: Introductionmentioning

confidence: 99%

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confidence: 99%

The effects of zolpidem in obstructive sleep apnea – An open‐label pilot study

Carberry

Grunstein

Eckert

2019

Journal of Sleep Research

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“…High doses of certain hypnotics in people with severe OSA can worsen hypoxaemia [6,10,11]. However, other studies show either no change in hypoxaemia or the apnoea-hypopnoea index (AHI) [12][13][14]. Given that arousals from sleep can be deleterious for many OSA patients [9,15], certain hypnotics reduce the AHI [16,17], particularly in those who wake easily to airway narrowing (i.e.…”

Section: Introductionmentioning

confidence: 99%

Role of common hypnotics on the phenotypic causes of obstructive sleep apnoea: paradoxical effects of zolpidem

et al. 2017

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Hypnotics are contraindicated in obstructive sleep apnoea (OSA) because of concerns of pharyngeal muscle relaxation and delayed arousal worsening hypoxaemia. However, human data are lacking. This study aimed to determine the effects of three common hypnotics on the respiratory arousal threshold, genioglossus muscle responsiveness and upper airway collapsibility during sleep.21 individuals with and without OSA (18-65 years) completed 84 detailed sleep studies after receiving temazepam (10 mg), zolpidem (10 mg), zopiclone (7.5 mg) and placebo on four occasions in a randomised, double-blind, placebo-controlled, crossover trial (ACTRN12612001004853).The arousal threshold increased with zolpidem and zopiclone placebo (mean±sd -18.3±10 and -19.1±9 -14.6±7 cmHO; p=0.02 and p<0.001) but not with temazepam (-16.8±9 cmHO; p=0.17). Genioglossus muscle activity during stable non-REM sleep and responsiveness during airway narrowing was not different with temazepam and zopiclone placebo but, paradoxically, zolpidem increased median muscle responsiveness three-fold during airway narrowing (median -0.15 (interquartile range -1.01 to -0.04) -0.05 (-0.29 to -0.03)% maximum EMG per cmHO epiglottic pressure; p=0.03). The upper airway critical closing pressure did not change with any of the hypnotics.These doses of common hypnotics have differential effects on the respiratory arousal threshold but do not reduce upper airway muscle activity or alter airway collapsibility during sleep. Rather, muscle activity increases during airway narrowing with zolpidem.

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“…Zolpidem is a hypnotic agent without deleterious effects on sleep architecture, neither in normal subjects [15] nor in volunteers or patients with insomnia [16,17]. The agent does not affect ventilation and SaO 2 in patients with chronic obstructive pulmonary diseases [18,19].…”

Section: Introductionmentioning

confidence: 99%

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

Beaumont

Batejat²,

Coste³

et al. 2004

Neuropsychobiology

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The effects of zolpidem or zaleplon on sleep architecture, respiratory patterns and performance were assessed at a simulated altitude of 4,000 m. Twelve male healthy subjects spent 4 nights in a decompression chamber, 1 at sea level (baseline), 3 at 4,000 m to test zolpidem (10 mg), zaleplon (10 mg) and placebo, given 15 min before switching the lights off. Sleep and respiratory patterns were analysed using polysomnography. Cognitive and physical performance was examined the next morning at sea level conditions. The study demonstrates that both zolpidem and zaleplon improved slow wave sleep at altitude, with zolpidem showing more marked effects than zaleplon. Both agents did not adversely affect respiration at altitude during the night, or cognitive or physical performance the next morning at the dosages used in this study. Thus, climbers may safely use both hypnotic agents.

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Effects of zolpidem on sleep architecture, night time ventilation, daytime vigilance and performance in heavy snorers.

Abstract: 4 Zolpidem intake did not impair daytime vigilance and performance evaluated the day after.

Cited by 34 publications

References 32 publications

The effects of zolpidem in obstructive sleep apnea – An open‐label pilot study

The effects of zolpidem in obstructive sleep apnea – An open‐label pilot study

Role of common hypnotics on the phenotypic causes of obstructive sleep apnoea: paradoxical effects of zolpidem

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

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