Polysomnographic Findings in a Cohort of Chronic Insomnia Patients with Benzodiazepine Abuse

Mazza, Marianna; Losurdo, Anna; Testani, Elisa; Marano, Giuseppe; Nicola, Marco Di; Dittoni, Serena; Gnoni, Valentina; Blasi, Chiara Di; Giannantoni, Nadia Mariagrazia; Lapenta, Leonardo; Brunetti, Valerio; Bria, Pietro; Janiri, Luigi; Mazza, Salvatore; Marca, Giacomo Della

doi:10.5664/jcsm.3354

Cited by 21 publications

(16 citation statements)

References 39 publications

(44 reference statements)

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“…Some studies [ 8 , 53 , 69 , 70 ], however, have failed to provide differences between insomniacs and controls over all these cardiovascular measures. In these studies, the cardiovascular differences are either not seen during all sleep stages or not confirmed for all studied parameters.…”

Section: Resultsmentioning

confidence: 99%

“…Using the traditional interpretations that an increase in HR and the LF/HF ratio are linked with increased sympathetic activity, seem to be in contradiction with the increase in RMSSD which is often linked to an increase in parasympathetic activity [ 8 ]. In another study by Mazza et al [ 70 ] sleep modifications induced by chronic benzodiazepine (BDZ) abuse in chronic insomniacs were evaluated. In this study, six insomnia patients affected by chronic BDZ abuse were compared to fifty five normal controls.…”

Section: Resultsmentioning

confidence: 99%

“…For example, in some studies [ 65 , 68 , 84 – 87 ], the patient group did not undergo screening for comorbid sleep disorders, and medical and psychiatric illnesses, such as apnea, narcolepsy, major depression, etc. In addition, some studies included patients who: i) occasionally took central nervous system-active medication [ 61 ]; ii) had chronic benzodiazepine abuse [ 70 ]; or iii) stopped medication 1-2 weeks before the study [ 69 ]. It is known that medication such as benzodiazepine and antidepressants influence cardiovascular activity [ 103 , 104 ].…”

Section: Discussionmentioning

confidence: 99%

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Measures of cardiovascular autonomic activity in insomnia disorder: A systematic review

et al. 2017

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BackgroundInsomnia disorder is a widespread sleep disorder with a prevalence of approximately 10%. Even though the link between insomnia and cardiovascular activity is not exactly clear, it is generally assumed that cardiovascular autonomic modifications could occur as a result of sleeplessness, or, alternatively, that autonomic alterations could be an expression of a hyper-arousal state. This review investigates whether cardiovascular measures are different between insomniacs and controls.MethodsElectronic databases were systematically searched, and 34 studies were identified. Heart rate variability features, the association of cardiac and EEG activity, physiologic complexity measures, and cardiovascular activity, assessed by measures such as pre-ejection time, blood pressure, and heart rate dynamics were studied. Given the heterogeneity of the studies, a narrative synthesis of the findings was performed.ResultsThis review study found overall differences in cardiovascular activity between insomniacs and controls in most of the observational studies (21/26), while the expression of cardiovascular regulation varied between the examined insomniac groups. All the studies that investigated the association of cardiac activity and EEG power reported an altered relation between autonomic activity and EEG parameters in insomniacs.ConclusionAutonomic regulation tends to be consistent between insomniacs, as long as they are grouped according to their respective phenotype, as shown in the insomnia subgroup with objectively short sleep duration. Our hypothesis is that these differences in the expression of cardiovascular activity could be explained by the heterogeneity of the disorder. Therefore, the determination of insomnia phenotypes, and the study of cardiovascular measures, rather than heart rate variability alone, will give more insight into the link between insomnia and cardiovascular regulation. This study suggests that cardiovascular activity differs between insomniacs and controls. These new findings are of interest to clinicians and researchers for a more accurate insomnia assessment, and the development of personalized technological solutions in insomnia.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Measures of cardiovascular autonomic activity in insomnia disorder: A systematic review

et al. 2017

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“… 65 , 66 However, chronic BDZ use in sleep-disordered patients is associated with a peculiar pattern of sleep modification involving all levels of sleep organization. 67 Poor subjective sleep quality, a marked increase in nocturnal awakenings, and gross disruption of the non-rapid/rapid eye movement sleep cycle have been reported. 67 …”

Section: Resultsmentioning

confidence: 99%

“… 67 Poor subjective sleep quality, a marked increase in nocturnal awakenings, and gross disruption of the non-rapid/rapid eye movement sleep cycle have been reported. 67 …”

Section: Resultsmentioning

confidence: 99%

Bridging the gap between education and appropriate use of benzodiazepines in psychiatric clinical practice

Dell’Osso¹,

Albert²,

Atti³

et al. 2015

NDT

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More than half a century after their discovery, benzodiazepines (BDZs) still represent one of the largest and most widely prescribed groups of psychotropic compounds, not only in clinical psychiatry but also in the entire medical field. Over the last two decades, however, there has been an increased focus on the development of antidepressants and antipsychotics on the part of the pharmaceutical industry, clinicians, and researchers, with a reduced interest in BDZs, in spite of their widespread clinical use. As a consequence, many psychiatric residents, medical students, nurses, and other mental health professionals might receive poor academic teaching and training regarding these agents, and have the false impression that BDZs represent an outdated chapter in clinical psychopharmacology. However, recent advances in the field, including findings concerning epidemiology, addiction risk, and drug interactions, as well as the introduction of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition with related diagnostic changes, strongly encourage an updated appraisal of the use of BDZs in clinical practice. During a recent thematic event convened with the aim of approaching this topic in a critical manner, a group of young Italian psychiatrists attempted to highlight possible flaws in current teaching pathways, identify the main clinical pros and cons regarding current use of BDZs in clinical practice, and provide an updated overview of their use across specific clinical areas and patient populations. The main results are presented and discussed in this review.

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Psychofarmaca en de behandeling van slaapstoornissen

Veen

Kamphuis

Lek

2020

Slaapstoornissen in De Psychiatrie

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Polysomnographic Findings in a Cohort of Chronic Insomnia Patients with Benzodiazepine Abuse

Cited by 21 publications

References 39 publications

Measures of cardiovascular autonomic activity in insomnia disorder: A systematic review

Measures of cardiovascular autonomic activity in insomnia disorder: A systematic review

Bridging the gap between education and appropriate use of benzodiazepines in psychiatric clinical practice

Psychofarmaca en de behandeling van slaapstoornissen

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