Effects of Zolpidem CR on Sleep and Nocturnal Ventilation in Patients with Heart Failure

Gatti, Rodrigo C; Burke, Patrick Rademaker; Otuyama, Leonardo Jun; Almeida, Dirceu Rodrigues; Tufik, Sérgio; Poyares, Dalva

doi:10.5665/sleep.6006

Cited by 15 publications

(17 citation statements)

References 32 publications

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“…Other studies raised concern that z-drugs may decrease blood oxygen concentration through a decrease in respiratory drive (Carter et al 2016) or via lenghtening in respiratory event duration (Edwards et al 2016). Indeed, high doses of zolpidem can worsen oxygen saturation in unselected patients with OSA (Cirignotta et al 1988) or in those with heart failure (Gatti et al 2016). Conversly, overnight oxygenation was not different in the current study between conditions and there was no alteration of systemic blood pressure on drug.…”

Section: Effects Of Zolpidem On Next-day Perceived Sleepiness Objectmentioning

confidence: 46%

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Zolpidem increases sleep efficiency and the respiratory arousal threshold without changing sleep apnoea severity and pharyngeal muscle activity

Messineo

Eckert

Lim

et al. 2020

The Journal of Physiology

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A decreased respiratory arousal threshold is one of the main contributors to obstructive sleep apnoea (OSA) pathogenesis. r Several recent studies have sought to find a drug capable of increasing the respiratory arousal threshold without impairing pharyngeal muscle activity to reduce OSA severity, with variable success. r Here we show that zolpidem increases the respiratory arousal threshold by ß15%, an effect size which was insufficient to systematically decrease OSA severity as measured by the apnoea-hypopnoea index. r Unlike recent physiological findings that showed paradoxical increases in pharyngeal muscle responsiveness during transient manipulations of airway pressure, zolpidem did not alter pharyngeal muscle responsiveness during natural sleep. It did, however, increase sleep efficiency without changing apnoea length, oxygen desaturation, next-day perceived sleepiness and alertness. r These novel findings indicate that zolpidem was well tolerated and effective in promoting sleep in people with OSA, which may be therapeutically useful for people with OSA and comorbid insomnia.

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Section: Effects Of Zolpidem On Next-day Perceived Sleepiness Objectmentioning

confidence: 46%

“…1988) or in those with heart failure (Gatti et al . 2016). Conversly, overnight oxygenation was not different in the current study between conditions and there was no alteration of systemic blood pressure on drug.…”

Section: Discussionmentioning

confidence: 99%

Zolpidem increases sleep efficiency and the respiratory arousal threshold without changing sleep apnoea severity and pharyngeal muscle activity

Messineo

Eckert

Lim

et al. 2020

The Journal of Physiology

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“…Based on the criteria described above 17 studies were included in this meta-analysis. [89101112131415161718192021222324] These represented a cumulative sample size of 2099 patients. The results are representative of global AHI outcomes providing data for patients exposed to different varieties and dosages of NBSH medications.…”

Section: Resultsmentioning

confidence: 99%

“…We present a robust review comprised of 17 studies conducted over the last 30 years including a total of 2099 patients to comprehensively assess the effects of NBSH on the existing AHI in patients with and without prior diagnosis of sleep-disordered breathing. [89101112131415161718192021222324]…”

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confidence: 99%

The effect of nonbenzodiazepines sedative hypnotics on apnea–hypopnea index: A meta-analysis

Nigam

Camacho

Riaz³

2019

Ann Thorac Med

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INTRODUCTION:Nonbenzodiazepine (non-BZD) sedative hypnotics (NBSH) refer to non-BZD sedatives that act as BZD receptor agonists such as zolpidem, zaleplon, and eszopiclone. Today, there is a high prevalence of insomnia with or without concurrent obstructive sleep apnea (OSA). Our goal was to study how NBSH use impacts the baseline apnea–hypopnea index (AHI) in patients with or without OSA.METHODS:PubMed/MEDLINE, Scopus, Web of Science and Cochrane Library databases were searched.RESULTS:Seventeen studies comprising a cumulative total of 2099 patients were identified in the last 30 years (between 1988 and 2017) that evaluated the effect of NBSH on respiratory parameters during sleep. The AHI mean (M) ± standard deviation (SD) in NBSH group was 13.17 ± 16.27 versus 15.94 ± 19.31 (mean difference [MD]-95% confidence interval [CI], 2.77 [1.463–4.076]). Six studies (100 patients) compared zolpidem with either placebo or no medication and demonstrated an AHI MD of −0.61 events/h (95% CI − 1.94, 0.71), overall effect Z = 0.9, P = 0.36. Four studies (362 patients) compared eszopiclone with placebo and demonstrated an AHI MD of −5.73 events/h0 (95% CI − 8.90, −0.2.57). Two large studies (979 patients) compared both zolpidem and eszopiclone to no medication and found AHI MD of −1.66 events/h (95% CI − 5.87, 0.2.55).CONCLUSIONS:The majority of patients using NBSH did not develop any worsening of existing AHI, when using NBSH, regardless of their baseline AHI values (mild, moderate, severe, or no OSA). On average, the AHI improved minimally with NBSH and eszopiclone showed the largest difference in AHI with an MD of −5.73 events/h.

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“…At present, they have been replaced by short and medium half-life benzodiazepines and benzodiazepine receptor agonists. However, these prescription drugs are not entirely free from complications and side effects related to tolerance and dependence [33][34][35][36]. Cognitive behavioral therapies that have longer-term positive effects and without the side effects of drugs are also recommended [37].…”

Section: Discussionmentioning

confidence: 99%

Sleep Quality in Patients with Heart Failure in the Spanish Population: A Cross-Sectional Study

Jorge-Samitier

Durante

Gea-Caballero

et al. 2020

IJERPH

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Background: Heart failure is a major problem in western societies. Sleep Disorders maintain a bidirectional relationship with heart failure, as shown by studies conducted in other countries. This study aims to describe the quality of sleep in Spanish patients with heart failure. Materials and methods: We carried out a cross-sectional study to analyze the quality of sleep in a sample of 203 patients with a diagnosis of heart failure admitted to an Internal Medicine Service. The Pittsburg Sleep Quality Index (PSQI) was used to evaluate sleep quality in our sample over a one-month period. Results: 75% of the sample presented sleep disorders. The most common problems included the interruption of sleep (73.5% nocturia and 30% breathing difficulties); 35% had poor sleep efficiency; 33% showed a decrease in daytime performance; 84% had used hypnotics at some point to induce sleep and 35% used them regularly. Conclusions: This is the first study to report on the perceived sleep quality of patients with heart failure in Spain. Self-perception of sleep quality differed from that estimated by the PSQI. The prevalence of the use of sleep-inducing medication was very high. The diurnal dysfunction generated by sleep disorders in a heart failure environment can contribute to the development of self-care and cognitive deterioration problems.

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Effects of Zolpidem CR on Sleep and Nocturnal Ventilation in Patients with Heart Failure

Abstract: Zolpidem CR improved sleep structure in patients with heart failure, did not change apnea hypopnea index, but slightly decreased lowest oxygen saturation.

Cited by 15 publications

References 32 publications

Zolpidem increases sleep efficiency and the respiratory arousal threshold without changing sleep apnoea severity and pharyngeal muscle activity

Zolpidem increases sleep efficiency and the respiratory arousal threshold without changing sleep apnoea severity and pharyngeal muscle activity

The effect of nonbenzodiazepines sedative hypnotics on apnea–hypopnea index: A meta-analysis

Sleep Quality in Patients with Heart Failure in the Spanish Population: A Cross-Sectional Study

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