Zolpidem-induced amnesia and somnambulism: Rare occurrences?

Tsai, Jui‐Hsiu; Yang, Pinchen; Chen, Cheng‐Chung; Chung, Weilum; Tang, Tze-Chun; Wang, Shing-Yaw; Liu, Jong-Kang

doi:10.1016/j.euroneuro.2008.08.007

Cited by 46 publications

(27 citation statements)

References 20 publications

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“…Sleep apnoeas, in turn, may lead to motor vehicle crashes, hypertension, heart failure, arrhythmias, cardiovascular diseases and death 26. Hypnotics may cause somnambulistic night-eating syndromes resulting in poor diet and obesity27 as well as other automaton-like behaviours, which can be dangerous 28 29. Indeed, in controlled trials, participants randomised to hypnotics experience more adverse medical events overall than those randomised to placebo 21 30…”

Section: Discussionmentioning

confidence: 99%

Hypnotics' association with mortality or cancer: a matched cohort study

2012

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ObjectivesAn estimated 6%–10% of US adults took a hypnotic drug for poor sleep in 2010. This study extends previous reports associating hypnotics with excess mortality.SettingA large integrated health system in the USA.DesignLongitudinal electronic medical records were extracted for a one-to-two matched cohort survival analysis.SubjectsSubjects (mean age 54 years) were 10 529 patients who received hypnotic prescriptions and 23 676 matched controls with no hypnotic prescriptions, followed for an average of 2.5 years between January 2002 and January 2007.Main outcome measuresData were adjusted for age, gender, smoking, body mass index, ethnicity, marital status, alcohol use and prior cancer. Hazard ratios (HRs) for death were computed from Cox proportional hazards models controlled for risk factors and using up to 116 strata, which exactly matched cases and controls by 12 classes of comorbidity.ResultsAs predicted, patients prescribed any hypnotic had substantially elevated hazards of dying compared to those prescribed no hypnotics. For groups prescribed 0.4–18, 18–132 and >132 doses/year, HRs (95% CIs) were 3.60 (2.92 to 4.44), 4.43 (3.67 to 5.36) and 5.32 (4.50 to 6.30), respectively, demonstrating a dose–response association. HRs were elevated in separate analyses for several common hypnotics, including zolpidem, temazepam, eszopiclone, zaleplon, other benzodiazepines, barbiturates and sedative antihistamines. Hypnotic use in the upper third was associated with a significant elevation of incident cancer; HR=1.35 (95% CI 1.18 to 1.55). Results were robust within groups suffering each comorbidity, indicating that the death and cancer hazards associated with hypnotic drugs were not attributable to pre-existing disease.ConclusionsReceiving hypnotic prescriptions was associated with greater than threefold increased hazards of death even when prescribed <18 pills/year. This association held in separate analyses for several commonly used hypnotics and for newer shorter-acting drugs. Control of selective prescription of hypnotics for patients in poor health did not explain the observed excess mortality.

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Section: Discussionmentioning

confidence: 99%

Hypnotics' association with mortality or cancer: a matched cohort study

2012

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“…In comparison with the data of Hwang et al22 and Tsai et al,21 our investigation focused on adverse reactions to zolpidem and zopiclone in nonpsychotic Taiwanese patients. For zolpidem, our study included 1,132 patients, which was 4.4–9.1 times larger than samples in the previous two articles.…”

Section: Discussionmentioning

confidence: 97%

“…The incidence, mechanisms, and management of CSBs have been reported,20 especially for zolpidem-induced amnesia and somnambulism 21. The only unique risk predictor of zolpidem-related CSBs was a high dosage of zolpidem (.10 mg/day) 22.…”

Section: Discussionmentioning

confidence: 99%

A comparison of complex sleep behaviors with two short-acting Z-hypnosedative drugs in nonpsychotic patients

Chen

Lin

Chou

et al. 2013

NDT

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ObjectiveComplex sleep behaviors (CSBs) are classified as “parasomnias” in the International Classifcation of Sleep Disorders, Second Edition (ICSD-2). To realize the potential danger after taking two short-acting Z-hypnosedative drugs, we estimated the incidence of CSBs in nonpsychotic patients in Taiwan.MethodsSubjects (N = 1,220) using zolpidem or zopiclone were enrolled from the psychiatric outpatient clinics of a medical center in Taiwan over a 16-month period in 2006–2007. Subjects with zolpidem (N = 1,132) and subjects with zopiclone (N = 88) were analyzed. All subjects completed a questionnaire that included demographic data and complex sleep behaviors after taking hypnotics.ResultsAmong zolpidem and zopiclone users, 3.28% of patients reported incidents of somnambulism or amnesic sleep-related behavior problems. The incidence of CSBs with zolpidem and zopiclone were 3.27%, and 3.41%, respectively, which was signifcantly lower than other studies in Taiwan.ConclusionThese results serve as a reminder for clinicians to make inquiries regarding any unusual performance of parasomnic activities when prescribing zolpidem or zopiclone.

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“…It has been suggested that complex behavior risks increase with both dose and binding affinity at α1-GABAA receptors [16]. The dose used in zolpidem-induced amnestic somnambulism has been reported to be higher than in control insomnia [17]. Furthermore, zolpidem has the highest receptor-binding affinity among the non-benzodiazepine receptor agonists, which may explain its more frequent association with hypnosedative complex behavior [16].…”

Section: Discussionmentioning

confidence: 99%

Zolpidem-induced sleep-related eating disorder

Yun

2010

Journal of the Neurological Sciences

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Zolpidem-induced amnesia and somnambulism: Rare occurrences?

Cited by 46 publications

References 20 publications

Hypnotics' association with mortality or cancer: a matched cohort study

Hypnotics' association with mortality or cancer: a matched cohort study

A comparison of complex sleep behaviors with two short-acting Z-hypnosedative drugs in nonpsychotic patients

Zolpidem-induced sleep-related eating disorder

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