Vermeeren Annemiek
Experimental Psychopharmacology Unit, Brain & Behaviour Institute, Faculty of Psychology, Maastricht University, Universiteitssingel 40, PO Box 616, ER 6229 Maastricht, The Netherlands.
CNS Drugs. 2004;18(5):297-328. doi: 10.2165/00023210-200418050-00003.
The risk of "hangover" effects, e.g. residual daytime sleepiness and impairment of psychomotor and cognitive functioning the day after bedtime administration, is one of the main problems associated with the use of hypnotics. However, the severity and duration of these effects varies considerably between hypnotics and is strongly dependent on the dose administered. This article reviews epidemiological evidence on the effect of hypnotics on patients' risk for accidents such as traffic accidents, falls and hip fractures (i.e. end-points for residual effects). Information on the duration and severity of residual effects of 11 hypnotics (flunitrazepam, flurazepam, loprazolam, lormetazepam, midazolam, nitrazepam, temazepam, triazolam, zaleplon, zolpidem and zopiclone) was derived from expert ratings, a meta-analysis and actual driving studies. Epidemiological studies show that the risks of an accident increase with increasing half-life of the hypnotic, but that the use of hypnotics with a short half-life, such as triazolam, zopiclone and zolpidem, can also be associated with increased risks. A summary of results from experimental studies should enable prescribing clinicians to compare residual effects of the various hypnotics at different doses and select the one considered most favourable in this respect for the individual patient. This information should also enable them to inform patients more adequately about the likelihood and duration of residual effects of a specific hypnotic dose.
“宿醉”效应的风险，例如睡前服药后次日白天残留的嗜睡感以及精神运动和认知功能受损，是与使用催眠药相关的主要问题之一。然而，这些效应的严重程度和持续时间在不同催眠药之间差异很大，并且强烈依赖于给药剂量。本文综述了关于催眠药对患者发生交通事故、跌倒和髋部骨折等事故风险（即残留效应的终点）影响的流行病学证据。关于11种催眠药（氟硝西泮、氟西泮、氯普唑仑、氯美扎酮、咪达唑仑、硝西泮、替马西泮、三唑仑、扎来普隆、唑吡坦和佐匹克隆）残留效应的持续时间和严重程度的信息来自专家评级、荟萃分析和实际驾驶研究。流行病学研究表明，事故风险随着催眠药半衰期的增加而增加，但使用半衰期短的催眠药，如三唑仑、佐匹克隆和唑吡坦，也可能与风险增加有关。实验研究结果的总结应使开处方的临床医生能够比较不同剂量下各种催眠药的残留效应，并为个体患者选择在这方面被认为最有利的药物。这些信息还应使他们能够更充分地告知患者特定催眠药剂量残留效应的可能性和持续时间。
