Utrecht Institute for Pharmaceutical Sciences, Faculty of Science, Section Psychopharmacology, Utrecht University, P.O. Box 80082, 3508 TB Utrecht, The Netherlands.
Sleep Med Rev. 2010 Aug;14(4):259-67. doi: 10.1016/j.smrv.2009.10.008. Epub 2010 Feb 18.
Disturbed body balance and standing steadiness are problematic for those who wake up at night or in the morning after using hypnotic drugs. As a result, falls and hip fractures are frequently reported in patients using sleep medication.
A literature search was performed to identify double blind, placebo-controlled clinical trials that examined body balance and standing steadiness. Drugs that were searched were nitrazepam, triazolam, lorazepam, temazepam, loprazolam, flunitrazepam, flurazepam, and the Z-drugs zopiclone, zolpidem and zaleplon.
A total of 57 studies were eligible for inclusion. Results showed that both benzodiazepine hypnotics and the Z-drugs significantly impair body balance and standing steadiness after single dose administration. Impairments correlate significantly with blood plasma levels and are greatest at peak plasma concentrations, but are sometimes still present upon awakening. Balance problems were dose-related and most pronounced in elderly. Co-administration of alcohol aggravated the impairment. After repeated daily use of hypnotic drugs partial tolerance develops to the impairing effects on standing steadiness.
Single dose administration of benzodiazepine hypnotics and Z-drugs significantly impair body balance in a dose-dependent manner. Zolpidem and zopiclone produced similar significant impairment as benzodiazepine hypnotics. Zaleplon significantly impaired balance up to 2 h after intake. Partial tolerance develops after repeated daily use. In conclusion, patients should be warned about the possible risk of imbalance and falls due to the use of sleep medication.
服用催眠药物后夜间或清晨醒来的人，其身体平衡和站立稳定性会出现问题。因此，经常有使用睡眠药物的患者报告跌倒和髋部骨折。
进行了文献检索，以确定研究身体平衡和站立稳定性的双盲、安慰剂对照临床试验。检索的药物包括硝西泮、三唑仑、劳拉西泮、替马西泮、氯硝西泮、氟硝西泮、氟西泮和 Z 类药物佐匹克隆、唑吡坦和扎来普隆。
共有 57 项研究符合纳入标准。结果表明，苯二氮䓬类催眠药和 Z 类药物单次给药后均显著损害身体平衡和站立稳定性。损害与血浆水平显著相关，在血浆峰值浓度时最大，但有时在醒来时仍存在。平衡问题与剂量有关，在老年人中最为明显。同时饮酒会加重损害。重复每日使用催眠药物后，对站立稳定性的损害会产生部分耐受性。
苯二氮䓬类催眠药和 Z 类药物单次给药会以剂量依赖的方式显著损害身体平衡。唑吡坦和佐匹克隆产生的损害与苯二氮䓬类催眠药相似。扎来普隆在摄入后 2 小时内仍显著损害平衡。重复每日使用后会产生部分耐受性。总之，应警告患者使用睡眠药物可能导致平衡和跌倒的风险。
