Sleep Disorders and Research Center, Henry Ford Hospital, Detroit, MI 48202, USA.
J Psychopharmacol. 2012 Aug;26(8):1088-95. doi: 10.1177/0269881111424455. Epub 2011 Oct 16.
Rebound insomnia, worsened sleep when discontinuing use of a hypnotic, is reported in some short-term studies. No study has prospectively assessed, using patient reports or nocturnal polysomnography (NPSG), the likelihood of rebound insomnia with chronic hypnotic use. The objectives of this study was to assess in primary insomniacs the likelihood of experiencing rebound insomnia and a withdrawal syndrome on repeated placebo substitutions over 12 months of nightly zolpidem use. A group of 33 primary insomniacs, without psychiatric disorders or drug and alcohol abuse, 32-65 years old, 15 men and 18 women, were randomized to take zolpidem 10 mg (n = 17) or placebo (n = 16) nightly for 12 months. In probes during months 1, 4, and 12, placebo was substituted for 7 consecutive nights in both the zolpidem and placebo groups. NPSGs were collected and Tyrer Bezodiazepine Withdrawal Symptom Questionnaires were completed on the first two discontinuation nights. Rebound insomnia was not observed on the first two and the seventh discontinuation nights and its likelihood did not increase over the 12 months of nightly zolpidem use. Some individuals did show rebound insomnia, approximately 30-40% of participants, but the percentage of 'rebounders' did not differ between the placebo and zolpidem groups and did not increase across 12 months. No clinically significant withdrawal symptoms on the Tyrer were observed on the discontinuation nights over the 12 months of nightly use. Chronic nightly hypnotic use at therapeutic doses by primary insomniacs does not lead to rebound insomnia or withdrawal symptoms.
在一些短期研究中报告了反弹性失眠，即停止使用催眠药后睡眠恶化。没有研究前瞻性地评估慢性使用催眠药时反弹性失眠的可能性，使用患者报告或夜间多导睡眠图（NPSG）。本研究的目的是评估原发性失眠患者在 12 个月的每晚唑吡坦使用过程中反复替代安慰剂时经历反弹性失眠和戒断综合征的可能性。一组 33 名原发性失眠患者，无精神障碍或药物和酒精滥用，年龄 32-65 岁，男性 15 名，女性 18 名，随机分为每晚服用唑吡坦 10mg（n = 17）或安慰剂（n = 16），共 12 个月。在第 1、4 和 12 个月的探针期间，唑吡坦和安慰剂组均连续 7 晚替代安慰剂。收集夜间多导睡眠图并在头两个停药夜间完成 Tyrer 苯二氮䓬戒断症状问卷。在头两个和第七个停药夜间未观察到反弹性失眠，并且随着每晚唑吡坦使用 12 个月，其可能性并未增加。大约 30-40％的参与者确实出现了反弹性失眠，但安慰剂和唑吡坦组之间的“反弹者”百分比没有差异，并且在 12 个月内没有增加。在每晚使用 12 个月的过程中，在停药夜间未观察到 Tyrer 上的任何临床显著戒断症状。原发性失眠患者每晚使用治疗剂量的慢性催眠药不会导致反弹性失眠或戒断症状。
