Neuroscience Research Australia (NeuRA) and the University of New South Wales, Sydney, NSW, Australia.
Adelaide Institute for Sleep Health, Flinders University, Adelaide, SA, Australia.
J Sleep Res. 2019 Dec;28(6):e12853. doi: 10.1111/jsr.12853. Epub 2019 Apr 10.
New knowledge on hypnotics and their effects on the phenotypic causes of obstructive sleep apnea indicate that zolpidem has therapeutic potential for certain patients. Specifically, zolpidem increases the threshold for arousal threshold and pharyngeal dilator muscle responsiveness. However, the effects of a standard dose of zolpidem (10 mg) on obstructive sleep apnea severity and symptoms have not been investigated. In an open-label pilot study, 12 unselected people with obstructive sleep apnea were recruited following a diagnostic in-laboratory sleep study. Participants then returned for a single-night sleep study in which 10 mg of zolpidem was given just prior to sleep. Tolerability, next-day sleepiness and the effects of zolpidem on polysomnography variables were assessed. Zolpidem was well tolerated and significantly improved the sleep efficiency compared with the no-drug night (77 ± 12% versus 84 ± 9%, p = 0.005). Individual responses on obstructive sleep apnea severity to zolpidem in this unselected obstructive sleep apnea patient population were variable with no overall systematic difference in apnea-hypopnea index (29 ± 18.2 events per hr versus 33 ± 28 events per hr, p = 0.45) or other key respiratory parameters (e.g. event duration or hypoxemia). Next-day sleepiness assessed via the Karolinska Sleepiness Scale was not different between visits (4 ± 1 versus 4 ± 2, p = 0.85). These findings provide the first insight into the effects of a standard dose of zolpidem in obstructive sleep apnea, and highlight its tolerability and potential to improve sleep quality. The variable effects on obstructive sleep apnea severity observed in this pilot also underscore the need for larger trials that incorporate phenotypic characterisation (e.g. arousal threshold, Pcrit and muscle responsiveness) to understand inter-individual heterogeneity and the therapeutic potential of zolpidem for certain people with obstructive sleep apnea.
关于催眠药及其对阻塞性睡眠呼吸暂停表型病因影响的新知识表明，唑吡坦对某些患者具有治疗潜力。具体来说，唑吡坦增加了觉醒阈值和咽扩张肌反应性的阈值。然而，尚未研究标准剂量唑吡坦（10mg）对阻塞性睡眠呼吸暂停严重程度和症状的影响。在一项开放标签的试点研究中，在经过诊断性实验室睡眠研究后，招募了 12 名未经选择的阻塞性睡眠呼吸暂停患者。然后，参与者返回进行单晚睡眠研究，在该研究中，在睡前给予 10mg 唑吡坦。评估了耐受性、次日嗜睡和唑吡坦对多导睡眠图变量的影响。唑吡坦耐受性良好，与无药物夜间相比，睡眠效率显著提高（77±12%对 84±9%，p=0.005）。在这个未经选择的阻塞性睡眠呼吸暂停患者人群中，个体对唑吡坦治疗阻塞性睡眠呼吸暂停严重程度的反应各不相同，呼吸暂停-低通气指数（29±18.2 次/小时对 33±28 次/小时，p=0.45）或其他关键呼吸参数（例如，事件持续时间或低氧血症）无总体系统差异。通过 Karolinska 嗜睡量表评估的次日嗜睡在两次就诊时无差异（4±1 对 4±2，p=0.85）。这些发现首次提供了关于标准剂量唑吡坦在阻塞性睡眠呼吸暂停中的作用的见解，并强调了其耐受性和改善睡眠质量的潜力。在这项试点研究中观察到的阻塞性睡眠呼吸暂停严重程度的可变影响也突出了需要进行更大规模的试验，这些试验将纳入表型特征（例如，觉醒阈值、Pcrit 和肌肉反应性），以了解个体间的异质性和唑吡坦对某些阻塞性睡眠呼吸暂停患者的治疗潜力。
