Department of Internal Medicine, Wayne State University School of Medicine, 4646 John R, Detroit, MI, 48201, USA.
Department of Internal Medicine, John D. Dingell VA Medical Center, Detroit, MI, USA.
Sleep Breath. 2023 Mar;27(1):173-180. doi: 10.1007/s11325-022-02593-3. Epub 2022 Mar 14.
Arousals may contribute to the pathogenesis of sleep-disordered breathing (SDB) and central sleep apnea (CSA). We aimed to determine the effect of the nonbenzodiazepine hypnotic zolpidem on the frequency of respiratory-related arousals and central apnea in patients with moderate-to-severe SDB. We hypothesized that zolpidem decreases the severity of SDB by decreasing the frequency of respiratory-related arousals.
Patients with apnea-hypopnea index ≥ 15 events/hour and central apnea-hypopnea index ≥ 5 events/hour underwent a sleep study on zolpidem 5 mg and a sleep study with no medication in a randomized order. The respiratory arousal index was compared between the two studies using a randomized crossover design. Sleep, respiratory, and physiologic parameters, including the CO reserve and the respiratory arousal threshold, were also compared.
Eleven participants completed the study. Compared to no treatment, zolpidem reduced the respiratory arousal index (39.7 ± 7.7 vs. 23.3 ± 4.4 events/h, P = 0.031). Zolpidem also lowered the total apnea-hypopnea index (55.6 ± 8.5 vs. 41.3 ± 7.5 events/hour, P = 0.033) but did not affect other clinical and physiologic parameters. Compared to control, zolpidem did not widen CO reserve (- 0.44 ± 1.47 vs. - 0.63 ± 0.86 mmHg, P = 0.81). The respiratory arousal threshold did not show a significant change on zolpidem compared to control (- 8.72 ± 2.1 vs. - 8.25 ± 2.81 cmHO, P = 0.41).
Nocturnal arousals and overall SDB severity were reduced with a single dose of zolpidem in patients with moderate-to-severe sleep-disordered breathing with increased susceptibility for central apnea. Zolpidem did not widen the CO reserve or increase the arousal threshold.
Clinicaltrials.gov. Sleep and Breathing in the General Population - Chemical Stimuli (NCT04720547).
觉醒可能导致睡眠呼吸障碍（SDB）和中枢性睡眠呼吸暂停（CSA）的发病机制。我们旨在确定非苯二氮䓬类催眠药唑吡坦对中重度 SDB 患者呼吸相关觉醒和中枢性呼吸暂停频率的影响。我们假设唑吡坦通过降低呼吸相关觉醒的频率来降低 SDB 的严重程度。
呼吸暂停低通气指数≥15 次/小时和中枢性呼吸暂停低通气指数≥5 次/小时的患者接受唑吡坦 5mg 睡眠研究和随机顺序无药物睡眠研究。使用随机交叉设计比较两项研究之间的呼吸觉醒指数。还比较了睡眠、呼吸和生理参数，包括 CO 储备和呼吸觉醒阈值。
11 名参与者完成了研究。与无治疗相比，唑吡坦降低了呼吸觉醒指数（39.7±7.7 与 23.3±4.4 次/小时，P=0.031）。唑吡坦还降低了总呼吸暂停低通气指数（55.6±8.5 与 41.3±7.5 次/小时，P=0.033），但不影响其他临床和生理参数。与对照组相比，唑吡坦并未扩大 CO 储备（-0.44±1.47 与-0.63±0.86mmHg，P=0.81）。与对照组相比，唑吡坦对呼吸觉醒阈值没有明显变化（-8.72±2.1 与-8.25±2.81cmHO，P=0.41）。
在对中枢性呼吸暂停易感性增加的中重度睡眠呼吸障碍患者中，单次给予唑吡坦可降低夜间觉醒和整体 SDB 严重程度。唑吡坦没有扩大 CO 储备或增加觉醒阈值。
Clinicaltrials.gov。普通人群的睡眠和呼吸-化学刺激（NCT04720547）。
