Onishi Naoya, Nishida Keiichiro, Minami Hironari, Toyoda Katsunori, Nishizawa Yoshitaka, Kubo Yoichiro, Ikeda Soichiro, Kanazawa Tetsufumi
Department of Neuropsychiatry Osaka Medical and Pharmaceutical University Osaka Japan.
Division of Respiratory Medicine and Thoracic Oncology, Department of Internal Medicine (I) Osaka Medical and Pharmaceutical University Osaka Japan.
PCN Rep. 2025 May 7;4(2):e70119. doi: 10.1002/pcn5.70119. eCollection 2025 Jun.
Insomnia is often treated with benzodiazepines, which can lead to long-term use and potential complications, especially if underlying conditions like sleep apnea syndrome (SAS) go undiagnosed. This case report describes a 70-year-old woman with chronic insomnia, benzodiazepine and alcohol abuse, and a previously undiagnosed severe SAS.
The patient, a 70-year-old woman was admitted for suspected delirium caused by benzodiazepine and alcohol abuse. She had been prescribed benzodiazepines by multiple health care providers for over 30 years. Additionally, she regularly consumed alcohol to self-medicate. These were replaced and treated with diazepam, but her sleep disturbances persisted. She had a noticeable snoring during her hospitalization, which led to a polysomnography. The results revealed that she had severe SAS with an apnea-hypopnea index of 57.1 during total sleep time. Continuous positive airway pressure therapy significantly improved her sleep quality. She also underwent testing for dementia, which showed frontal lobe dysfunction on imaging and psychological testing. She was discharged after 66 days of treatment, able to live independently with home care support.
This oversight led to prolonged use of benzodiazepines and self-medication with alcohol, worsening her condition. The case emphasizes the need for thorough assessments in patients with treatment-resistant insomnia, particularly to identify organic causes like SAS that may be contributing to their symptoms. This case highlights the importance of reevaluating patients whose insomnia does not improve with sleep medication.
失眠通常使用苯二氮䓬类药物治疗，这可能导致长期使用并引发潜在并发症，尤其是在睡眠呼吸暂停综合征（SAS）等潜在病症未被诊断出来的情况下。本病例报告描述了一名70岁患有慢性失眠、滥用苯二氮䓬类药物和酒精且先前未被诊断出患有严重SAS的女性。
该患者为一名70岁女性，因疑似苯二氮䓬类药物和酒精滥用导致的谵妄入院。她被多名医护人员开具苯二氮䓬类药物超过30年。此外，她经常饮酒进行自我治疗。这些药物被换成地西泮并进行治疗，但她的睡眠障碍仍然存在。她住院期间打鼾明显，这导致进行了多导睡眠图检查。结果显示她患有严重SAS，总睡眠时间的呼吸暂停低通气指数为57.1。持续气道正压通气治疗显著改善了她的睡眠质量。她还接受了痴呆症检测，影像学和心理测试显示存在额叶功能障碍。经过66天的治疗后出院，在家庭护理支持下能够独立生活。
这种疏忽导致苯二氮䓬类药物的长期使用和酒精自我治疗，使她的病情恶化。该病例强调了对难治性失眠患者进行全面评估的必要性，特别是要识别可能导致其症状的诸如SAS等器质性病因。本病例突出了对使用睡眠药物后失眠未改善的患者进行重新评估的重要性。
