Ware J C, Walsh J K, Scharf M B, Roehrs T, Roth T, Vogel G W
Sleep Disorders Center, Sentara Norfolk General Hospital, VA 23507, USA.
Clin Neuropharmacol. 1997 Apr;20(2):116-25. doi: 10.1097/00002826-199704000-00002.
This study examined rebound insomnia after discontinuation of chronic use of zolpidem (10 mg), a short elimination half-life imidazopyridine. The zolpidem group was bracketed by a placebo group and a positive control group taking 0.5 mg of triazolam (twice the recommended dose), which is known to produce rebound insomnia. Ninety-nine patients with sleep complaints that were polysomnographically documented participated in the study. After randomization, patients completed a 2-night, single-blind, placebo baseline period, a 28-night double-blind treatment phase, and a 3-night, single-blind, placebo substitution period. Polysomnographic and subjective sleep variables indicated a lack of rebound insomnia for the zolpidem group. The positive triazolam control group had rebound insomnia only on the first discontinuation night. There was no significant correlation between rebound insomnia and the level of initial insomnia, the degree of response to treatment in week 4, or the amount of tolerance that developed during drug use. During the 4-week treatment period, efficacy diminished for both drugs. From these data, it cannot be determined whether the lack of rebound insomnia with zolpidem is a result of drug dose or some property of the drug such as receptor selectivity.
本研究考察了长期使用唑吡坦（10毫克，一种消除半衰期短的咪唑吡啶类药物）停药后的反弹性失眠情况。唑吡坦组两侧分别为安慰剂组和服用0.5毫克三唑仑（两倍推荐剂量）的阳性对照组，已知三唑仑会导致反弹性失眠。99名有睡眠主诉且经多导睡眠图记录的患者参与了该研究。随机分组后，患者完成了一个为期2晚的单盲安慰剂基线期、一个为期28晚的双盲治疗期以及一个为期3晚的单盲安慰剂替代期。多导睡眠图和主观睡眠变量表明唑吡坦组不存在反弹性失眠。阳性三唑仑对照组仅在停药的第一晚出现反弹性失眠。反弹性失眠与初始失眠程度、第4周的治疗反应程度或用药期间产生的耐受量之间无显著相关性。在为期4周的治疗期内，两种药物的疗效均有所下降。从这些数据中，无法确定唑吡坦不存在反弹性失眠是药物剂量的结果还是药物的某些特性（如受体选择性）所致。
