The effect of temazepam on assessment of severity of obstructive sleep apnea by polysomnography
- 201 Downloads
To determine the effect of temazepam on assessment of the severity of obstructive sleep apnea (OSA) by polysomnography (PSG).
Analysis of diagnostic laboratory-PSG studies was performed in OSA patients who were administered temazepam (10 mg) to facilitate sleep (“temazepam group”, n = 73) and in OSA patients (matched for age, gender, body mass index and study date) in whom temazepam was not administered (“control group”, n = 73). Sleep- and respiratory-related variables were compared between the groups for the (i) first 3 h of study following temazepam in the temazepam group (when peak blood concentration is expected) or following lights out in the control group, and (ii) entire study duration.
Within the first 3 h, no differences in sleep-related variables were observed between the groups. Over the entire study duration, the temazepam group had a reduced total sleep time compared to the control group, likely due to the overnight sleep difficulties that led to its use. Whether measured during the first 3 h of study or over the entire study duration, no significant differences were detected between the groups for any respiratory-related variable, including apnea hypopnea index, arousal index, oxygen desaturation, apnea index, hypopnea index, and event duration. When patients were considered in terms of OSA severity, decreased arousal index was noted in the temazepam group over the entire study duration, but only in those with severe OSA.
Oral administration of 10 mg of temazepam during the course of PSG does not systematically affect assessment of the severity of OSA by PSG.
KeywordsRespiratory sleep disorder Benzodiazepine AHI Airway obstruction Sedatives Airway collapsibility
This study was supported by a National Health and Medical Research Council project grant (No. 572647) and Sir Charles Gairdner Hospital Research Advisory Committee grant (2016-043). PRE was supported by a National Health and Medical Research Council Senior Research Fellowship (No 513704). CV received a Dr. Margaret Loman-Hall Honours Scholarship.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
All patients had provided written consent to have information obtained in association with their PSG study used for research purposes but formal consent by the patients for this particular study was not required. The study was approved by the Human Research Ethics Committee at Sir Charles Gairdner Hospital (Ref 2011-027) and was performed in accordance with the ethical standards of the institution and the 1964 Declaration of Helsinki and its later amendments.
- 1.Holbrook AM, Crowther R, Lotter A, Cheng C, King D (2000) Meta-analysis of benzodiazepine use in the treatment of insomnia. Can Med Assoc J 162(2):225–233Google Scholar
- 2.Glass JR, Sproule BA, Herrmann N, Streiner D, Busto UE (2003) Acute pharmacological effects of temazepam, diphenhydramine, and valerian in healthy elderly subjects. J Clin Psychopharmacol 23(3):260–268. https://doi.org/10.1097/01.jcp.0000084033.22282.b6 Google Scholar
- 3.Hanly P, Powles P (1993) Hypnotics should never be used in patients with sleep apnea. J Psychosom Res 37(Suppl 1):59–65Google Scholar
- 5.Wang D, Marshall NS, Duffin J, Yee BJ, Wong KK, Noori N, Ng SS, Grunstein RR (2011) Phenotyping interindividual variability in obstructive sleep apnoea response to temazepam using ventilatory chemoreflexes during wakefulness. J Sleep Res 20(4):526–532. https://doi.org/10.1111/j.1365-2869.2011.00931.x CrossRefGoogle Scholar
- 9.Rechtschaffen A, Kales A (1968) A manual of standardized terminology, technique and scoring system for sleep stages of human sleep. National Institutes of Health, Washington, DC.Google Scholar
- 10.Edwards BA, Eckert DJ, McSharry DG, Sands SA, Desai A, Kehlmann G, Bakker JP, Genta PR, Owens RL, White DP, Wellman A, Malhotra A (2014) Clinical predictors of the respiratory arousal threshold in patients with obstructive sleep apnea. Am J Respir Crit Care Med 190(11):1293–1300. https://doi.org/10.1164/rccm.201404-0718OC CrossRefGoogle Scholar
- 11.R Development Core Team (2015) R: A language and environment for statistical computing. [computer program]. Vienna, Austria. URL http://www.R-project.org/.2015. R Foundation for Statistical Computing, Vienna, Austria
- 18.Hoijer U, Hedner J, Ejnell H, Grunstein R, Odelberg E, Elam M (1994) Nitrazepam in patients with sleep apnoea: a double-blind placebo-controlled study. Eur Respir J 7(11):2011–2015Google Scholar
- 22.Eckert DJ, Owens RL, Kehlmann GB, Wellman A, Rahangdale S, Yim-Yeh S, White DP, Malhotra A (2011) Eszopiclone increases the respiratory arousal threshold and lowers the apnoea/hypopnoea index in obstructive sleep apnoea patients with a low arousal threshold. Clin Sci (Lond) 120(12):505–514. https://doi.org/10.1042/CS20100588 CrossRefGoogle Scholar
- 28.Ratnavadivel R, Chau N, Stadler D, Yeo A, McEvoy RD, Catcheside PG (2009) Marked reduction in obstructive sleep apnea severity in slow wave sleep. J Clin Sleep Med 5(6):519–524Google Scholar
- 30.Luyster FS, Buysse DJ, Strollo PJ Jr (2010) Comorbid insomnia and obstructive sleep apnea: challenges for clinical practice and research. J Clin Sleep Med 6(2):196–204Google Scholar