Abstract
Background: Hypnotics are usually avoided in patients with chronic hypercapnic respiratory failure. Among hypercapnitic patients receiving long-term nocturnal noninvasive ventilation (NIV), many complain about insomnia. It should be important to evaluate the safety and efficacy of hypnotics in hypercapnic patients receiving long-term NIV.
Methods: Twenty six patients who received long-term NIV were studied prospectively (Multicenter, Randomized, Placebo-Control, Double blinded, Cross-over study; UMIN000005989). After more than five days' washout periods, patients received first polysomnography under nocturnal ten hours' NIV, taking whether zolpidem (5mg) or placebo. After next one week without hypnotics, they received second polysomnography taking an inverse medication. Sleep stage, transcutaneous PCO2 (PtcCO2), and Leeds Sleep Evaluation Questionnaire (LSEQ) in the morning were measured and analyzed.
Results: 26 patients consist of 12 restrictive thoracic disease, 6 COPD, 8 miscellaneous diseases. Their mean daytime PaCO2 was 55.1 mmHg. Total sleep time (440 vs 374 min; p=0.0012), stage-2 sleep (205 vs 162 min; p=0.0002), stage-3/4 sleep (72 vs 50 min; p=0.0012) all significantly increased when patients' taking zolpidem. There was no significant difference between zolpidem and placebo in PtcCO2 at stage-1, -2, -3/4, REM sleep, and awake, respectively. In LSEQ, getting to sleep was significantly quicker (p=0.04) and quality of sleep tended to be more restful (p=0.06) when patients' taking zolpidem.
Conclusion: Zolpidem may be safe and improve sleep quality in hypercapnic patients receiving long-term NIV.
- © 2014 ERS