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Effect of sleep-inducing drugs on central and obstructive apnea
Sleep apnea is a condition associated with repeated breathing pauses during sleep. It may be result of upper airway occlusion (obstructive sleep apnea) or altered automatic breathing control (central sleep apnea). Several medications have an effect on sleep respiratory physiology, including sleep-inducing drugs. Benzodiazepines, for instance, may cause muscle relaxation, leading to weakness of pharyngeal muscle tonus and obstructive respiratory events.
The objective of this study was to evaluate the effects of sleep-inducing drugs on central and obstructive apnea.
An cross-sectional study of polysomnography reports (PSG) performed between 2008 and 2016 was conducted, totaling 30159 reports. Exclusion criteria were repeated PSG of the same patient, split-night or CPAP PSG reports, and age below 18 years. Of the resulting 23,178 cases, 21,961 had taken no medication, 568 used benzodiazepines, 217 used z-drugs, 312 used other drugs, and 120 used multiple sleep-inducing drugs. Two one-way ANOVA with Games-Howell post-hoc tests were conducted, with medication as group factor and apnea-hypopnea index (AHI) and central apnea index (CAI) as dependent variables.
Patients who used medication before PSG were thinner (-5.9 BMI points, p<0.001), younger (-20.3 years, p<0.001), and women (67% X 41%, p<0.001). AHI was greater in no-medication group comparing to z-drugs (+18.2/h), benzodiazepines (+14.2/h), and others (+14.6/h); there was no difference between drug groups. CAI was greater in no-medication group comparing to benzodiazepines (+3.2/h) and multiple drugs (+3.2/h); no other difference was significant. Those effects remained even after controlling for BMI, age and sex.
As opposed to what was expected in the literature, sleep-inducing drugs had a protective effect in both obstructive and central apneas. One limitation of the study was that the information about the reason of the PSG was lacking. As people who used sleep-inducing drugs had the same epidemiological profile of insomniacs, one may infer that that was the reason for performing PSG in such group. Even though, drug classes did not differ in their effects on both types of apnea.
Sleep apnea, benzodiazepines, z-drugs
Universidade Federal do Paraná - Parana - Brasil
Gabriela Alves Marroni, Fernando Mazzilli Louzada, João Guilherme Fiorani Borgio