PURPOSE: Limited studies suggest premedication of patients undergoing initial polysomnography (PSG) for suspected sleep-disordered breathing (SDB) with a nonbenzodiazepine hypnotic agent improves study quality and efficacy of positive airway pressure (PAP) titration. The effects of ramelteon, a melatonin agonist non-controlled substance hypnotic, are unknown in this setting. We compare the effects of eszopiclone and ramelteon on diagnostic quality, sleep architecture and efficacy of PAP titration during split night PSG.
METHODS: Patients ages 18-65 undergoing initial split night polysomnogram for suspected sleep disordered breathing were enrolled. Subjects received eszopiclone 3mg, ramelteon 8mg or placebo in a randomized, double-blind fashion, thirty minutes prior to PSG. Sleep latency, total sleep time (TST), sleep efficiency, wake after sleep onset (WASO), sleep architecture, CPAP titration and residual apnea-hypopnea index (AHI) were compared among groups. Frequency of poor quality studies defined as those with total sleep time < 120 min, sleep efficiency < 70%, or CPAP titration studies resulting in either CPAP intolerance or residual AHI > 5/ hr were also compared.
RESULTS: One-hundred two subjects were enrolled; 42 received eszopiclone, 39 received ramelteon, and 21 control subjects received neither medication. Mean age, height, weight, body mass index, ESS, and baseline AHI were similar among groups. Compared to the ramelteon group, median sleep latency was shorter in the eszopiclone group (13.5 min vs 5.8 min, respectively; p < 0.05). Overall sleep efficiency with eszopiclone was better than with placebo (median 88.7 vs 76.6%, respectively; p< 0.05). Median TST, WASO and sleep architecture were similar among groups. Polysomnographic quality and frequency of successful CPAP titration were also similar among groups.
CONCLUSION: In subjects with suspected SDB, neither eszopiclone nor ramelteon improved the quality of polysomnogram or CPAP titration. However, eszopiclone shortened sleep latency and improved sleep efficiency.
CLINICAL IMPLICATIONS: Acute administration of single dose eszopiclone or ramelteon does not improve polysomnographic quality or efficacy of CPAP titration in subjects with suspected SDB.
DISCLOSURE: Ronson Sato, No Financial Disclosure Information; No Product/Research Disclosure Information