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Original Research: SLEEP MEDICINE |

Sedative Use During Continuous Positive Airway Pressure Titration Improves Subsequent Compliance: A Randomized, Double-Blind, Placebo-Controlled Trial

Christopher J. Lettieri, MD, FCCP; Jacob F. Collen, MD; Arn H. Eliasson, MD, FCCP; Timothy M. Quast, MD
Author and Funding Information

Affiliations: From Pulmonary, Critical Care & Sleep Medicine (Drs. Lettieri, Collen, Eliasson, Quast), Walter Reed Army Medical Center, Washington, DC; and the Department of Medicine (Drs. Lettieri and Eliasson), Uniformed Services University of the Health Sciences, Bethesda, MD.

Correspondence to: Christopher J. Lettieri, MD, FCCP, Pulmonary, Critical Care & Sleep Medicine, Walter Reed Army Medical Center, 6900 Georgia Ave NW, Washington, DC 20307; e-mail: christopher.lettieri@us.army.mil


Funding/Support: Study medications were provided by Sepracor Inc (Marlborough, MA). No other financial support was provided.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/site/misc/reprints.xhtml).


© 2009 American College of Chest Physicians


Chest. 2009;136(5):1263-1268. doi:10.1378/chest.09-0811
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Background:  The initial experience with continuous positive airway pressure (CPAP) may predict subsequent compliance. In a retrospective study, we found that premedication with nonbenzodiazepine sedative-hypnotic agents during CPAP titration polysomnography independently predicted short-term compliance. To validate these findings, we conducted a prospective clinical trial to assess whether premedication with eszopiclone prior to CPAP titration would improve short-term CPAP compliance.

Methods:  Subjects in this randomized, double-blind, placebo-controlled trial received 3 mg of eszopiclone or matching placebo prior to undergoing CPAP titration polysomnography. We compared the quality of CPAP titrations and objective measures of compliance during the first 4 to 6 weeks of therapy between the two groups.

Results:  We enrolled 117 subjects, and 98 subjects completed the protocol (eszopiclone, 50 subjects; placebo, 48 subjects). Other than there being more women in the eszopiclone group, the groups were similar at baseline. Compared with placebo, premedication with eszopiclone significantly improved mean (± SD) sleep efficiency (87.8 ± 5.8% vs 80.1 ± 10.5%, respectively; p = 0.002) and mean total sleep time (350.9 ± 33.6 min vs 319.7 ± 48.7 min, respectively; p = 0.007). A trend toward improved sleep latency (19.4 ± 16.1 min vs 31.8 ± 30.4 min, respectively; p = 0.08) and the number of residual obstructive events observed at the final CPAP pressure (6.4 ± 7 events/h vs 12.8 ± 14.6 events/h, respectively; p = 0.08) during polysomnography was found. Eszopiclone significantly improved CPAP compliance. Among subjects premedicated with eszopiclone, CPAP was used on a higher percentage of nights (75.9 ± 20.0% vs 60.1 ± 24.3%, respectively; p = 0.005) and for more hours per night (4.8 ± 1.5 h vs 3.9 ± 1.8 h, respectively; p = 0.03).

Conclusions:  Premedication with eszopiclone on the night of CPAP titration improved the quality of CPAP titration and led to significantly greater short-term compliance.

Trial registration:  ClinicalTrials.gov Identifier: NCT00507117

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