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Sleep Disorders |

Zolpidem and Eszopiclone Improve Sleep Efficiency During PSG and Do Not Impact Subsequent Compliance

Geoffrey Loh; Karen Shiekh; Andrei Khramtsov; Aaron Holley
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Walter Reed National Military Medical Center, Bethesda, MD


Chest. 2014;146(4_MeetingAbstracts):934A. doi:10.1378/chest.1993746
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Abstract

SESSION TITLE: Sleep Posters I

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 29, 2014 at 01:30 PM - 02:30 PM

PURPOSE: CPAP adherence remains poor despite efforts to increase use. A previous study showed that a single administration of eszopiclone (E) immediately prior to PSG can impact subsequent compliance. We sought to determine whether zolpidem (Z) has a greater effect on compliance than E.

METHODS: We abstracted data on patients initiating CPAP at our facility. PSG results and compliance data at four weeks were analyzed by whether or not the patient received Z, E or no sleep aid prior to PSG.

RESULTS: Data was available on 300 patients, 185 (61.7%) were given zolpidem, 54 (18.0%) eszopiclone and 61 (20.3%) received no sleep aid. On PSG both Z and E, when compared to no sleep aid, were associated with a significant decrease in stage III sleep (p<0.001 for both drugs), an increase in the total arousal index (TAI) (Z: p=0.001; E: p=0.003), and an increase in the apnea-hypopnea index (AHI) (Z: p<0.001; E: p=0.01). Sleep efficiency improved with Z (p=0.04) but not E (p=0.08), and REM was decreased with Z (p=0.01) but not E (p=0.2). CPAP Adherence download at 4 weeks showed no difference between Z and E for percentage nights used (43.7% vs 38.7%; p=0.35) or percentage nights > 4 hours (34.2% vs 29.7%; p=0.35), but patients using E had a lower residual AHI at 4 weeks (1.7 / hr vs 2.7 / hr; p=0.01). After adjusting for baseline AHI and age using linear regression neither Z nor E were predictive of compliance at 4 weeks.

CONCLUSIONS: Both Z and E had effects on sleep architecture that have been previously demonstrated. The increase in TAI and AHI may be due in part to selection bias - providers that prescribe Z or E likely have different referral patterns from those who do not prescribe a sleep aid. After controlling for AHI and age neither Z nor E use were associated with an increase in compliance at 4 weeks when compared to taking no medications.

CLINICAL IMPLICATIONS: Both zolpidem and eszopiclone can be used to improve sleep efficiency during an overnight titration but neither affect compliance at 4 weeks.

DISCLOSURE: The following authors have nothing to disclose: Geoffrey Loh, Karen Shiekh, Andrei Khramtsov, Aaron Holley

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