Use Of Sleep Meds For Patients With Apnea Questioned By Research

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Use Of Sleep Meds For Patients With Apnea Questioned By Research

http://www.medicalnewstoday.com/medicalnews.php?newsid=56589

Prescription sleep aids may do little to improve the use of

continuous positive airway pressure (CPAP) among patients with

obstructive sleep apnea (OSA). A new study published in the November

issue of CHEST, the peer-reviewed journal of the American College of

Chest Physicians (ACCP), finds that patients with OSA who were given

prescription sleep aids were no more likely to use their CPAP

machines than patients with OSA taking a placebo.

" CPAP treatment improves daytime alertness and quality of life for

most patients with OSA and may prevent some of the long-term

complications of this disorder, including heart attacks and

strokes, " said the study's lead author Capt. A. Bradshaw, MD,

FCCP, Naval Medical Center, San Diego, CA. " Yet, many people find

CPAP difficult to use. People with a good initial experience are

more likely to use CPAP regularly. Our hypothesis was that a

sleeping pill might help new CPAP users adjust to sleeping with the

equipment and promote long-term usage. "

To determine the effect prescription sleep medications have on CPAP

compliance, Capt. Bradshaw and colleagues compared CPAP use among 72

newly diagnosed male patients (mean age 38 ? 7 years) who were

referred for CPAP treatment. All patients participated in

standardized CPAP training and were randomized to receive the

sleeping agent zolpidem (N=24), a placebo pill (N=24), or standard

care (N=24) with no sleeping pill or placebo. Patients taking

zolpidem or placebo were instructed to take one pill each night, 30

minutes prior to bedtime for the first 14 days of treatment. During

the four-week trial, CPAP use was recorded by an internal data chip.

Compared with the placebo pill and standard care groups, the

zolpidem group did not show greater CPAP usage in terms of total

days used or average time used per night over the course of four

weeks. When the initial 14 days of CPAP treatment were analyzed

separately, there was also no difference in number of days used or

average nightly use. Despite results, researchers believe

prescription sleep medications, when used correctly, may prove

helpful for a subset of patients with OSA.

" Studies have shown that almost half of patients with OSA have

insomnia complaints, " said Capt. Bradshaw. " Our study does not

support prescription sleeping pills for all new CPAP users, but OSA

patients with insomnia symptoms might benefit. " Still, researchers

remain cautious regarding the use of prescription sleep medications

for patients with OSA.

" We are concerned, however, about the potential risk for worsening

sleep apnea if patients intentionally or inadvertently remove the

mask before the effects of the sleeping pill have worn off, " said

Capt. Bradshaw. " Also, sleeping pills sometimes have residual

daytime effects, such as sleepiness, and can interfere with

cognitive function - both of which are already problems for many

patients with OSA, even after treatment with CPAP. "

Upon completion of the trial, all patients showed significant

symptom improvement on the Epworth Sleepiness Scale (ESS) and

Functional Outcomes of Sleep Questionnaire (FOSQ). Baseline

demographics revealed no difference in age, body mass index, ESS,

FOSQ, nadir oxygen saturation, or CPAP pressure setting among the

three groups. Despite randomization, the standard care group had a

higher apnea/hypopnea index than the other two groups.

" When used consistently, CPAP is a highly effective therapy for

patients with obstructive sleep apnea, " said Mark J. Rosen, MD,

FCCP, President of the American College of Chest Physicians. " More

research is needed to determine interventions that can help optimize

the initial experience with CPAP and improve long-term usage. "