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Mittal N, Mittal R, Gupta MC. Zolpidem for Insomnia: A Double-Edged Sword. A Systematic Literature Review on Zolpidem-Induced Complex Sleep Behaviors. Indian J Psychol Med 2021; 43:373-381. [PMID: 34584301 PMCID: PMC8450729 DOI: 10.1177/0253717621992372] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Being a nonbenzodiazepine, zolpidem is believed to have a favorable side-effect profile and is widely prescribed for insomnia. However, in the past few years, numerous neuropsychiatric adverse reactions, particularly complex sleep behaviors (CSBs), have been reported with zolpidem. OBJECTIVE To conduct a systematic review of zolpidem-associated CSBs. DATA SOURCES An electronic search was conducted using MEDLINE, Embase, PubMed, and Cochrane database of systematic reviews to extract relevant articles till July 2020. STUDY ELIGIBILITY CRITERIA Any type of literature article (case report, case series, and observational or interventional study) reporting CSBs associated with zolpidem. RESULTS In this review, we present aggregate summarized data from 148 patients presenting with zolpidem-induced CSBs (79 patients from 23 case reports and 5 case series; 69 patients out of 1454 taking zolpidem [4.7%] from three observational clinical studies). Various types of CSBs associated with zolpidem were reported, most common being sleepwalking/somnambulism and sleep-related eating disorder. On causality assessment, around 88% of cases were found to have a probable association with zolpidem. LIMITATIONS Extraction of data from observational studies and spontaneous reports, due to nonavailability of any randomized controlled trials relevant to the study objective. CONCLUSION AND IMPLICATION OF KEY FINDINGS Zolpidem-induced CSBs, although not very common, may develop when the drug is used at therapeutic doses for insomnia. Doctors need to be alert to monitor such adverse effects of zolpidem and exercise caution while prescribing it.
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Affiliation(s)
- Niti Mittal
- Dept. of Pharmacology, Pandit Bhagwat
Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana,
India
| | - Rakesh Mittal
- Dept. of Pharmacology, Pandit Bhagwat
Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana,
India
| | - M. C. Gupta
- Dept. of Pharmacology, Pandit Bhagwat
Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana,
India
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Ge Y, Sheng B, Qu W, Xiong Y, Sun X, Zhang K. Differences in visual-spatial working memory and driving behavior between morning-type and evening-type drivers. ACCIDENT; ANALYSIS AND PREVENTION 2020; 136:105402. [PMID: 31862644 DOI: 10.1016/j.aap.2019.105402] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 10/08/2019] [Accepted: 12/10/2019] [Indexed: 06/10/2023]
Abstract
Circadian rhythms are changes in life activities over a cycle of approximately 24 hours. Studies on chronotypes have found that there are significant differences in physiology, personality, cognitive ability and driving behavior between morning-type and evening-type people. The purpose of this study is to explore the relationship between visual-spatial working memory and driving behavior between morning-type and evening-type drivers in China. A total of 42 Chinese drivers were selected to participate in this study according to their score on the Morningness-Eveningness Questionnaire, including 22 morning-type drivers and 20 evening-type drivers. During the experiment, the participants completed one cognitive task (visual-spatial working memory), two simulated driving tasks (car-following task and pedestrian-crossing task), and the Dula Dangerous Driving Index (DDDI). The results showed that evening-type drivers self-reported more dangerous driving behaviors but had better lateral control on the simulated driving task than morning-type drivers. In addition, evening-type drivers had greater accuracy when performing the visual-spatial working memory task. Moreover, the accuracy on the visual-spatial working memory task positively predicted the percentage of time over the speed limit by 10 mph (POS10) and negatively correlated with the reaction time measure (time to meet pedestrians) in the pedestrian-crossing task. The relationships among chronotype, cognitive ability and driving behavior are also discussed. Understanding the underlying mechanisms could help explain why evening-type drivers perform dangerous driving behaviors more often.
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Affiliation(s)
- Yan Ge
- CAS Key Laboratory of Behavioral Science, Institute of Psychology, Beijing, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Biying Sheng
- CAS Key Laboratory of Behavioral Science, Institute of Psychology, Beijing, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Weina Qu
- CAS Key Laboratory of Behavioral Science, Institute of Psychology, Beijing, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing, China.
| | - Yuexing Xiong
- CAS Key Laboratory of Behavioral Science, Institute of Psychology, Beijing, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Xianghong Sun
- CAS Key Laboratory of Behavioral Science, Institute of Psychology, Beijing, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Kan Zhang
- CAS Key Laboratory of Behavioral Science, Institute of Psychology, Beijing, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
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Sabe M, Kashef H, Gironi C, Sentissi O. Zolpidem stimulant effect: Induced mania case report and systematic review of cases. Prog Neuropsychopharmacol Biol Psychiatry 2019; 94:109643. [PMID: 31071363 DOI: 10.1016/j.pnpbp.2019.109643] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Revised: 01/30/2019] [Accepted: 05/02/2019] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Zolpidem is the most widely prescribed hypnotic agent worldwide. This easy-access drug seems to have a high addictive potential among specific populations and is now listed by the World Health Organization (WHO) as being as dangerous as benzodiazepines for dependence and abuse. Many side effects have been reported, but drug-induced mania is still extremely rare. We conducted a systematic review to study the zolpidem-induced stimulation, euphoric or manic effects. METHODS MEDLINE, PsycINFO, Science Direct, and Google Scholar were searched for articles in English, French, German, Italian and Spanish published up to the 15th October 2018. RESULTS Eighteen relevant cases were identified, highlighting the need for more reports; therefore, one case that occurred in our department was included. The mean usual dose was 363.31 mg (± 292.2), the minimum dose was 10 mg, the maximum dose was 2000 mg, and the mean intake duration was 35.20 months (±48.0). We found that 89.4% of cases were euphoric and 15.7% had drug-induced mania with delusions. A total of 15.7% of cases took zolpidem for relaxant and stimulant effects, 47% of cases suffered various depression or anxiety disorders, of which 62.5% used zolpidem to cope with depression or an anxiety disorder. A total of 26.3% of cases had concomitant drug dependence or abuse. Seventy-five percent of cases suffering from depression consumed zolpidem for more than 1 year, with significantly more increased daily doses than in non-depressed cases (p < .5). CONCLUSIONS The latest FDA recommendations for lowering zolpidem doses should be adopted by all countries. Zolpidem prescriptions should be contraindicated for populations with identified risk factors.
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Affiliation(s)
- M Sabe
- Division of Adult Psychiatry, Department of Psychiatry, Geneva University Hospitals, Switzerland.
| | - H Kashef
- Department of Radiology, Geneva University Hospitals, Switzerland
| | - C Gironi
- Division of Adult Psychiatry, Department of Psychiatry, Geneva University Hospitals, Switzerland
| | - O Sentissi
- Division of Adult Psychiatry, Department of Psychiatry, Geneva University Hospitals, Switzerland
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Yang BR, Kim YJ, Kim MS, Jung SY, Choi NK, Hwang B, Park BJ, Lee J. Prescription of Zolpidem and the Risk of Fatal Motor Vehicle Collisions: A Population-Based, Case-Crossover Study from South Korea. CNS Drugs 2018; 32:593-600. [PMID: 29796977 DOI: 10.1007/s40263-018-0520-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Zolpidem is one of the most frequently used hypnotics worldwide, but associations with serious adverse effects such as motor vehicle collisions have been reported. OBJECTIVE The objective of this study was to evaluate the association of fatal motor vehicle collisions with a prescription for zolpidem, considering the context of the motor vehicle collisions. METHODS We conducted a case-crossover study, where each case served as its own control, by linking data about fatal motor vehicle collisions from the Korean Road Traffic Authority between 2010 and 2014 with national health insurance data. The case period was defined as 1 day before the fatal motor vehicle collisions, and was matched to four control periods at 90-day intervals. Conditional logistic regression was performed to calculate the odds ratio for fatal motor vehicle collisions associated with zolpidem exposure, and odds ratios were adjusted for time-varying exposure to confounding medications. A stratified analysis was performed by age group (younger than 65 years or not), the Charlson Comorbidity Index, and whether patients were new zolpidem users. RESULTS Among the 714 subjects, the adjusted odds ratio for a fatal motor vehicle collision associated with a prescription for zolpidem the previous day was 1.48 (95% confidence interval 1.06-2.07). After stratification, a significantly increased risk was observed in subjects with a high Charlson Comorbidity Index (odds ratio 1.81; 95% confidence interval 1.16-2.84), the younger age group (odds ratio: 1.62; 95% confidence interval 1.03-2.56), and new zolpidem users (odds ratio 2.37; 95% confidence interval 1.40-4.00). CONCLUSION A prescription for zolpidem on the previous day was significantly related to an increased risk of fatal motor vehicle collisions in this population-based case-crossover study.
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Affiliation(s)
- Bo Ram Yang
- Medical Research Collaborating Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Ye-Jee Kim
- Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, Seoul, Republic of Korea
| | - Mi-Sook Kim
- Medical Research Collaborating Center, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Sun-Young Jung
- College of Pharmacy, Chung-Ang University, Seoul, Republic of Korea
| | - Nam-Kyong Choi
- Department of Health Convergence, College of Science and Industry Convergence, Ewha Womans University, Seoul, Republic of Korea
| | - Byungkwan Hwang
- Department of Neurology, Texas Tech University Health Science Center, Lubbock, TX, USA
| | - Byung-Joo Park
- Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Joongyub Lee
- School of Medicine, Inha University, Incheon, Republic of Korea.
- Department of Prevention and Management, Inha University Hospital, 27, Inhang-ro, Jung-gu, Incheon, Republic of Korea.
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Platt LM. Zolpidem and Facebook Don't Mix. J Am Psychiatr Nurses Assoc 2018; 24:414. [PMID: 30213249 DOI: 10.1177/1078390318777301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Irfan M, Schenck CH, Howell MJ. Non-Rapid Eye Movement Sleep and Overlap Parasomnias. Continuum (Minneap Minn) 2017; 23:1035-1050. [PMID: 28777175 DOI: 10.1212/con.0000000000000503] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE OF REVIEW This article reviews the spectrum of non-rapid eye movement (non-REM) sleep parasomnias, including sleepwalking, confusional arousals, and sleep terrors, which represent the range of phenotypic disorders of arousal from non-REM sleep that occurs in children and adults. RECENT FINDINGS The International Classification of Sleep Disorders, Third Edition (ICSD-3) classifies parasomnias according to the sleep stage they emerge from: REM, non-REM, or other. Demographics, clinical features, and diagnosis of non-REM parasomnias are reviewed in this article, and an up-to-date synopsis of guidelines for management strategies to assist in the treatment of these sleep disorders is provided. SUMMARY The non-REM parasomnias are most common in children and adolescents but may persist into adulthood. They can be distinguishable from REM parasomnias and nocturnal epilepsies, and, importantly, may lead to injury. Additionally, other parasomnias in this spectrum include sleep-related eating disorder and sexsomnia. Overlap parasomnia disorder includes one or more manifestations of a non-REM parasomnia seen in combination with REM sleep behavior disorder, representing an apparent erosion of the normally distinct stages of non-REM and REM sleep. A similar yet much more extreme dissociation of states underlies agrypnia excitata and status dissociatus, which represent rare, severe dissociations between non-REM, REM, and wake states resulting clinically in oneiric behaviors and severe derangement of normal polysomnographic wake and sleep stage characteristics. Management of non-REM and overlap parasomnias and state dissociation disorders include ensuring bedroom safety and prescription of clonazepam or hypnosis, in select cases, although in children and adolescents with noninjurious behaviors, non-REM parasomnias are often age-limited developmental disorders, which may ultimately remit by adulthood, and, in these cases, counseling and education alone may suffice. Timely and accurate recognition of the non-REM and overlap parasomnias is crucial to limiting potential patient injury.
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Stallman HM, Kohler M, White J. Medication induced sleepwalking: A systematic review. Sleep Med Rev 2017; 37:105-113. [PMID: 28363449 DOI: 10.1016/j.smrv.2017.01.005] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Revised: 01/13/2017] [Accepted: 01/20/2017] [Indexed: 10/20/2022]
Abstract
Medications that trigger sleepwalking may inadvertently put the patient at risk of injury to themselves and/or others, and contribute to poor treatment adherence. The aim of this study was to systematically review the literature to identify drugs that may increase the risk of sleepwalking. A search of CINAHL, EMBASE, PsycINFO, PubMed, and ScienceDirect was conducted with the keywords 'sleepwalking' OR 'somnambulism'. Of the original 83 sourced papers, 62 met the inclusion criteria and were subsequently included for review. Twenty-nine drugs, primarily in four classes-benzodiazepine receptor agonists and other gamma aminobutyric acid (GABA) modulators, antidepressants and other serotonergic agents, antipsychotics, and β-blockers-were identified as possible triggers for sleepwalking. The strongest evidence for medication-induced sleepwalking was for zolpidem and sodium oxybate. All other associations were based on case reports. This research highlights the importance of considering sleepwalking in risk profiles in clinical trials, particularly for drugs that enhance GABA activity at the GABAA receptor, enhance serotonergic activity, or block the activity of noradrenaline at β receptors. The results also have implications for prescribers to consider sleepwalking as a potential adverse effect and ensure that: 1) the patient is educated about a safe sleep environment; 2) they are encouraged to report the onset or exacerbation of sleepwalking, and 3) alternative treatments are considered if sleepwalking occurs.
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Affiliation(s)
- Helen M Stallman
- Centre for Sleep Research, University of South Australia, Australia.
| | - Mark Kohler
- Centre for Sleep Research, University of South Australia, Australia
| | - Jason White
- School of Pharmacy and Medical Sciences, University of South Australia, Australia
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Sun Y, Lin CC, Lu CJ, Hsu CY, Kao CH. Association Between Zolpidem and Suicide: A Nationwide Population-Based Case-Control Study. Mayo Clin Proc 2016; 91:308-15. [PMID: 26776243 DOI: 10.1016/j.mayocp.2015.10.022] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2015] [Revised: 09/20/2015] [Accepted: 10/08/2015] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To evaluate the association between zolpidem and the risk of suicide. PATIENTS AND METHODS In this nationwide case-control study, the case group comprised 2199 people who committed suicide or were hospitalized due to suicide attempt between January 1, 2002, and December 31, 2011. To create a control group, we randomly selected 10 people matched to each case according to age, sex, urbanization, and occupation. We measured the risk of suicide/suicide attempt in association with zolpidem exposure by using adjusted odds ratios (ORs) and assessed the dose-response effect of zolpidem. RESULTS After adjustment for potential confounders such as the comorbidities of schizophrenia, major depression, bipolar disorder, anxiety, insomnia, substance use, and other mental disorders, the Charlson comorbidity index, and use of benzodiazepine or antidepressants, zolpidem exposure was found to be significantly associated with the risk of suicide/suicide attempt with an OR of 2.08 (95% CIs, 1.83-2.36). The risk increased with the level of zolpidem use. The ORs (95% CIs) for cumulative defined daily doses of less than 90, 90 to 179, and 180 mg or more were 1.90 (1.65-2.18), 2.07 (1.59-2.67), and 2.81 (2.33-3.38), respectively (for trend, P<.001). Subgroup analyses showed that the exposure to zolpidem consistently increased the OR in different age groups, sex, urbanization level, occupation, mental disorders, and Charlson comorbidity index levels and in groups of people with or without the presence of insomnia. CONCLUSION This study demonstrated a significant association between using zolpidem and suicide or suicide attempt in people with or without comorbid psychiatric illnesses (all P<.05).
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Affiliation(s)
- Yu Sun
- Department of Neurology, En Chu Kong Hospital, New Taipei, Taiwan
| | - Che-Chen Lin
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan; College of Medicine, China Medical University, Taichung, Taiwan
| | - Chien-Jung Lu
- Department of Neurology, En Chu Kong Hospital, New Taipei, Taiwan
| | - Chung-Y Hsu
- Graduate Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan
| | - Chia-Hung Kao
- Graduate Institute of Clinical Medical Science and School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan; Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung, Taiwan.
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Costello RB, Lentino CV, Boyd CC, O'Connell ML, Crawford CC, Sprengel ML, Deuster PA. The effectiveness of melatonin for promoting healthy sleep: a rapid evidence assessment of the literature. Nutr J 2014; 13:106. [PMID: 25380732 PMCID: PMC4273450 DOI: 10.1186/1475-2891-13-106] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2014] [Accepted: 08/28/2014] [Indexed: 11/19/2022] Open
Abstract
A systematic review was conducted using Samueli Institute’s Rapid Evidence Assessment of the Literature (REAL©) process to determine the evidence base for melatonin as an agent to optimize sleep or improve sleep quality, and generalize the results to a military, civilian, or other healthy, active, adult population. Multiple databases were searched yielding 35 randomized controlled trials (RCTs) meeting the review’s inclusion criteria, which were assessed for methodological quality as well as for melatonin effectiveness. The majority of included studies were high quality (83.0%). Overall, according to Grading Recommendations, Assessment Development and Evaluation (GRADE) methodology, weak recommendations were made for preventing phase shifts from jet lag, for improving insomnia in both healthy volunteers and individuals with a history of insomnia, and for initiating sleep and/or improving sleep efficacy. Based on the literature to date, no recommendations for use in shift workers or to improve hormonal phase shift changes in healthy people can be made at this time. Larger and longer-duration RCTs utilizing well characterized products are needed to warrant melatonin recommendations in young, healthy adults.
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Affiliation(s)
| | | | | | | | | | | | - Patricia A Deuster
- Uniformed Services University of the Health Sciences, Department of Military and Emergency Medicine, 4301 Jones Bridge Road, Bethesda, MD 20814-4799, USA.
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