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Guo Y, Chen Y, Yang Q, Hou F, Liu X, Ma Y. Multi-Scale Permutation Entropy: A Potential Measure for the Impact of Sleep Medication on Brain Dynamics of Patients with Insomnia. ENTROPY (BASEL, SWITZERLAND) 2021; 23:1101. [PMID: 34573726 PMCID: PMC8472826 DOI: 10.3390/e23091101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 08/21/2021] [Accepted: 08/22/2021] [Indexed: 11/23/2022]
Abstract
Insomnia is a common sleep disorder that is closely associated with the occurrence and deterioration of cardiovascular disease, depression and other diseases. The evaluation of pharmacological treatments for insomnia brings significant clinical implications. In this study, a total of 20 patients with mild insomnia and 75 healthy subjects as controls (HC) were included to explore alterations of electroencephalogram (EEG) complexity associated with insomnia and its pharmacological treatment by using multi-scale permutation entropy (MPE). All participants were recorded for two nights of polysomnography (PSG). The patients with mild insomnia received a placebo on the first night (Placebo) and temazepam on the second night (Temazepam), while the HCs had no sleep-related medication intake for either night. EEG recordings from each night were extracted and analyzed using MPE. The results showed that MPE decreased significantly from pre-lights-off to the period during sleep transition and then to the period after sleep onset, and also during the deepening of sleep stage in the HC group. Furthermore, results from the insomnia subjects showed that MPE values were significantly lower for the Temazepam night compared to MPE values for the Placebo night. Moreover, MPE values for the Temazepam night showed no correlation with age or gender. Our results indicated that EEG complexity, measured by MPE, may be utilized as an alternative approach to measure the impact of sleep medication on brain dynamics.
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Affiliation(s)
- Yanping Guo
- School of Electrical & Mechanical Engineering and Automation, Nanhang Jincheng College, Nanjing 211156, China;
| | - Yingying Chen
- School of Science, China Pharmaceutical University, Nanjing 210009, China; (Y.C.); (Q.Y.); (F.H.)
- School of Software, Nanjing University of Science and Technology, Nanjing 210094, China
| | - Qianru Yang
- School of Science, China Pharmaceutical University, Nanjing 210009, China; (Y.C.); (Q.Y.); (F.H.)
| | - Fengzhen Hou
- School of Science, China Pharmaceutical University, Nanjing 210009, China; (Y.C.); (Q.Y.); (F.H.)
| | - Xinyu Liu
- School of Science, China Pharmaceutical University, Nanjing 210009, China; (Y.C.); (Q.Y.); (F.H.)
| | - Yan Ma
- Osher Center for Integrative Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA 02215, USA;
- Beth Israel Deaconess Medical Center, Division of Interdisciplinary Medicine and Biotechnology, Department of Medicine, Harvard Medical School, Boston, MA 02215, USA
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Hu LL, Zhang X, Liu WJ, Li M, Zhang YH. Suan zao ren tang in combination with zhi zi chi tang as a treatment protocol for insomniacs with anxiety: a randomized parallel-controlled trial. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2015; 2015:913252. [PMID: 25793006 PMCID: PMC4352487 DOI: 10.1155/2015/913252] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/26/2014] [Revised: 01/19/2015] [Accepted: 01/21/2015] [Indexed: 11/17/2022]
Abstract
Insomnia is a serious worldwide health problem that is often comorbid with anxiety. The purpose of the present study was to evaluate the efficacy of a Chinese formula containing Suan Zao Ren Tang (SZRT) and Zhi Zi Chi Tang (ZZCT; SZR-ZZC) for improving sleep quality and anxiety states with four indices of Polysomnography (PSG), the Insomnia Severity Index (ISI), the Pittsburgh Sleep Quality Index (PSQI), and the Self Rating Anxiety Scale (SAS). Methods. A randomized, parallel-controlled trial compared SZR-ZZC to lorazepam tablet in insomniacs with anxiety. Patients were randomized to the SZR-ZZC treatment group (n = 60) and the lorazepam tablet treatment group (n = 59). Results. SZR-ZZC significantly improved scores on all four treatment indices. Compared with lorazepam, treatment with SZR-ZZC resulted in a significant reduction in the ISI (P = 0.029), the PSQI (P = 0.017), and wake after sleep onset (WASO; P = 0.008) scores and improved sleep architecture (P = 0.000-0.003) after a 4-week treatment period. Only one subject in the SZR-ZZC group experienced adverse side effects. Conclusion. Treatment with SZR-ZZC for 4 weeks appears to be a relatively safe and effective complementary therapeutic option when aiming to improve sleep quality and anxiety in insomniacs with anxiety.
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Affiliation(s)
- Lin-lin Hu
- School of Traditional Chinese Medicine, Zhejiang Chinese Medicine University, Zhejiang 310053, China
| | - Xin Zhang
- School of Traditional Chinese Medicine, Heilongjiang University of Chinese Medicine, Heilongjiang 150040, China
| | - Wen-juan Liu
- Department of Medicine, The Seventh Hospital of Hangzhou, Mental Health Care of Hangzhou, Zhejiang 310013, China
| | - Mei Li
- School of Medicine, Anhui Medical University, Anhui 230032, China
| | - Yong-hua Zhang
- Department of Medicine, The Seventh Hospital of Hangzhou, Mental Health Care of Hangzhou, Zhejiang 310013, China
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Abstract
Zaleplon is a pyrazolopyrimidine hypnotic used for the treatment of insomnia. Zaleplon binds preferentially at the α1β2γ2 subunit of gamma aminobutyric acid type A (GABAA) receptors in the central nervous system, and has a half-life of about one hour. Efficacy studies show that zaleplon is a suitable hypnotic for sleep initiation purposes. However, because of its short half-life, zaleplon is less effective in sleep maintenance when compared with other hypnotics. Nevertheless, zaleplon does increase total sleep time. No rebound effects are observed after treatment discontinuation. The use of zaleplon is relatively safe. Adverse effects are mild and of short duration. No important interactions have been reported, and there is no evidence of abuse potential. Relative to benzodiazepine hypnotics, the biggest advantage of zaleplon is that current evidence suggests it does not produce residual next-day effects. As early as four hours after intake of zaleplon, no effects on cognitive, memory, psychomotor performance, and the ability to drive a car have been reported. Future studies should confirm these findings, and comparisons with new nonbenzodiazepine hypnotics should determine the importance of zaleplon in the future treatment of insomnia.
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Affiliation(s)
- Marieke M Ebbens
- Utrecht Institute for Pharmaceutical Sciences, Division of Pharmacology, Utrecht University, The Netherlands
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Noguchi H, Kitazumi K, Mori M, Shiba T. Electroencephalographic properties of zaleplon, a non-benzodiazepine sedative/hypnotic, in rats. J Pharmacol Sci 2005; 94:246-51. [PMID: 15037809 DOI: 10.1254/jphs.94.246] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
The encephalographic (EEG) properties of zaleplon were investigated in comparison with those of other sedative hypnotics in conscious rats with chronically implanted electrodes. The oral administration of zaleplon (0.25-1.0 mg/kg), triazolam (0.0625-0.25 mg/kg), zopiclone (1.0-4.0 mg/kg), brotizolam (0.0625-0.25 mg/kg), and nitrazepam (0.125-0.5 mg/kg) lengthened the total sleep in a dose-dependent manner. On distribution of sleep-wakefulness stages, zaleplon, in particular, increased the slow wave deep sleep (SWDS), whereas triazolam, brotizolam, and nitrazepam increased the slow wave light sleep (SWLS) in a dose-dependent manner. Zopiclone significantly increased the SWDS at a dose of 2 mg/kg and both the SWLS and the SWDS at a dose of 4 mg/kg. All tested hypnotics caused no influence on fast wave sleep (FWS) at doses tested. The appearance of the sleep-inducing activity of zaleplon was more rapid than those of any compounds tested, and zaleplon significantly increased the relative EEG power density in the delta frequency band over that of triazolam at 20 and 30 min after the administration in the spectral analysis. Therefore, the present findings suggest that the non-benzodiazepine zaleplon can be expected to exhibit high practical potential as a hypnotic and is characterized by an increase in SWDS with rapid onset of hypnotic action.
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Affiliation(s)
- Hideaki Noguchi
- Medical Research Laboratories, Wyeth Lederle (Japan), Ltd, Saitama, Japan.
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Abstract
Ceiling and floor effects dictate that the efficacy of sleep-promoting stimuli should be proportional to the degree of pre-stimulus sleep impairment. This review addressed CF effects in polysomnographic research involving hypnotic drugs and exercise. Correlations of placebo/baseline levels of sleep with changes in sleep following hypnotic or exercise treatment were assessed across both literatures. CF effects were further addressed by comparing sleep-promoting effects of hypnotics vs exercise, after ANCOVA control for substantial baseline differences reported in studies of these stimuli. Significant correlations between placebo-baseline levels and sleep changes were observed following both hypnotic and exercise stimuli. Indeed, approximately 60% of the variance in improvement in sleep latency (SOL), wakefulness after sleep onset (WASO) and total sleep time (TST) following hypnotic treatment was associated with differences in baseline levels. ANCOVAs revealed significantly greater decreases in SOL and WASO following hypnotics compared with exercise. However, no significant difference between stimuli was found for TST, and exercise elicited a significantly greater increase in slow wave sleep. Similar results were found when a comparison between hypnotics and exercise was limited to good sleepers. The results show powerful CF influences on sleep responses to hypnotics and exercise and suggest a need for comparing these treatments in poor sleepers.
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Affiliation(s)
- Shawn D Youngstedt
- Department of Psychiatry and Sam and Rose, Stein Institute for Research on Aging, University of California, San Diego, California 92093-0667, USA.
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Lippmann S, Yusufzie K, Nawbary MW, Voronovitch L, Matsenko O. Problems with sleep: what should the doctor do? COMPREHENSIVE THERAPY 2003; 29:18-27. [PMID: 12701339 DOI: 10.1007/s12019-003-0003-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Complaints of poor sleep are frequent. The physician's assessment should seek to diagnose the social, medical, and psychiatric etiologies of insomnia and to treat the identified causative conditions. Management must match the specific pathology and type of sleep problem.
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Affiliation(s)
- Steven Lippmann
- University of Louisville School of Medicine, Louisville, Kentucky, USA
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Weitzel KW, Wickman JM, Augustin SG, Strom JG. Zaleplon: a pyrazolopyrimidine sedative-hypnotic agent for the treatment of insomnia. Clin Ther 2000; 22:1254-67. [PMID: 11117652 DOI: 10.1016/s0149-2918(00)83024-6] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
BACKGROUND Insomnia is the subjective complaint of poor sleep or an inadequate amount of sleep that adversely affects daily functioning. For the past 4 decades, treatment of insomnia has shifted away from the use of barbiturates toward the use of hypnotic agents of the benzodiazepine class. However, problems associated with the latter (eg, next-day sedation, rebound insomnia, dependence, and tolerance) have prompted development of other agents. OBJECTIVE This review describes the recently approved nonbenzodiazepine agent, zaleplon. METHODS Studies of zaleplon were identified through a search of English-language articles listed in MEDLINE and International Pharmaceutical Abstracts, with no limitation on year. These were supplemented by educational materials from conferences. RESULTS The efficacy and tolerability of zaleplon have been documented in the literature. Zaleplon has been shown to improve sleep variables in comparison with placebo. Like most hypnotic agents, zaleplon can be used for problems of sleep initiation at the beginning of the night, but its short duration of clinical effect may also allow patients to take it later in the night without residual effects the next morning. Zaleplon can be taken < or = 2 hours before awakening without "hangover" effects. It is generally well tolerated, with headache being the most commonly reported adverse event in clinical trials (15%-18%). Compared with flurazepam, a long-acting benzodiazepine sedative-hypnotic agent, zaleplon causes significantly less psychomotor and cognitive impairment (P < 0.001). Zaleplon has not been studied in pregnant women or children. The dose of zaleplon should be individualized; the recommended daily dose for most adults is 10 mg. CONCLUSIONS Insomnia has a substantial impact on daily functioning. If pharmacologic treatment is indicated for insomnia, the choice of an agent should be guided by individual patient characteristics.
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Affiliation(s)
- K W Weitzel
- Department of Pharmacy Practice, Mercer University School of Pharmacy, Atlanta, Georgia, USA.
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Heydorn WE. Zaleplon - a review of a novel sedative hypnotic used in the treatment of insomnia. Expert Opin Investig Drugs 2000; 9:841-58. [PMID: 11060714 DOI: 10.1517/13543784.9.4.841] [Citation(s) in RCA: 183] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Zaleplon (N-[3-(3-cyanopyrazolo[1,5-a] pyrimidin-7-yl) phenyl]-N-ethyl acetamide) is a non-benzodiazepine recently introduced for clinical use. This agent is indicated for the short-term treatment of insomnia. Preclinical studies have shown that the benzodiazepines triazolam and Ro17-1812 can substitute for zaleplon in animals trained to distinguish zaleplon from saline. The benzodiazepine antagonist flumazenil can antagonise the discriminative stimulus effect of zaleplon. These findings suggest that zaleplon is recognised by animals as a benzodiazepine agent. Zaleplon is active after ip. and oral administration in a variety of motor performance tests, including locomotor activity, rotarod and the loaded grid. Zaleplon has been shown to be active in a number of different anticonvulsant models, including the pentylenetetrazole, isoniazid and electroshock models. The compound is also reported to be active against convulsions induced by bicuculline, picrotoxin and strychnine. Studies in anxiolytic models suggest that zaleplon may have weak anxiolytic activity. From preclinical studies, it appears zaleplon possesses a reduced risk of tolerance compared to triazolam, is less likely to potentiate the effects of ethanol and is unlikely to produce amnestic effects. In man, zaleplon is rapidly absorbed and undergoes extensive presystemic metabolism. The compound has a plasma half-life of approximately one hour and is metabolised primarily via the aldehyde oxidase system to form 5-oxo-zaleplon. This metabolite, along with other minor metabolites formed in vivo, do not appear to contribute to the activity of zaleplon. Metabolites of zaleplon are excreted primarily via the urine. Phase I studies suggest that single daytime doses of zaleplon up to 15 mg are well-tolerated. Short-term impairment of performance occurs when zaleplon is administered during the day at doses epsilon 20 mg. However, given the short half-life of the compound, significant impairment of daytime performance is unlikely if zaleplon is administered at bedtime or shortly after retiring for the evening. Results from Phase II/III studies suggest that zaleplon (5 - 20 mg) produces a dose-dependent reduction in sleep latency in patients suffering from primary insomnia. The clinical efficacy of zaleplon persists for at least four weeks at doses of 10 mg and 20 mg. Studies in patients with a history of drug abuse suggest that the abuse potential of zaleplon (at doses above the therapeutic dose range) is similar to that seen with the benzodiazepine triazolam.
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Affiliation(s)
- W E Heydorn
- Associate Medical Director - CNS, Forest Laboratories, 909 Third Avenue, New York, NY 10022-4731, USA.
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Abstract
Pharmacological management of insomnia is continually evolving. The introduction of non-benzodiazepine benzodiazepine receptor agonist hypnotics provides an opportunity to understand different patterns of pharmacological activity with mechanistic differences in receptor activity. The impact of insomnia on daytime functioning and long-term health and socioeconomic status has been recognized. Epidemiological studies indicate that insomnia is associated with increased absenteeism and healthcare costs (although the latter appear to be partly attributable to comorbid depression). It will thus be important to determine whether hypnotics, in addition to their effects on sleep, provide other benefits for the patient that are related to these parameters. The successful resolution of this issue will require the adoption of additional outcome measures, such as effects on quality of life and healthcare costs. Recognition that long-term hypnotic use is widespread among insomniacs has prompted proposals for alternative prescribing patterns. Although certain hypnotics appear to be free of tolerance on prolonged use, caution is required in the long-term use of any hypnotic because of the lack of systematic data on chronic efficacy and safety. Therefore, alternative administration schedules (e.g. intermittent and 'as required') are being investigated. These may have very different consequences in terms of abuse liability and patients' perceptions of efficacy, and thus permit a more effective and appropriate use of this drug class.
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Affiliation(s)
- T Roth
- Henry Ford Hospital, Sleep Disorders and Research Center, Detroit, Michigan 48202, USA.
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Abstract
Each month, subscribers to The Formulary® Monograph Service receive five to six researched monographs on drugs that are newly released or are in late Phase III trials. The monographs are targeted to your Pharmacy and Therapeutics Committee. Subscribers also receive monthly one-page summary monographs on the agents that are useful for agendas and pharmacy/nursing in-services. A comprehensive target drug utilization evaluation (DUE) is also provided each month. The monographs are published in printed form and on diskettes that allow customization. Subscribers to the The Formulary Monograph Service also receive access to a pharmacy bulletin board called The Formulary Information Exchange (The F.I.X). All topics pertinent to clinical pharmacy are discussed on The F.I.X. Through the cooperation of The Formulary, Hospital Pharmacy publishes selected reviews in this column. If you would like information about The Formulary Monograph Service or The F.I.X., call The Formulary at 800-322-4349. The January 2000 Formulary monographs are on entacapone, exemestane, oseltamivir, perindopril, and clinafloxacin. The DUE is on entacapone.
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Affiliation(s)
- Dennis J. Cada
- The Formulary, Washington State University at Spokane, 601 West First Avenue, Spokane, WA 99201-3899
| | - Danial E. Baker
- Drug Information Center, Washington State University at Spokane, 601 West First Avenue, Spokane, WA 99201-3899
| | - Terri Levien
- Drug Information Pharmacist: College of Pharmacy, Washington State University at Spokane, 601 West First Avenue, Spokane, WA 99201-3899
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